Dissertations / Theses on the topic 'Operating theatre management'

Improved utilization of scarce resources such as health care personnel is necessary to address well-known problem of long waiting times within the health care. Implementing mathematically modeled scheduling in the operating theatre has the potential to result in more efficient allocation of resources and financial gains. Despite the promising results, the adoption rate of such models is low. This thesis examines the impact of a mixed-integer linear programming model using an overlapping strategy. We perform a computational experiment where both sequential and parallel schedules are produced with real surgery data from an orthopedic department at a Swedish university hospital. The generated schedules are compared against each other in measurements of cost productivity. Statistical analysis shows that there is a statistical significant difference between the two schedules, favoring the optimized schedule. The results further suggest that three operating rooms and four surgery teams is the most optimal combination of the 18 combinations analyzed, where operating rooms and surgery teams varies between 1-4 and 1-6, respectively.

[Abstract]This study examines how preventable delay could be identified and minimised by using adapted lean thinking within the Operating Theatre Management Process (OTMP). The study uses the operating theatre of a regional hospital in Toowoomba (Queensland, Australia) as a case study. The theoretical framework for this study comprised socio-technical system theory and coordination theory. From the perspective of socio-technical system theory, each activity within the OTMP has two types of elements: social elements and technical elements. Coordination theory, on the other hand, considers the coordination between various elements of the activities. Time and motion study has been employed to analyse activities in terms of operation, transportation, delay and monitoring within the operating rooms. Subsequently, adapted lean thinking has been employed as an integrating approach to identify preventable delay and disruption within both value added and non-value added activities. Identifying preventable delay within the value added activities inside the operating room is one of the most important contributions of this study. This research uses an exploratory qualitative case study. The focus of this research is to study activities inside the operating rooms, rather than the whole OTMP. Notwithstanding the limited time available to the researcher within a Masters degree, the study sought to establish the direct link of the activities inside the operating rooms with patients‘ waiting time. Data were collected from 22 surgery cases through direct observations. In each surgery, the research team followed patient progress from the pre-operative holding area through to discharge. The researcher observed and recorded the timing of all the activities inside the operating rooms. As much detail as possible was observed and recorded to capture sufficient details to allow identification of problems. Moreover, initial observation results were verified and additional information was collected as necessary through communications and interviews with medical staff (surgeons, scrub nurses, technicians etc.) and review of documents. The study indicates that coordination, motion economy, consent form, protocol policy, and surgeon preference sheets were the major areas impacting on preventable delay in the operating theatre suite activities. With the application of lean thinking, the results suggest that preventable delay and disruption within both value added and non-value added activities could be eliminated or minimized through better work organization, motion economy training and better coordination of tasks. For further study, a benchmarking based study could be conducted to see if similar sets of preventable delay are observed in other healthcare institutions. In addition, examination of other related sections in a hospital is highly desirable to identify the wide range of preventable delay within the OTMP. This, in turn, will help to improve OTMP efficiency and, accordingly, reduce the waiting time of waiting lists.

Syfte. Att belysa attityder hos operationspersonal samt risken för intraoperativa stick- och skärskador. Bakgrund. Det finns flera olika tekniker för att hantera stickande och skärande instrument och olika säkerhetsprodukter som kan användas för att minimera risken för stick- och skärskador. Det finns många studier som handlar om lämpliga arbetssätt för att minimera risken för stick- och skärskador, men bara ett fåtal studier som belyser betydelsen av användarnas attityder och inställning till användande av tekniker och säkerhetsprodukter samt uppföljning och rapportering av tillbud. Metod. Studiens design är en empirisk intervjustudie med kvalitativ ansats. Semistrukturerade intervjuer utfördes med sju operationssjuksköterskor och fyra operatörer på två sjukhus i Sverige. Data insamlades oktober-december 2015. Resultat. Resultatet visar på att det finns olika attityder hos operationspersonal som kan påverka risken för stick- och skärskador, vilka redovisas under fyra olika teman: Att ha ett säkert arbetsklimat; Att skydda sig själv, medarbetare och patient; Att vara följsam till riktlinjer och arbetsrutiner samt Att vara oföljsam riktlinjer och arbetsrutiner. Slutsats. Risken för stick- och skärskador går inte att eliminera då det alltid finns riskområden som man som operationspersonal måste ta hänsyn till. Det finns mycket kunskap kring säkerhetsprodukter och tekniker som syftar till att minimera risken för stick- och skärskador men om användarens attityd får styra kanske inte dessa används på rätt sätt om ens alls. I denna studie framkommer det en antydan till att attityder hos operationspersonal kan påverka risken intraoperativa stick- och skärskador.
Aim. To illustrate the attitudes of the operating theatre personnel and the risk of intraoperative sharp injuries. Background. There are several ways to manage sharp instruments such as various techniques and safety products to minimize the risk of sharps injuries. There are many studies about working practices to minimize the risk of sharps injuries but only a few that illustrate the importance of attitudes towards techniques and safety products as well as follow up and reporting incidents. Method. The design of the study is an empirical interview study with a qualitative approach. Semi-structured interviews were conducted with seven theatre nurses and four surgeons at two hospitals in Sweden. Data collected October-December 2015. Findings. The findings show that there exists different attitudes of the operating theatre personnel that could affect the risk of sharps injuries. The finding is presented in four themes: To have a safe working environment; To protect oneself, co-worker and patient; To be compliant to guidelines and working practices and To be non-compliant to guidelines and working practices. Conclusions. The risk of sharp injuries can’t be eliminated since there is always a risk of sharp injuries which the operating theatre personnel must pay attention to. There are a lot of knowledge about safety products and techniques for minimizing the risk of sharps injuries but when the attitude of the user come into play the safety product may not be used correctly, if used at all. In this study a indication appears that the attitudes of the operating theatre personnel may be affecting the risk of intraoperative sharp injuries.

