Dreaming on Board


Yesterday, on the run, I got to see Peter in the operating theatre corridor.

He was giving a guided tour to some of the members of the board.

It is always a pleasure to see Peter on the floor.

It humanises him, and humanises us.

Pete is one of the senior executives for the hospital, and hence the fall guy for the executive level decisions that get made to our advantage or disadvantage.

A tough job.

Unfortunately, I was busy, and so all I got to do was have a joke with him about what sized gloves he would like, and then keep on the move.

If I had time, what would I have liked to have done?

I would like to have given the board members a tour myself.

In my dream, it would go like this:

"Welcome to our operating theatres.

I'm Pete.

This is MY world.

Ten theatres, one of the main engine rooms of the hospital.

The most important single location in theatres is here, the allocation board.

It represents our time, infrastructure and human resource boundaries.

The most important things on the board are here (the number of staff vacancies across the floor); here (the clinical support team); here (the hours 17:30 and 22:30); and here (night duty staffing numbers).

The number of staffing vacancies represents how hard we are going to have to push everyone over the course of the day. We want everyone to be working at their best, and the more we smash them, the less at their best they can be.

I can give you the mathematical model if you want.

The clinical support team is the safety valve. We work to a high level of uncertainty, every hour of every day.

In order to be able to flux with changing demand, we need flux in the number of people we can leverage immediately, in half an hour, or at peak demand times such as at the end of session times and changeover times.

If the clinical support team is ineffective or unavailable, we get into problems of flow at peak times, and we become less efficient.

Simple, really. I can give you the mathematical model if you want.

These particular hours represent our funnelling down of resources times.

We want to be able to hit our targets with a high degree of certainty.

17:30 represents the finish of 80 hours of elective surgery time.

If we don't hit our target then, we sacrifice some or most of the 9 hours we have available for urgencies and emergencies from then until 22:30, which is when we close down to one theatre.

If we don't hit our targets then, we risk needing to utilise overtime or our on-call teams.

And using overtime or on-call is high risk practice for a number of reasons.

I can give you the mathematical model if you want.

Lastly, the number of night duty staff influences the effectiveness with which we can handle overnight cases,

To do sequential cases overnight, we need a certain amount of staff if we are to avoid ripping people out of their beds.

And since we are the 8th busiest hospital in Australia, we can reasonably predict, even if we don't have cases every night, that we WILL have cases most nights.

We don't want our night staff to be busy ALL the time.

Between 2AM and 5AM are the dead times for fatigue risk, but so long as these people can catch the last of the emergency cases for the day and the 6AM Caesar the next morning, then they will have optimised our entire next day's ability to function.

But we DO need them to be ready to go the moment the phone rings.

I can give you the mathematical model if you want.

The hardest thing for US to understand is that we have to be more than just clinicians.

We have to be teams within teams and communicators within decision-making structures.

And all the time, we have to focus on the one particular task we have at hand.

The hardest thing for you to understand is that we will ALWAYS do the best we can within the limits of our capacity.

And that capacity has a limit.

I can give you the mathematical model if you want.

For you, and for us, the danger is that we, both groups, don't know what we don't know.

Trust is vitally important.

If I can trust Peter and Peter can trust me, we can then concentrate on marking out our common ground and then working towards finding solutions to obstacles and the differences of understanding in our paths.

On our wanders, I would introduce the board members to Chris and Mandy, and say,

"Hey. This is Chris and this is Mandy. These people are awesome. If I could have a hundred of these guys, I would be a very happy person indeed."

And I could introduce them to Shaun, and say: "Shaun is awesome. He already has a job elsewhere to go to, but he REALLY would like to stay with US. That states categorically something about the potential of what we have right here, right now, doesn't it!"

Then I would take them to look through the window into the cardiac theatre, and just let them stand in awe of the everyday stuff we do without batting an eyelid.

And on the way out, I would introduce them to Bree.

And I would say:

"This is Bree.

Bree is what we are all about.

We want to look after her here so that she can look after her family.

We want her here in good condition to work.

And we want her there in good condition to enjoy those who really matter to her.

Smash her here and she can't there. And if she can't there, then she can't here.

Important to remember, I think."

Back at the front door of theatres, I would shake the board members hands before I send them on their way.

And Peter's, too, as I give him a pair of Size 9 gloves (the biggest we have! Joke!)

And I would finish by saying:

"Hey. You are all intelligent, special people.

You have skills and abilities we could only dream of.

And in my dream, I'm going to dream that your skills and knowledge will dovetail with our skills and knowledge, and together we can make this place as great as we can with the resources we've got.

Because awesome is awesome, so long as awesome is allowed to be awesome.

And we want that we will all be awesome together."

And THAT is the end of my dream.


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