Monday, April 20, 2009

Surgical Task Flows

I am trying to define a best practice for a surgical procedure to implant a medical device. Here's my approach:

Step 1: Who?
What kinds of surgeons and surgical support staff are involved in this procedure?

What kinds of surgical techniques are they familiar and comfortable with and what will be new or different to what they currently do?

Step 2: What?
What products need to be supplied by the medical device company?

What products would be commonly available for these clinicians, but not supplied?

Step 3: Where?
OR or Clinic setting?

What needs to be present in the environment? (sterile, xray, other tools or equipment needed)

What might be present that could pose a hazard? (magnetic or other emissions)

Step 4: How?
What are the primary activites during the surgical procedure?
ex: Assess patient condition

What are the functions within activity?
ex: Intake patient

What are the tasks within each function?
ex: Obtain patient record

What are the steps within each task?
ex: Review patient progress

Note who is involved and where it is done for each task.

Step 5: Document and Review
I start all of this in a spreadsheet with the first column being the Activity (high level of what is being done), the second column the Function (sub-activities that may have different goals), the third column Tasks (Short, 1 to 8 words that describe something that has a clear start and end point; performed by only one user/doer), the fourth column Steps(the precise description of how this is performed and the order of how to do it.) The spreadsheet has a bunch of other columns to capture who is performing the Task, what environment the user is in when performing the Task and some other info and notes columns.

Once I have completed all of the Task Analysis research in the spreadsheet, I create a visio diagram of the draft surgical flow. This is very similiar to the diagrams clinicians use when triaging or diagnosing patients, so I have found this to be a good way to get the clinician involved in helping me to refine the flow and steps when we review and iterate on the recommended surgical procedure. For complex procedures, the flow is per task with each step in it's own box. For simpler procedures, the flow is per function with each task in it's own box. It really depends on where I have the questions and where I think there will be disagreement in surgical approach.

The National Istitute of Health; MedLine provides videos of surgical procedures. I have viewed many of them in their entirety, but squeamish beware!