Designing extended overall equipment effectiveness: application in healthcare operations

ABSTRACT

Hospitals are forced to develop performance assessment tools, and mainly in areas with high resource consumption and high added value, such as surgical units or operating rooms. Based on methods inspired by lean management in the industry, this paper explores an extended Overall Equipment Effectiveness (E-OEE) approach to an entire process involving material and human resources. This research is based on data on the medical activities of Operating Rooms (OR) in 10 hospitals, as well as the opinions of relevant personnel (physicians, service agents, executives) and analyses of the various existing processes. Additional data were provided in 2015 by four hospitals. In order to solve the performance of processes involving both human resources and critical material resources, we built an indicator based on the measurement of effective valuable time of work executed by the operators, coupled with the measurement of machine performance with a classic OEE model. The extended OEE (E-OEE) is a new indicator to evaluate operating facilities and – possibly – all other activities where high HR involvement is a key factor of performance. E-OEE can complete the traditional Overall Effectiveness indicators taking both HR performance and Equipment performance into account.

KEYWORDS:

• Industrial management
• continuous improvement
• management science
• healthcare

Acknowledgments

I thank G. de Gavre, C. Grosso, G. Delorme and R. Lardeux for their contribution to this research. This work is part of a research program I am conducting on health supply chain.

Notes

1. Mission nationale d’expertise et d’audit hospitalier, which was incorporated into the Agence nationale d’appui à la performance des établissements de santé et médico-sociaux (ANAP) in 2009.

2. The OEE was first introduced by Nakajima (1988) in the context of total productivity maintenance (TPM) and lean management of equipment/machines. OEE is a quantitative metric that has been increasingly used in mass-production environments for controlling and monitoring the productivity of production equipment (Samuel et al. 2002).

3. Temps Réel d’Occupation des Salles = time when the OR is actually used to perform surgery; TROS = time spent by the patient in the OR + cleaning of the OR after the operation.

4. http://www.fnro.net/documents/Officiel/ANAP/files/06BlocsOperatoires.pdf.

5. IBODE = Infirmière de Bloc Opératoire Diplômée d’Etat.

6. IADE = Infirmière Anesthésiste Diplômée d’Etat.

7. Note that it is possible to assign a coefficient to every four categories of tasks in the calculation of NVAT, to take into account the ranking of categories in a numeric way, forming a Weighted Net Value Added Time (WNVAT). But the choice of coefficients may strongly depend on the kind of organization already in place and must be chosen accordingly.

8. The fast-track process applied to operating rooms relies on a rapid recovery of patients after surgery. As the next step of ambulatory surgery, the fast-track process is linked to a decrease in the length of time spent by any given patient in the surgery’s flow, and consequently to an increase in the number of operations per facility.

9. Temps de Présence du Patient en Salle = time spent by a patient in an operating room.