Determinación del Volumen de los Residuos Sólidos

With our model in mind, let us now look at how surgery order protocol compilation can be used to influence the amount of instrument tray supplies and instrument tray demand. Here the question of “are we using the trays that we should be using?” plays a central role. To investigate this question, let us first recapitulate what we have learned about tray and order protocol compilation so far.

In section 3.1 we described the current pragmatic way in which instrument trays and order protocols are compiled from a clinical perspective. From the interviews on which this section was based, we can conclude that the medical personnel has a high degree of freedom when it comes to the selection of the right tools for the job. In the view of the staff, the role of a medical specialist or an OA (instrument specialist) has to be seen as a craft or trade which requires a specific set of skills. In these roles a strong medical expertise, a feel for the patient’s needs and a certain flexibility regarding the selection of an optimal treatment are indispensable.

Due to the importance of the major health and security aspects involved in the work of medical staff we opine that the initiative for clinical decision making should always have clinical experts in the lead. The compilation of instrument trays and surgery order protocols is such as decision. This does not mean, however, that a central management authority cannot influence the decentralized decision making process. Instead of an imposed optimization and standardization from the top down, we therefore propose to formalize the decision making process that lies at the foundation of instrument tray and order protocol compilation. Here a centralized management authority can influence the decision making process described in 3.1, by imposing restrictions, creating incentives and empowering staff members [18], [58]. Here an optimized version of the prediction model can be used to achieve staff empowerment because it has the potential to form a platform for informed debate.

To clarify this statement let us look at the following examples of the (intermediate) results displayed in section 5.2 and 5.3:

1) From the description of order protocols and instrument trays in section 3.1 one might argue that surgery order protocols provide a clear-cut directive for which tray subsets are to be used for a specific procedure. In practice, however, the relationship between a subset of trays and a procedure is not as unambiguous as one might hope (figure 13). For this reason we used a relatively empirical method to establish these relationships for our model in section 5.2. Examples as seen in figure 13 can therefore serve an informative role in the aim of standardizing work processes. Here questions should be asked like; “why do we do what we do?” and “can this be done more efficiently?”. Of course the answer to the latter question can be a “substantiated no” but it is questions like these that will help keeping the medical staff sharp.

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Figure 13. Examples of requested trays per procedure lists where it is hard to determine which trays are used for which surgery by default.

2) Another example for a source of debate can be generated by retrospectively comparing the cross table introduced in section 5.2.2, to the surgical order protocols (Demand prediction.xlxs; sheet “Instrument demand calculation”). In the case of the procedure “prostate millin” for example, “OLVG Urologisch net” is commonly exchanged for “OLVG Urologisch net extra lang”. For the procedures “Nier urs niersteen” and “Ureter urs diagnostisch”, on the other hand, “OLVG Optiek 30° URO” is commonly added to the tray list as an additional piece of equipment. Adjusting the surgical order protocols based on these finding should be relatively straight forward.

3) The last example that we will give can be found in the results from section 5.3 (Prediction validation.xlxs sheets “Comparison count vs prediction” and “Comparison count vs weekly prediction”). In this section we concluded that if we focus on the demand per specific tray type, especially the results for “CYSTOSCOPIE 22.5 FR 12° 30° OK URO” were remarkable. For this tray type the recorded demand was significantly higher than what was expected based on the forecast. This is most likely caused by the fact that this tray is one of the most common pieces of back-up equipment if the standard surgery order protocol was not followed. Here it would be interesting to investigate why this piece of equipment is used so frequently as a back-up tray. Here examples of appropriate questions to ask can include the following:

- Are the supplies for the default trays not sufficient enough? - Do the default trays lack functionality?

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- For which procedures can this switch in default trays result in a safer, more effective treatment?

- For which procedures can this switch in default trays result a more (cost) efficient solution?