Thesis (PhD)--Macquarie University, Macquarie Graduate School of Management, 2001.
Bibliography: leaves 288-310.
Introduction -- Introduction to research problem and methodology -- Study context -- Theoretical framework - Review of the literature -- Study design and methods -- Study sites, surgical procedures, and labour input to surgical production -- New intra-operative artefacts: goals, choices and consequences -- Conclusion.
Surgical technologies since the late 1980s have undergone substantial innovations that have involved ...the adoption of new machines, instruments, and related surgical materials... referred to throughtout this thesis as intra-operative artefacts... typically represents a commitment of substantial financial resources by the hospitals concerned. However, little is documented about the process whereby the decisions are made to adopt new intra-operative artefacts, and no previous research appears to have explored the work-related consequences of new intra-operative artefact adoption within operating theatre services. This thesis explores the reasons why new intra-operative artefacts are adopted, how the decisions are made, who are the participants in the decsion process and what are the expected and actual organisational consequences of new intra-operative artefact adoption.
Electronic reproduction.
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Au sein d’un établissement hospitalier, le bloc opératoire représente un des secteurs les plus emblématiques et les plus coûteux. Le fonctionnement du bloc opératoire est orchestré par un programme opératoire qui consiste à construire un planning prévisionnel des interventions chirurgicales à réaliser pendant un horizon donné. La littérature abondante sur le sujet est unanime sur le fait que la construction du programme opératoire est une tâche complexe, car il s’agit non seulement de planifier et d’ordonnancer les interventions, mais aussi de satisfaire des exigences souvent antagonistes. Ce projet est le fruit d’une collaboration entre la Communauté d’Agglomération de Sarreguemines Confluences et la Région Lorraine, des membres du secteur hospitalier (Hôpital Robert Pax de Sarreguemines) et l’équipe Gestion Industrielle et Logistique (GIL) du Laboratoire de Génie Industriel, de Production et de Maintenance (LGIPM). L’objectif de cette recherche est d’apporter une aide aux gestionnaires du bloc opératoire, qui ont besoin de plus en plus des méthodes et des outils d’aide à la décision en vue d’optimiser leur fonctionnement. Pour répondre à ce besoin nous nous intéressons dans la première partie de cette thèse à la gestion des opérations électives en prenant en compte différentes contraintes et en particulier la disponibilité des chirurgiens. Nous nous plaçons dans le contexte d’une stratégie « open scheduling » et nous proposons deux modèles mathématiques permettant d’élaborer le programme opératoire. La complexité des modèles mathématiques et leur explosion combinatoire rendent difficile la recherche de l’optimum pour des tailles réalistes. Ceci nous a donc amené à proposer une heuristique constructive utilisant le modèle proposé et permettant d’obtenir des solutions là où la méthode exacte ne nous le permettait pas. Dans la seconde partie de cette thèse, nous considérons l’intégralité du processus opératoire (brancardage vers le bloc opératoire, préparation et anesthésie, acte chirurgicale et réveil). Nous modélisons ce processus comme un flow shop hybride à 4 étages avec contrainte de blocage de type RSb, et nous le résolvons à l’aide d’un algorithme génétique dont l’objectif est de synchroniser toutes les ressources nécessaires, en respectant au mieux le programme opératoire prévisionnel. Outre les opérations électives, nous nous intéressons dans la dernière partie aux opérations urgentes. Nous proposons un outil d’aide à la décision pour la gestion des opérations urgentes. En prenant en considération la pathologie et la gravité de l’état du patient, nous distinguons principalement 3 degrés d’urgences et proposons pour chacune un algorithme permettant d’intégrer en temps réel ces opérations dans le programme prévisionnel, tout en minimisant différents critères (temps d’attente avant affectation, heures supplémentaires, décalage par rapport aux anciennes dates de débuts)
The operating theater is one of the most critical and expensive hospital resources. Indeed, a high percentage of hospital admissions are due to surgical interventions. Rising expenditures spur health care organizations to organize their processes more efficiently and effectively. This thesis is supported by the urban community of Sarreguemines-France and the region of Lorraine-France, and is carried out in collaboration with the Centre Hospitalier de Sarreguemines - Hôpital Robert Pax. In the first part of this work, we propose two mathematical programming models to help operating theater managers in developing an optimal operating rooms scheduling. We also propose a constructive heuristic to obtain near optimal results for realistic sizes of the problem. In the second part of our work, the whole scheduling process is modeled as a hybrid four-stage flow shop problem with RSb blocking constraint, and is solved by a genetic algorithm. The objective is to synchronize all the needed resources around the optimal daily schedule obtained with the proposed mathematical model. The last part of our work is dedicated to non-elective surgeries. We propose a decision support tool, guiding the operating room manager, to handle this unpredictable flow of patients. Non-elective patients are classified according to their medical priority. The main contribution of the proposed decision support tool is to provide online assignment strategies to treat each non elective patient category. Proposed assignments are riskless on patient’s health. According to non-elective surgery classes, the proposed adjusted schedule minimizes different criteria such as patient’s waiting time, deviation from the firstly scheduled starting time of a surgery and the amount of resulting overtime

This study investigates the prevalence of peri-operative anxiety and the effective management of intra-operative anxiety during awake surgery. Plastic and vascular surgical patients were selected for the study as many procedures performed within these specialities are performed under local or regional anaesthesia. The study consists of two distinct stages. The first stage was a postal survey of patients (n=213) who had undergone awake plastic, renal access or carotid surgery up to two weeks previously, in order to determine retrospectively the prevalence of peri-operative anxiety. The second stage of the study was a randomised controlled trial of interventions for the effective management of intra-operative anxiety in patients (n=128) having undergone the same surgical procedures described in stage one. The interventions tested in stage two were handholding and an anxiety management package involving a relaxation technique and a procedural information leaflet, against a 'usual care' control. The findings from stage one of the study suggest that peri-operative anxiety prevalence is low, although unacceptable levels of anxiety are seen to elevate during the intra-operative phase. The RCT in stage two demonstrated that intra-operative anxiety was no more effectively managed by the interventions tested than by usual care alone. The validity and reliability of retrospective anxiety measurement was investigated by comparing anxiety scores from stage one with contemporaneous and post-hoc anxiety scores from stage two and found to be an accurate measure of anxiety experienced at the time of the event.

Au sein d’un établissement hospitalier, le bloc opératoire représente un des secteurs les plus emblématiques et les plus coûteux. Le fonctionnement du bloc opératoire est orchestré par un programme opératoire qui consiste à construire un planning prévisionnel des interventions chirurgicales à réaliser pendant un horizon donné. La littérature abondante sur le sujet est unanime sur le fait que la construction du programme opératoire est une tâche complexe, car il s’agit non seulement de planifier et d’ordonnancer les interventions, mais aussi de satisfaire des exigences souvent antagonistes. Ce projet est le fruit d’une collaboration entre la Communauté d’Agglomération de Sarreguemines Confluences et la Région Lorraine, des membres du secteur hospitalier (Hôpital Robert Pax de Sarreguemines) et l’équipe Gestion Industrielle et Logistique (GIL) du Laboratoire de Génie Industriel, de Production et de Maintenance (LGIPM). L’objectif de cette recherche est d’apporter une aide aux gestionnaires du bloc opératoire, qui ont besoin de plus en plus des méthodes et des outils d’aide à la décision en vue d’optimiser leur fonctionnement. Pour répondre à ce besoin nous nous intéressons dans la première partie de cette thèse à la gestion des opérations électives en prenant en compte différentes contraintes et en particulier la disponibilité des chirurgiens. Nous nous plaçons dans le contexte d’une stratégie « open scheduling » et nous proposons deux modèles mathématiques permettant d’élaborer le programme opératoire. La complexité des modèles mathématiques et leur explosion combinatoire rendent difficile la recherche de l’optimum pour des tailles réalistes. Ceci nous a donc amené à proposer une heuristique constructive utilisant le modèle proposé et permettant d’obtenir des solutions là où la méthode exacte ne nous le permettait pas. Dans la seconde partie de cette thèse, nous considérons l’intégralité du processus opératoire (brancardage vers le bloc opératoire, préparation et anesthésie, acte chirurgicale et réveil). Nous modélisons ce processus comme un flow shop hybride à 4 étages avec contrainte de blocage de type RSb, et nous le résolvons à l’aide d’un algorithme génétique dont l’objectif est de synchroniser toutes les ressources nécessaires, en respectant au mieux le programme opératoire prévisionnel. Outre les opérations électives, nous nous intéressons dans la dernière partie aux opérations urgentes. Nous proposons un outil d’aide à la décision pour la gestion des opérations urgentes. En prenant en considération la pathologie et la gravité de l’état du patient, nous distinguons principalement 3 degrés d’urgences et proposons pour chacune un algorithme permettant d’intégrer en temps réel ces opérations dans le programme prévisionnel, tout en minimisant différents critères (temps d’attente avant affectation, heures supplémentaires, décalage par rapport aux anciennes dates de débuts)
The operating theater is one of the most critical and expensive hospital resources. Indeed, a high percentage of hospital admissions are due to surgical interventions. Rising expenditures spur health care organizations to organize their processes more efficiently and effectively. This thesis is supported by the urban community of Sarreguemines-France and the region of Lorraine-France, and is carried out in collaboration with the Centre Hospitalier de Sarreguemines - Hôpital Robert Pax. In the first part of this work, we propose two mathematical programming models to help operating theater managers in developing an optimal operating rooms scheduling. We also propose a constructive heuristic to obtain near optimal results for realistic sizes of the problem. In the second part of our work, the whole scheduling process is modeled as a hybrid four-stage flow shop problem with RSb blocking constraint, and is solved by a genetic algorithm. The objective is to synchronize all the needed resources around the optimal daily schedule obtained with the proposed mathematical model. The last part of our work is dedicated to non-elective surgeries. We propose a decision support tool, guiding the operating room manager, to handle this unpredictable flow of patients. Non-elective patients are classified according to their medical priority. The main contribution of the proposed decision support tool is to provide online assignment strategies to treat each non elective patient category. Proposed assignments are riskless on patient’s health. According to non-elective surgery classes, the proposed adjusted schedule minimizes different criteria such as patient’s waiting time, deviation from the firstly scheduled starting time of a surgery and the amount of resulting overtime

The lack of discrete motivation strategies to improve the consistency of employees' performances was the problem that instigated this research. The purpose of this single-case study was to explore the motivation strategies live-entertainment artistic directors (ADs) use to improve consistency in the artists' performances. Data were collected within an international live-entertainment company to uncover whether artists self-determined the approach to improving consistency in performance or whether consistency occurred from strategies developed by the ADs. Data were collected from face-to-face interviews with ADs and senior ADs and performance evaluations of employees, and then analyzed using Miles, Huberman, and Saldana's data analysis method. The 2 emergent themes indicated that the ADs achieved consistency from performers through strategies supporting well-being and technical proficiency. Analysis of employee evaluations indicated the use of alternative motivational strategies for achieving and improving consistency at the show level. Some ADs rely on artists to self-determine consistency when working in environments perceived as conducive to consistent behavior. These findings might result in a mutual understanding between employers and employees of the role of consistency in employees' live performances, which may also improve employer-to-employee relationships in the live-entertainment sector. Such understanding might lead to positive social change by improving cultural output to the community and improving employees' economic viability and ability to contribute to society.

This thesis presents the business case for installing green roofs on movie theaters and shopping centers. These businesses can then derive increased profits from the environmental benefits of reduced energy use and increased stormwater retention. After presenting the basic design and benefits of a green roof, the thesis develops stand-alone business plans for a movie theater and shopping center. The author finds that green roofs are a profitable sustainability solution for the commercial enterprise.

碩士
國立臺灣師範大學
美術學系
103
The original building of the Guling Street Avant-garde Theatre is a wooden, Japanese-style dormitory constructed in 1906. As the Taiwan Provincial Governor's Office took over Taiwan in 1945, the building became the office of the Taipei City Police Department’s Criminal Investigation Unit. Two enforced-brick floors were added in 1954, and the building officially served as the office of the Police Department’s Seventh Branch. From 1959 to 1969, another floor was added to the rear building at the east side. In 1967, the Seventh Branch was renamed as Guting Branch, and renamed again in 1990 as Zhongzheng Second Precinct. However, the room was inadequate for office use by the time, and the Department had to find new space. In 1995, the Department’s new building was constructed at the intersection of Nanhai Road and Chongqing South Road, and the precinct moved to the new office. Guling Street gradually developed to a cluster of bookstalls in 1950s and 1960s, until Taipei City Government tore down most bookstalls in 1972 in the name of facilitating transportation and amenity. The remained bookstalls are so few now that one would find it difficult to imagine the street’s golden age. Standing at the street’s corner, the Guling Street Avant-garde Theatre’s two facades were in the style of Art Deco, and the detention room in the building is preserved as it was, keeping the architectural characteristics of police branch. Taipei City Government officials investigated the site with representatives from art communities in 1996, after the police branch moved out. It was then decided that the building should be planned for theater’s use. Related agencies were summoned to coordinate and alter the title deed registration to meet the regulations of the Building Act. In 1997, with the suggestions of scholars and experts, the building was listed as Taipei City’s commemorative building. The Zhongzheng Second Precinct Theater started to operate in October 1998, and became the city’s first case of releasing idle public space for cultural use. In accordance with the Cultural Heritage Preservation Act, the city’s Department of Cultural Affairs announced the building as historical architecture on April 8, 2014. From 1998, Taipei City Government followed the Operate-Transfer (OT) model and commissioned Taipei City Little Theater Union (October 1998 to October 2001), IFKids Theatre (December 2001 to December 2004) and Body Phase Studio (July 2005 to June 2014) to operate the theater. However, the first two groups seemed to be trapped in the predicaments of building maintenance, financial problems, poor management and the marginalization of theater in their nearly six-year operation. The public sector launched the self-financing strategy during the third group’s operation, bringing the group’s finance in rags. This thesis will go through the three groups’ operating process to investigate the conflicts and differences between the public sector’s discourses on cultural space management and artists’ participation in the performing space operation. It is hoped that by looking into this case, the homogenized OT policies for public space which the public sector relies for long and the art groups’ deficiency on operating cultural venues can be reviewed, and a new way of thinking and coordinating relations for cultural management between the public and private sectors can be formed.

碩士
國立臺北藝術大學
文創產業國際藝術碩士學位學程
101
This study was to investigate the management and operation of Song Song Song Children and Puppet Theatre (SSSCPT) in Taipei, Taiwan. Survey questionnaires and interviews were used to obtain descriptions of managerial behaviors on job and to identify SSSCPT’s organizational culture. It was concluded that a clear vision, sense of mission, a strong sense of commitment and good level of satisfaction of staff and audience, have lead SSSCPT to be able to provide high quality services to the audience as target beneficiary of the Company. As a result, the high quality services provided by SSSCPT have enabled the Company to lead and carve a niche for itself in Children Puppet Theatre.

碩士
元智大學
藝術管理研究所
97
One of the most urgent problems of Taiwan experimental performing troupes is the deficiency of space. Recently, the government has carried out the Rehabilitation Unused Spaces Policy since year 2000, providing re-used abandoned spaces to them by entrusting the management and operation of the spaces as their working and performing places. The spaces of the experimental theaters in this study refer to those places which are entrusted by government, including The Guling Street Avant-garde Theatre, The Performing Art School 36 and The O Space. The main purpose of this study is to analyze and examine the operation and management of the space by using document analysis, intensive interview and participation observation which lead us to find out more about the problems, including their missions and visions; human and financial resources; locations and spaces features; space renting and operation; core and marketing strategies encountered by the troupes while managing the space to find out the difficulties and conflicts; furthermore, to make suggestions for the improvement.

Projeto de mestrado em Gestão de Unidades de Saúde
Na sociedade hodierna assistimos a grandes transformações nas políticas dos setores associados à saúde, em grande parte devido à necessidade de diminuir os custos, mantendo a dinâmica e cultura de cuidados de qualidade e eficiência num serviço. É inadiável a adoção de medidas que proporcionem a sustentabilidade económica dos serviços de saúde no presente e no futuro. Na organização hospitalar, o bloco operatório assume a grande parte dos custos, por tudo o que lhe está associado, seja pela sua estrutura física e material como organizacional e humana. Neste âmbito, a utilização de técnicas Lean constitui-se como uma atividade fundamental para a gestão estratégica das organizações hospitalares, uma vez que o doente atual coloca desafios não apenas sob o ponto de vista clínico, mas também organizacional. A adoção do modelo organizacional Lean Production, designada de Lean Services, tem sido aplicada com sucesso em vários serviços, designadamente no setor da saúde. Lean Healthcare não pode ser encarado como um sinónimo de soluções, mas sim como uma oportunidade de melhoria, através de ferramentas e princípios com vista a atingir objetivos. Deste modo, desenvolveu-se um projeto no bloco operatório do Hospital de Braga, recorrendo a conceitos e a algumas ferramentas Lean. Através da realização deste caso de estudo, foi possível diagnosticar as causas principais e secundárias de desperdício no bloco operatório durante a sua atividade de produção diária. Através desta identificação foi possível reunir uma série de sugestões de melhoria com vista à redução ou eliminação de desperdícios e ao aumento de eficiência e qualidade. Neste sentido, torna-se fundamental o envolvimento e formação dos colaboradores do bloco operatório para a continuação de uma política de melhoria e de qualidade. Os resultados sugerem soluções que podem trazer uma contribuição relevante para a melhoria da atividade laboral no bloco operatório, tendo em vista o incremento da eficiência.
In today’s society we have witnessed major changes in the health sector policies mostly due to the need to reduce costs maintaining the dynamics and culture of quality of care and efficiency. In order to provide economic sustainability of the health services, in the present and in the future, is urgent to take measures. The Operating Theatres assume a great part of the costs within the hospital organization for all that it is associated including physical, material, structure, organizational and human resources. In this context, the use of Lean techniques become an essential activity for the strategic management of hospital organizations, since today a hospital patient is a challenge not only from the clinical point of view, but also organizational. The adoption of the Lean Production organizational model, called Lean Services has been successfully applied to different services. Lean Services can’t be seen as a synonym for solutions but as an opportunity to improve through tools and ideas to achieve goals. For this reason, this project was developed in the operating theatres settings of the Braga Hospital using concepts and some Lean tools. Through the accomplishment of this case study, it was possible to diagnose the main and secondary causes of waste in the operating theatres during its daily activity. Through this identification it was possible to join suggestions of improvement: reduce or eliminate waste and increase efficiency and quality. In addition, the involvement and training of the operating theatres employees is essential for the continuation of the improvement and quality policies. The results suggest solutions that it can bring a relevant contribution to the improvement of the labor activity in the operative theatres, in order to increase efficiency.