VENTILATION
overarching holistic goals to be achieved with minimal effort, so saving much operational time. While the practical implementation and
operation of management’s safety policy and procedures relating to the engineering aspects of ventilation systems is the responsibility of the Authorised Person (Ventilation) AP(V), the management of a healthcare provider’s ventilation systems is overseen by a Ventilation Safety Group (VSG), which should: l Have clearly defined roles and responsibilities covering all aspects of the ventilation system’s life cycle – plan, acquire, use, maintain, and dispose.
l Be part of a healthcare organisation’s governance structure and report to the ‘Designated Person’ at Board level.
Decisions affecting the resilience, safety, and integrity of the ventilation systems and associated equipment should be taken with the agreement of the VSG. Major investment decisions require considerable amounts of information, but the associated decision-making processes can often be straightforward. With increasing pressure to optimise the availability of resourcing, management processes need to be established to support the continual programme of decision making based on the flows of verification information, its analysis, and the resulting performance rankings. The improved transparency available
from a smart logbook will facilitate communication and enable AP(V)s to support all members of their VSG to operate effectively. By adopting relatively simple techniques based on better flows of information, VSGs can also deliver the incremental performance improvements which are expected in today’s goal- oriented operations, and they can ensure essential marginal gains in theatre availability. Parallels for the introduction of
continuous improvement can be found in other areas of healthcare e.g. a system centred risk management model for primary care organisations which had a major impact on risk. By sharing risk information in an easily digested format by clinicians and administrators, 90 per cent risk reduction was achieved in the repeat prescription of medicines. The risk management model was based on systems thinking, in particular W. Edwards Deming’s iterative four stage PDSA (Plan- Do-Study-Act) management method which is used extensively in business for the control and continual improvement of processes and products.5
In order to
achieve improvements, outcomes are monitored and then reviewed so processes can be revised to enhance performance even further.
74 Act Plan
of his SPoK. It echoes the work of Peter Senge who also emphasised the need for building a shared vision and team learning, which was summarised in his book The Fifth Discipline: The art and practice of the learning organization.7
Study Do
an associated cultural shift, teams can progress from simply reacting to the present issues and to becoming focused on delivering continuous improvement to create the better future outcomes.
Figure 1. The PDSA Cycle.
Systems thinking – optimising the delivery of better ventilation outcomes Systems thinking is a holistic approach to problem solving. It is often used to develop effective actions for complex situations and it focuses on both how a system’s constituent parts interrelate, and how that system works within the context of larger systems. Deming’s PDSA cycle is a proven example of systems thinking which enables continuous quality improvement processes. It is an ideal approach for VSGs to adopt in order to deliver better ventilation outcomes.
PDSA process Informed by verification data, the PDSA process can be introduced to drive continuous improvement. Information derived from the analysis of the verification data can immediately support the study step of the process for an abbreviated initial cycle which then informs both the actions and allows a plan to be established for the ongoing improvement cycles (see Figure 1). With suitable engagement by all
concerned, this continuous quality improvement process will have positive outcomes which impact directly on a Trust’s performance and so result in increased theatre availability and revenue.
Organisational culture While the PDSA improvement process can be established easily, its success is entirely dependent on the organisation’s culture. Deming realised this and proposed his System of Profound Knowledge (SPoK) which provides a highly integrated framework for the cultural transformation needed to support continuous improvement. Beginning with transformation of the individual, SPoK will ensure managers become leaders and also ensure people in those organisations continually improve, with the aim of everybody winning. His book The New Economics for Industry, Government, Education6
Smarter ways of working – ISO 55001 Systems thinking is becoming more widely adopted in healthcare and it forms the basis of several similar management techniques, such as Kaizen and Six Sigma. They each have slightly different terminologies and focus, but they all require cohesion and learning. There is also a considerable overlap
between the PDSA cycle and ISO 55001. While the standard is more about identifying and controlling risk to internal and external stakeholders of the defined asset portfolio, those who adopt will realise opportunities for continuous improvement throughout their life cycles.
Conclusion
While not specifically written about data and the rapidly changing world, HTM 03- 01 outlines the functional responsibilities of designated staff and the data to be collected during verification. It provides a sound platform for establishing procedures which support resource optimisation.
Smart logbooks improve the visibility
of verification information, which in turn enables AP(V)s to improve their control of maintenance and the flow of information to their VSG, both of which can lead to higher levels of theatre availability. However, when that smart collaborative technology is also coupled with the innovative management practices which deliver continuous quality improvement, every VSG can lead improvements in their Trust’s management of ventilation systems and optimise their availability.
References 1
https://www.england.nhs.uk/estates/health- technical-memoranda.
2 NHS: HTM 00 Polices and principles of healthcare engineering, 2014.
3 NHS: HTM 03-01 Specialised ventilation for healthcare buildings, 2021.
4 Humphreys H. Infection prevention and control considerations regarding ventilation in acute hospitals, 2021 .
5 Moen R. Foundation and History of PDSA Cycle, 2009.
6 Deming WE. The New Economics for Industry, Government, Education. 2nd edn. The MIT Press, 2000.
presents a detailed explanation
7 Senge PM. The Fifth Discipline: The art and practice of the learning organization. 2nd edn. Random House Business, 2006.
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