The above link to an international journal paper of a redesigned workflow and sedation paradigm was conceived by myself and Alan Gray, the radiation oncologist, one day while sharing coffee at KFSH&RC in Riyadh, Saudi Arabia. We wanted to implement the changes quickly and effectively with minimal disruption. Within a month the radiation technicians and I had converted and trained the other anesthetists to the new techniques and flow. The departments of Finance, IT, Systems Engineering, and Personnel were not involved in the redesign.
The study consisted of 1,033 procedures. The process design decreased the workload of four full time people in the pediatric radiation lab from an 8 hour day to 75 minutes while creatively using slack time (no extra anesthetist or interference with the OR schedule) from the anesthesia department. It lowered risk and decreased morbidity of the children, as well as decreased stress for mother, child, and radiation lab personnel.
The paper shows the actual resulting health benefits from using specific clinical, financial and operational knowledge in the creative design of a clinical process. The immediate decrease in personnel activity for a team of 4 was (6.75 x 4 x 220 days = 5,940 hrs = 742 radiation tech days) for less than a year’s study. Direct equipment use was decreased to approximately one sixth of what it was before. Data entry by the anesthesiologist was designed (cut) to 1/100 of the normal anesthesia sheet so as to provide exactly the history of what the next anesthesiologist would need during the next repeat sedation for maximum safety and efficiency and let him focus on the patient instead of data entry.
The actual direct cost savings, however, are mostly dependent on step costs; the opportunity costs (revenue and net) could be 5 times as much as previously (if not provided for free by the kingdom); and the extended economic and family benefits of less-than-an-hour sedated child versus a potentially 8-24 hour sedated, non-feeding child was great, but not easily converted into a monetary equivalent.