THORAXCENTRUM ERASMUS MC

BACKGROUND


The Thorax Center of the Erasmus Medical Center (Erasmus MC) faces a lot of competition in the area: there are seven other heart centers within a radius of 80 kilometers. One of the most important sources of income is open heart surgery. Despite the fact that more than 1000 open heart surgeries were performed in 2015, the market share is relatively low. This is mainly due to long waiting lists and missed referrals. In addition to external competition and internal pressure to perform, the surgeons in the heart center faced challenges that are typical for this patient group. Think of long and highly variable surgeries, many (semi-)emergency cases and often complex pre-operative preparation. At the start of this project, the Thorax Center had set two goals:

1) make more efficient use of people and resources; and

2) Increase the number of open heart surgeries by 50% by the end of 2017.


RESULTS


In the three months following the implementation of the new method, the number of open-heart surgeries had increased significantly, by more than 25%. The waiting list had also decreased from 12-14 weeks to 2-3 weeks. The heart center then continued the new method to achieve the full desired increase in production (see publication).

APPROACH

To achieve the above goals, Maartje and Femke have optimized the planning process on a tactical and operational level. The Thoraxcentrum has also slightly increased the operating and clinical capacity in the bed house and we have worked on the relationship with referrers in the area. The project consisted of two phases:


 Phase 1: Bottleneck AnalysisUsing interviews with all relevant stakeholders and extensive data analysis, we identified the bottlenecks that led to inefficiencies and hindered planning:

  • Long waiting lists (12-14 weeks versus 1-2 weeks in other heart centers) that affected the patient experience and reputation of the Thorax Center;
  • Unreliable scheduling and frequent last-minute changes;
  • Incorrect estimations of surgical time;
  • Cancellations due to capacity problems and incomplete preoperative preparation.


Together with the Thoraxcentrum we have drawn up an action plan focusing on four areas:

  • Preoperative preparation of the patient;
  • The tactical and operational planning process, use of available capacity;
  • Access and quality of referrals;
  • Internal and external communication.



Phase 2: Implementation

To implement the necessary changes, a multidisciplinary project team was formed. Every week we discussed the progress of the project, divided tasks, monitored results and introduced new work routines.