The Foothills Medical Centre took a novel approach to improving the perioperative patient journey. Rather than a “surgery-only” initiative with the usual attempt to solicit physician buy-in early, it was modeled as a “site” initiative across 10 departments and four directors, with physician participation purposely delayed. Thus, operations areas were getting the site in order before engaging physicians. In the beginning, the team examined the end to end perioperative process from decision for surgery through to discharge. One priority issue was chosen to address first: about 90% of first case patients were late arriving in the surgical suite. This caused a cascade of delays and postponements, safety concerns for patients, and increased costs to the centre. With multiple rapid cycle improvements, front-line input, and frequent iteration of the Executive Lead’s quote, “Everything is on the table; what do we need to do to make it work?” at the core of the improvements, results were outstanding. By August of 2011, 74% of first case patients were arriving at the surgery suites on time, despite increased travel time due to the distance to the new surgical wing and our ageing elevators being under repair. Examples of improvements are: 1) moving routine preoperative investigations into the community and 2) analytic modeling of patient arrival times having led to adjusted start times for Admitting, Nursing, Lab, DI, and ECG staff. This has in turn provided staff enough time to complete their work without inconveniencing patients.

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