Sinding - Local planning in the surgical department Cases on Management, Leadership and Organisations

Knud Sinding

Local planning in the surgical department

Knud Sinding

Local planning in the surgical department

From the book:

Knud Sinding and Anne Bllingtoft

Cases on Management, Leadership and Organisations, 1st edition 2012, chapter 20

1st e-book chapter 2013

Samfundslitteratur 2012

Cover design: Klahr|Graphic Design

Typeset: SL grafik, Frederiksberg

E-book production: Rosendahls BookPartnerMedia

ISBN: 978-87-593-9523-3

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CHAPTER 20

LOCAL PLANNING IN THE SURGICAL DEPARTMENT

Nurses assist surgeons in operations. These nurses are specialists just as surgeons are specialist doctors and should not be confused with the nurses in a hospital ward. Its a matter of getting the daily work to run smoothly in combination with all the considerations that must continuously be taken into account.

The department is part of the regions main hospital. The hospital has a total of about 1,700 employees spread across 40 different professions and 22 clinical departments. Each department is led by a department management team consisting of a head nurse and a clinical director. One of the departments conducted some small, organisational changes as part of a job satisfaction project, focusing on the way in which the work was organised and divided among the employees.

The employees, the organisation of the work and the culture

Within the hospital, the surgical department was organised in different sections: Anaesthesia, intensive care and sterilisation. One department manager (the head nurse) was responsible for the four sections. The surgical department had 43 full-time positions in the nursing field, of which eight were nursing assistant positions while 35 were qualified nurse positions. The surgical department had four specialties, which were combined into two areas: Orthopaedic surgery, which was merged with gynaecology, and organ surgery, which was merged with cardiovascular and thorax surgery. Each area had a managing nurse along with 15 to 20 nurses. Just six months earlier, one head department nurse ran the two areas. Traditionally the two areas collaborated in a lot of areas. People helped each other during day shifts, and people from both areas worked together during the evening/night and weekend shifts.

All nurses, except for the managing nurses, were part of the alternating shift system. A day shift lasted from 7:30 a.m. to 3:15 p.m. Each day, a nurse from each department was on so-called emergency call from 9:00 a.m. to 5:00 p.m. Each department provided two nurses to the evening/night shift, which lasted from 2:50 p.m. to 7:30 a.m.; the time after midnight was on-call time where only emergencies were handled. When lucky, nurses might get a bit of sleep during a night. On weekends, regular operations were normally not scheduled, so here an emergency response team, made up of a few day shifts and a few 24-hour shifts, were primarily provided. Doctors were also affiliated with the department, but their work was organised independently from the nurses and nursing assistants in a separate scheduling system.

A typical workday started with a morning meeting at 7:30 a.m. where the head nurse had made a floor plan based on the planned operations. This was discussed and perhaps adjusted if anyone was absent or if there were any special requests. At about 7:50, about 9 operating theatres went into action. They continued until 2:30 p.m., hereafter they began to close theatres down so only three theatres were in use when then evening shift began at 3:00 p.m., and the day shift ended. The three operating theatres continued until about 5:00 p.m. where the on-call shift went home. Then, activities were further reduced, but it was quite normal for a single theatre to continue being in use until about 10:00 p.m. After midnight, only emergency operations would be carried out. One section would typically attend to caesarean sections while the other, for example, would attend to bleeding ulcers.

Work intensity in the surgical department had grown tremendously in recent years. More operations were performed every day than ever before. The increased work tempo meant that the shift system needed to be changed. A distinctive feature of the surgical department was that the development in the various specialist fields was very rapid with regard to both new equipment and new methods and treatments. Ideally, all nurses should be capable of participating in all operation across the two areas, in order to enable complete flexibility. In reality, it became more and more difficult.

The individual nurses couldnt keep up with all four specialties. In order to promote flexibility, the hospital tried to introduce rotation between the two areas, but it didnt really work because very few nurses actually wanted to rotate, and changing your mind and returning to a previous area of work was not an option. On the other hand, everyone agreed that it was important that everyone help each other across the specialties, just like they were dependent upon each other during night and weekend shifts. It was a difficult balancing act that nobody had really found a solution for.

Before the project, the head nurse made up the shift schedule for the entire surgical department. The plans covered four weeks at a time. Before the plans were made, one could make requests regarding shifts etc. As these plans were always made four weeks in advance, if one needed to make a request it had to be made up to eight weeks in advance.

In addition to requests from employees, the head nurse also took into consideration the composition of the various teams to make sure shifts were covered by a mixture of experienced nurses and trainee nurses. Being in the surgical department required a high degree of training after graduation. Although not an official specialisation studied after completion of the basic education, it took at least 6 months before a newly graduated nurse could safely handle a shift.

Another consideration was achieving a somewhat even distribution of day shifts, evening-/night shifts, emergency shifts and weekend shifts, partly to distribute the burden fairly, but also to ensure that all staff earned a somewhat even income.

The scheduling also had to take into account whether the number of people who actually showed up for work corresponded to the number of people needed. When the plan was finished, it was posted well in advance for general viewing. However, by the time it came into force it soon became unrecognisable. Shifts had been swapped left and right and exchanging of shifts occurred up until the day prior to the actual shift. According to an informal rule at the hospital, shifts could only be exchanged if it was absolutely necessary. Everyone reminded each other of this rule from time to time when the swapping of shifts went out of control. Staff also exchanged shifts evenly (i.e. dayshift for dayshift etc.) so as not to cause extra administrative burdens. Finally, staff also attempted, to as large a degree as possible, to swap shifts at the same level, so that a trainee swapped with another trainee, and an experienced staff member with another experienced staff member, so that the ward was adequately staffed. Swapping shifts was fully accepted by management, for several reasons: