1. 1. Dr. Prahlada N.B MBBS, MS(PGI), MBA, MHA Karnataka ENT Hospital & Research Center, Chitradurga
2. 2. What is time? Time is capital and not renewable income! Time and Tide waits for no man! Time is the only thing which cannot be stretched beyond 24 hours! Time is the most valuable gift, which can be offered by one to another! Give time for children, be good parents! Have time for subordinates good superiors! We can not make time but surely we can find time.
3. 3. Advantages of Time Management
4. 4. Advantages: Surgeon Time is money More Consultation time More surgeries in less time More time for other academic activities More time for extra-curricular activities More time for family!
5. 5. Advantages: Patient Economical Less discomfort Less chance of operating wound infection Less anaesthesia risk Less OT risk Less hospital stay
6. 6. Advantages: Hospital Efficient use of OT Time Efficient use of OT Staff Less hospital borne infection rate Less OT Risk for the patient Less Hospital stay More turnover Economical Reputation
7. 7. My average timing! CM + Tympanoplasty - 26 minutes MRM + Tympanoplasty - 52 minutes
8. 8. Why? Al Shifa Hospital, Perinthalmanna
9. 9. Why? Surgical Camps
10. 10. Why? MBA Father of Scientific Management Frederick Taylor (1856-1915) Taylorism
11. 11. Taylorism Analyzed and synthesized workflows Improving economic efficiency & Enhancing labor productivity Standardization of process steps Time and motion studies
12. 12. Surgical Time audit Recording all events in OT Classification of events Analysis of events
13. 13. Surgical time audit Recording of all events in OT Pre-operative Intra operative Post-operative
14. 14. Surgical time audit Intra-operative events analysis Divide the steps When you have large task on hand divide them into small pieces and perform! Prepare a Time-audit chart.
15. 15. Time audit chart Surgical Steps Time in mins. Local Infiltration 3 mins End-aural incision 4 mins Post-aural incision and Harvesting TM Fascia graft 5 mins Tympanomeatal flap elevation 2 mins Denuding the malleus 2 mins Cortical mastoidectomy and canaloplasty 4 mins Check ossicular mobilty & round window reflex 30 secs Check E-tube patency 30 secs Grafting & Stabilizing 3 mins Closure 3 mins Total time taken 28 mins
16. 16. Surgical time audit Classification of events Very important Not particularly important Worthless
17. 17. Surgical time audit Analysis of events What is the best of way doing particular task in least possible time? Can you dedicate more time to high-value steps? Can you spend less time with low-value steps? Are there any distractions you can avoid? Can you modify the technique? Can you delegate the task?
18. 18. Surgical time audit Surgical Steps Before Now Local Infiltration 10 3 mins End-aural incision 10 4 mins Post-aural incision and Harvesting TM Fascia graft 20 5 mins Tympanomeatal flap elevation 20 2 mins Denuding the malleus 20 2 mins Cortical mastoidectomy and canaloplasty 30 4 mins Check ossicular mobilty & round window reflex 5 30 secs Check E-tube patency 5 30 secs Grafting & Stabilizing 20 3 mins Closure 20 3 mins Total time taken 2 Hrs 40 mins 28 mins
19. 19. Factors affecting Surgical time
20. 20. Patient factors General physical condition Risk factors Type of pathology Intra-op bleeding
21. 21. Surgeon factors Attitude Training Philosophy Planning Execution Delegation Team work
22. 22. Practice makes man perfect!
23. 23. SWOT Analysis
24. 24. TQM Six Sigma
25. 25. Anaesthetist Attitude Training Philosophy Team work
26. 26. Type anaesthetist Superficial Gas Man! Freelancer
27. 27. Staff factors Attitude Training Team work
28. 28. Staff Motivation Discipline Participation and involvement Time management Morale Skill development Communication
29. 29. Learn the Kaizen way!
30. 30. Operation theatre Design Lighting Air conditioning
31. 31. Operation theatre
32. 32. Equipment Right equipment Working equipment Serviced! Multi-use
33. 33. Microscope
34. 34. Equipment Micro-instruments double ended High speed micro drill Good burrs Patent suction tips! Scissors which cut!
35. 35. Surgical technique Plan! Plan! Plan! Investigate appropriately Communicate plan to the team Right surgical technique Right approach Right surgical step Complement surgical steps Do only what is necessary
36. 36. Surgical Approach Transcanal Endomeatal End-aural Post-aural
37. 37. Surgical Approach Trans-canal approach Post-traumatic perforation - < 3 months
38. 38. Surgical Approach Endomeatal approach Wide canal Post-traumatic perforation - > 3 months Central perforation other aetiology < 3 months.
39. 39. Surgical Approach End-aural approach Narrow Canal Posterior Central perforation When Cortical mastoidectomy is not planned
40. 40. Surgical Approach End-aural incsions for Koerners flap/Post-aural approach Anterior perforation/Anterior bony overhang Large perforation/Subtotal/total perofrations When Cortical mastoidectomy is contemplated All Cholesteatoma surgery
41. 41. Cholesteatoma Decision making Only Canal wall down Obliterate when possible Single stage ossicular reconstruction Modified Bondys mastoidectomy with obliteration Minimal cholesteatoma Ossicular chain intact