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Four steps to improve workplace safety and operations

How a Boston surgeon reduced operating room injuries — and saved money along the way.

By Dylan Walsh  |  February 10, 2017

Four steps to safety infographic

Carlos Estrada, a pediatric urologist and Executive MBA student at MIT Sloan, was sitting in a safety training session at Boston Children’s Hospital when the conversation turned to sharps-related injuries to employees. “As a surgeon, I thought I’d naturally know about this,” he said. But when the data were presented — 90 to 100 accidental sticks with suture or hypodermic needles every year — Estrada was floored. “Imagine if 90 to 100 patients got stuck,” he said. “We wouldn’t be in business.”

The problem not only puts employee health at risk, increasing the chance of infectious disease transfer, but it’s expensive: Estrada estimated that accidental sticks cost the hospital roughly $200,000 every year.

Eager to find a solution, Estrada examined the problem in Organizations Lab, in which MIT Executive MBA students work to solve a specific issue in their company. Over the course of the semester, Estrada designed and implemented an intervention that reduced the unsafe transfer of sharps to only five instances across as many surgeries; no accidental stick occurred. A control group with no intervention reported 42 unsafe transfers over four surgeries, with one accidental stick.

Such stark differences resulted from a straightforward process that any company, in any sector, can use to improve safety and efficiency.

Get the problem on paper — size A3, to be precise
Once Estrada decided to address accidental sticks from sharps transfers, he summarized the whole issue — background, root causes of problem, intervention design, execution plan, and takeaways — on a single sheet of A3 paper, roughly 11-by-16 inches. “This forces you to really find out what’s important,” he said. “From that you can hone down on the issue and really focus your problem-solving skills.”

One essential part of this process, he said, is a concise problem statement. He noted that it’s often easy to write at-length about a problem, but too much detail muddies the search for a solution. Writing a problem briefly and clearly instead helps to establish a manageable scope. “You get down to the heart of it,” Estrada said.

Take time to observe the process you’re reforming
Estrada was emphatic about the importance of observation. “Go and see the work,” he said. Many senior managers are distant from operations; they may not directly oversee the assembly line or the call centers or the scheduling of meetings. Whatever the process under investigation, study it before trying to reform it.

2017-estrada Dr. Carlos Estrada in his office at Boston Children’s Hospital.

Estrada referred to advice he received from MIT Sloan Professor Nelson Repenning, the faculty director of the Executive MBA program. “What Nelson told us was absolutely brilliant,” he said. “If you go and see the work and you’re not embarrassed to some degree, then you’re not really seeing the work.”

Observation is also useful for providing clarity through distance. Though Estrada had been working in operating rooms for 15 years, he never recognized the need for safer sharps transfer practices. (Indeed, such closeness likely obscured the problem.) “When I stepped away I had a kind of ‘duh’ moment,” he said.

Simplicity and collaboration help earn stakeholder buy-in
Interventions need to be simple. Managers — or surgeons in Estrada’s case — are preoccupied with the task on-hand, like performing surgery. If they are asked to make big changes then the request “will be dead in the water,” said Estrada. Recognizing this, he followed three basic guidelines as he designed the intervention: no additional work for any team member; no additional operative time; and no capital expenditure.

Data, too, are a useful ally. Demonstrating the largely hidden problem of unsafe sharps transfers in the operating room, along with the results of his intervention, helped Estrada earn support from the chief of surgery and the hospital’s chief operating officer.

Finally, the idea for a change should be introduced openly and inclusively. Estrada highlighted the need to be “hyperaware of the social and political consequences of coming in and planting a flag.” Instead, he brought his proposed intervention to the table and went about its implementation by “having everyone take part. It was a contributory group effort.”

From A3 to action: use education and competition
People are often comfortably set in their ways. Estrada said surgeons develop their own methods over a career. So how do you encourage adoption of a new idea?

“It’s essential to raise awareness about whatever problem needs reforming,” said Estrada. He created informational flyers on accidental sticks and their costs, both monetary and health (in terms of infectious disease transfer); he pasted these all over Boston Children’s Hospital. This raised the profile of the problem.

Estrada then created a competition to reduce unsafe sharps transfers, with points earned by following the proper procedure. This, he said, tapped into the well-known competitive nature of surgeons and helped to build participation. Though competition may not work in every setting, he noted that behavior is not easy to change, so any intervention needs to be aligned with — and take advantage of — the specific culture of a workplace.