In this section, conclusions will be drawn from the results of and from the experienced gained in working with the OR process model. Recommendations are made on the basis of these conclusions and experiences.
Conclusions about the process description of the OR The process description method based on the—adapted—method by In ’t Veld [166], has proved useful for describing the processes in the OR, and is for that reason probably also useful for describing other hospital departments.
3During the creation of the OR process model, it became clear that a discrepancy existed between how
things were actually done—indicated by the German word ‘Ist’—and how things were supposed to be done— indicated by the German word ‘Soll’.
4.2 Process model 93
Strong points of this method are that:
• The model presents the processes in their natural order i.e. the processes are shown in the order in which the patient passes through the different processes.
• The model has different aggregation levels.
• The model uses measuring and control loops with standards.
This results in an unequivocal description of the processes in a department. During the creation of the model of the OR, it turned out that:
• Before an operation, instruments are counted but their number is not recorded, in contrast to gauzes (the number of which is recorded).
• There are no clear rules with regard to ordering blood for an operation and with regard to the control of this procedure.
Recommendations about the process description of the OR The model of the OR can be used:
• To identify weaknesses in patient care. In this way: − Nothing is forgotten, omitted or overlooked. − It is clear which duties are carried out by whom.
For these reasons, the model can be used with an FMEA but also with other risk assessment methods like HazOp [61].
• To realise process control with the results of e.g. an FMEA or CIIs. Certain mea- suring and control loops may, for instance, be set up.
• To serve as a starting-point for further analysis. For instance, certain processes can be opened up for further analysis.
• To serve as basis for an overview of all processes in the OR and as an overview for the main flows of information between them. This is a requirement which the In- formation Service4of the Catharina Hospital imposes on the OR as a precondition for making a start with the computerisation.
• To serve as a basis for a quality assurance system for the OR (PACE project, see section 2.5.3). For this purpose a model is needed which makes clear the connec- tion between different aspects that are necessary for quality assurance.
• In the case of consultation between different function groups, for the purpose of reorganisations etc. in which an overview over the OR-event is needed in order to achieve a good result.
The “In ’t Veld” method could be used more extensively because only a small number of the methods described by In ’t Veld [166] were actually used in this research.5
The model is in need of maintenance, i.e. changes with regard to processes and their control must be carried through.
It is useful to use the model also if there are problems or if processes have to be designed. It is merely a tool which can produce an excellent overview of which aspects are relevant and of which connections exist between them. If necessary, a certain process can be opened up to obtain a clearer view of how to solve certain problems. However, it should be used sensibly like every model: it is a simplification of reality (this makes it attractive) and it is never complete (i.e. it contains only a limited number of aspects).
The model shows straightaway that:6
• Instruments must not only be counted but their number must also be recorded.7 • (If necessary,) the ordering of blood before an operation and control of this must
be properly organised.8
These problems of a lack of control should be dealt with.
To increase the clarity and accessibility of the model, the model can be printed in colour. The main flow, and the measuring and control loops, will then stand out imme- diately.
5For instance, in the case of procedure failure (ECM: OP) of a certain process, the standard for this process
can be opened up to examine what exactly is wrong with the procedure. At that moment, ‘the control loop of the standard setting’ can be used which is not used in the current OR model but is described by In ’t Veld. The model could also be further developed into a comprehensive model of an aspect system. This model could increase the insight into the structures and into the functions of the management and planning. In such a model, the steady state model is in the operational plane, and the so-called ‘innovation model’ is at a right angle to this [166].
6I.e. during the creation of the OR process model—in this case mainly during interviews (keeping process
control in mind) and less during the drawing of the model—the following risks were found straightaway. See also table 4.3 on page 92.
7See also process number 44 in the file Opereren.cht on the CD-ROM (appendix B).
8See also process number 70 in the file Algemeen.cht and e.g. process number 67 in the file Algemeen.cht,
process numbers 72 and 74 and measuring and control loop C in the file Anesth1.cht, and process number 29 in the file Opereren.cht on the CD-ROM (appendix B).