Good business performance, patient welfare and compassionate care are not conflicting goals   By Ulrich Matern   About the author: PD Dr. Ulrich Matern is a medical doctor, Ass. Prof. for Medical Technology and President of "wwH‐c  GmbH",  which  was  formerly  know  as  "Experimental  OR  &  Ergonomics"  at  the University Hospital  in Tübingen. He manages the  innovative Hospital Group, the Cluster for Health Care Systems in Baden‐Württemberg, Germany.   In 2006, Experimental OR & Ergonomics, an institution open to international participation, was set up at the University Clinic  in Tübingen.  In collaboration with a team of planners, architects  and  more  than  80  international  partners  from  the  medical  equipment  and building services  industry, a complete operating  theatre wing, parts of an  intensive care unit  including all the technical equipment was set up to carry out research, development and testing on new modules and systems.  This  highly  successful  institution was  currently  being  transformed  into  an  independent company  under  the  name  wwH‐c  GmbH  to  provide  better  service  to  industrial  and healthcare  industry customers  (hospitals and public health care agencies). wwH‐c GmbH runs  the  “Experimental‐OR”  as  a  lab  for  system  integration,  as  well  as  a  showroom, training  and  conference  centre  for  the  INNOVATIVE  HOSPITAL  Cluster  in  Baden‐Württemberg.   INNOVATIVE  HOSPITAL  is  a  group  of  specialized  German  companies  from  the  field  of medical and building  technologies  linked  to German Hospitals and Universities. Working together  in  the  “Experimental‐OR”  they  learned  that  customized,  approved  and  usable systems  including  teaching &  training are  safer and more efficient  for patients, hospital staff and administration. Therefore, they founded INNOVATIVE HOSPITAL with the goal to consult,  plan  and  realize  hospitals  worldwide  and  support  our  customers  in  the qualification of their hospital staff.   Nowadays  hospitals  face  a  number  of  challenges.  They  are  expected  to  cut  costs  and increase quality and efficiency at the same time. They have to get employees "involved" and make sure that patients and customers are not "lost ". The operating room of the future identifies ways to improve efficiency and quality.  1. Efficiency  in  the operating  room  improves patients and staff workflow as well as logistics within the entire hospital Opportunities to reduce patient turnover times and increase throughput should be exploited to increase the efficiency of operating rooms. What has to be in place to ensure that things run smoothly in the operating room and thereby in the hospital?  

The  most  important  factor  is  well  trained  personnel.  A  highly  committed  team  can compensate  to  some extent  for  shortcomings  in building  layout or workflow organisation. However,  that  in  it  self will not make  the operating  room  really efficient. Previous efforts have reduced best case turn over times to 1/2 hour.  If you analyze the sub‐processes that take  place  during  patient  turnover,  you  immediately  notice  that  the  processes  are unstructured. Video‐based  analysis  oft  he  process  steps  during  patient  turnover  that  takes  33 minutes reveals opportunities to make structured  improvements. Labour  intensive activities such as record keeping are repeatedly  interrupted by doctors and nursing staff. Sub‐processes,  for example  instrument preparation,  taking of X‐rays, etc.  could be performed outside of  the operating room.  Objective, video‐based analysis of the individual activities in combination with staff training on how to make improvements can significantly enhance the effectiveness of the operating room team. From the management point of view, it makes sense to go even further in order to optimize the process flow and  improve the utilisation factor  in the operating room.  It  is not possible to do this in many older clinics because:  

• the access and staging areas are too constricted  • the necessary equipment and connection points are not available  • staffing levels are insufficient.  

 It  is  worth  investing  the  effort  in  detailed  process  oriented  planning  for  the  building, equipment  and  staff,  because  that  leads  to  greater  efficiency  and  increased  return  on investment  (ROI),  and  it  has  significant  benefits  for  patients  (=  customer  acquisition  and loyalty) as well. Essentially, the results are as follows: 

• more surgeon time is spent on productive activity • operating room utilisation increases • as a  result of higher productivity  in  the operating  rooms,  the existing space can be 

used productively for other purposes • increased  productivity  does  not  necessarily  lead  to  changes  in  working  hours 

(overtime or shift work) • concentration  on  specialised  operating  room  processes  increases  quality  and 

reinforces the daily routine, which enhances safety  The  results  of  the  studies  carried  out  by  wwH‐c  GmbH  clearly  show  that  hospital management teams would be well advised to analyze and simulate their own process to find out  specifically  whether  adding  staff  and  optimizing  their  equipment  might  make  their operating rooms safer, more profitable and more patient friendly.   

2. Safety in the operating room reflects safety in the entire hospital More than 90% of the equipment in an operating room  is stand‐alone, and  it  is adjusted at the device control panel.  Intuitive,  safe operation  in  the operating  room  is not  something that  should be  taken  for  granted. Training  is  generally  inadequate, and  this  increases  the potential risk to everyone in the operating room (Table).  Operating room equipment cannot be operated safely. Results from two national surveys of surgeons and OR staff in Germany. The article can be uploaded at www.wwH‐c.com/downloads Statement  Surgeons %  OR Staff % It is not possible to intuitively operate correctly in every situation  69.8  48.9 Believe that they have not received adequate equipment training  58.8  40.3 Problems operating the equipment has repeatedly put persons in the OR at risk  39.7  47.7   An analysis of  incident  reports  received by  the German Drug and Medical Product Agency (BfArM) between 2000 and 2006 confirms the impressions of operating room staff. For 1,330 reported  events where  a  total  of  1,531  causes were  identified,  about  half  resulted  from misinterpreted communications between users and the medical product (operability). Only a third was traced back to technical problems with the equipment. Misunderstandings caused patient injury, longer time on the operating table and the need for later surgical intervention twice as often. The medical equipment procurement process  including  the customary  trial period, which has  led to the situation described above, should definitely be subjected to a critical review. The products cannot be checked systematically during a trial period. A recent unpublished study on the suitability for use of only three products uncovered more than 100 potential  problem  areas which  had  not  been  detected  during  previous  trial  periods.  An analysis of suitability for use should be part of the procurement process, All that needs to be done is to place 10 typical users in a simulated but typical situation and ask them to operate the equipment. A recording is made of what happens, and the results are analysed. This type of study uncovers more than 90% of potential operating problems. Comparative studies on products  from  different  suppliers  clearly  show which  product  is more  suitable,  and  this information can have a major influence on the purchase decision.   

3. Lessons learned  In order to maximize utilisation and ensure efficient, safe use of every resource, operating room  process  /  equipment  optimisation  would  appear  to  be  an  absolute  necessity  for hospital management teams. Operating rooms are the most cost intensive functional units in the  hospital.  Surgical  teams  "earn"  their money within  these  "four walls".  Every  incident caused by a process or equipment  inadequacy which contributes to a delay  in therapy and convalescence (complication) costs time and money within the entire hospitals.  

   

4. INNOVATIVE HOSPITAL Partners in Dubai at the ArabHealth 2011   IMTECH  (http://www.imtech.eu/eCache/DEF/9/354.bGFuZz1FTg.html)  offers  for  hospitals and administrations  

• turn key solutions • specified high standard building technology 

  TÜV‐Süd (www.tuev‐sued.de) offers for hospitals  

• Accreditation  • Audits of processes, medical and building technology 

  wwH‐c GmbH (www.wwH‐c.com) helps hospitals and administrations to 

• use operable system‐enabled equipment • optimize workflow and architecture • teaching and training of technical and medical staff 

 wwH‐c GmbH helps manufacturers to 

• develop operable system‐enabled equipment   The  interdisciplinary,  holistic  approach  offered  by  the  partners  of  innovative  Hospital provides  valuable  insights  into  the  interaction  between  medicine,  medical  equipment, building  technology,  architecture,  hygiene  and  business  management.  Lateral  thinking questions traditional attitudes and casts doubt on the conventional wisdom which is codified in existing standards. It opens a window on totally new horizons during the hospital design phase and ongoing operation.    Contact: innovative Hospital Group managed by wwH‐c GmbH Tel: +49 (0) 7071‐97732‐12 Fax: +49 (0) 7071‐97732‐29  uIrich.matern@wwH‐c.com www.innovative‐hospital.de 

Made in Germany

Priv. Doz. Dr. med. Ulrich Materninnovative Hospital Clustermanaged by

www.innovative-hospital.deulrich.matern@wwh-c.com

Your Partner in planning, realization & personnel qualification for your Hospital

Cluster in Baden-Württemberg

Made in Germany

The Requirements

The need for Healthcare is increasing worldwide

best hospitalsbest doctorsbest nursing staffbest administrationbest hospital-engineers

Made in Germany

Quality Efficiency

innovative Hospital

Vision

Made in Germany

Increase efficiency and safety of hospitalsHygiene Medical TechnologyBuilding TechnologyWorkflow / Process-ManagementArchitecturePersonal Qualification / Teaching and Training

Mission

Made in Germany

Vision:Customized and approved hospitals incl. Staff Qualification

Mission:Research & DevelopmentPlanning, Realization, furnishing of HospitalsTeaching and Training of PersonalsQuality Management

Cluster in Baden-Württemberg

Made in Germany

„Best Hospital Practice“ the hospital standard of innovative Hospital

Processes / SOPs (KTQ, JCI)HygieneGerman and international standards for hospital and medical technologyProcess adapted ArchitectureTeaching and Training of PersonalStandards for special facilities like EUSOMA for breast centers

We help hospitals to reach a higher level

Made in Germany

The „Experimental-OR“ of wwH-c GmbH is our …

Lab for Research & Development for new medical & building technologiesTesting of hospital technology System Integration

International Reference & ExhibitionConference-, Teaching- & Training Center

Made in Germany

Customized System incl.• Processes• Sub-Processes• Tasks• Organization structure

Customized System incl. • Architecture• Medical-• Building-• Information-Technology

Customized Teaching & Training of • Employees • Teams

Processes

Staff Qualification

Patient

Technology

The Magic triangle for Success, Safety, Efficiency and Quality

Made in Germany

Training, Qualification, Certification

Operation

Ger

man

Lan

guag

e Sk

ills

Studying Medicine at a German University

Training as a Medical Specialist at a German Hospital

Cooperation with German Hospital, University

Continuous Teaching & Training

Continuous QM Optimization

Continuous Cooperation and local Support

Validation,Commissioning,Documentation

Construction & Project Management

Procure-ment

DetailEngineeringBasicPre

BasicConceptual Design

Execution Comm./ValidationPlanning Scheduling

After-sales ServiceRequirements

Your Partner in planning, realization & personnel qualification for your Hospital

MasterBachelor in Hosp. Administration

MasterBachelor in Hosp. Engineering

Prof. TrainingNurses, MTA, TRA, …

Contact:PD Dr. med. Ulrich MaternwwH-c GmbHErnst-Simon-Str. 1672072 Tuebingen, Germanyulrich.matern@wwH-c.comwww.innovative-hospital.de

Teaching & Training in Germany

Project Management, Support

Personal Qualification Universities in Baden-Württemberg

University of Tübingen

UAS Pforzheim

UAS Offenburg

UAS Furtwangen

University of Karlsruhe

University of Freiburg

University of Stuttgart

University of Ulm

UAS Ulm

UAS Albstadt/Sigmaringen

MBA Tuttlingen

University of Heidelberg

NursesDoctors

Med. Students,Nurses,Doctors

Experimental-OR Interdisciplinary Training Center for Engineers, Doctors, Med. Students, Anesthesia- and OR-Nursing Staff

Engineers

Personal Qualification innovative Curricula within the Experimental-OR

Made in Germany

Cos

t

Planning

Investment

Installation

Commissioning

Maintenance

Operation (e.g. Energy)

Modification

Personal

Con

vent

iona

lH

ospi

tal

Succ

essf

ulH

ospi

tal

Lower Live Cycle Costs by higher Safety, Efficiency and Quality

Made in Germany

ConclusionMade in Baden-Württemberg

Visit us at the booth of Baden-Württemberg

in the German section: