1. Dr. Prahlada N.B MBBS, MS(PGI), MBA, MHA Karnataka ENT
Hospital & Research Center, Chitradurga
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. Advantages of Time Management
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. Advantages: Patient Economical Less discomfort Less chance
of operating wound infection Less anaesthesia risk Less OT risk
Less hospital stay
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. My average timing! CM + Tympanoplasty - 26 minutes MRM +
Tympanoplasty - 52 minutes
8. Why? Al Shifa Hospital, Perinthalmanna
9. Why? Surgical Camps
10. Why? MBA Father of Scientific Management Frederick Taylor
(1856-1915) Taylorism
11. Taylorism Analyzed and synthesized workflows Improving
economic efficiency & Enhancing labor productivity
Standardization of process steps Time and motion studies
12. Surgical Time audit Recording all events in OT
Classification of events Analysis of events
13. Surgical time audit Recording of all events in OT
Pre-operative Intra operative Post-operative
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. 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. Surgical time audit Classification of events Very important
Not particularly important Worthless
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. 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. Factors affecting Surgical time
20. Patient factors General physical condition Risk factors
Type of pathology Intra-op bleeding
21. Surgeon factors Attitude Training Philosophy Planning
Execution Delegation Team work
22. Practice makes man perfect!
23. SWOT Analysis
24. TQM Six Sigma
25. Anaesthetist Attitude Training Philosophy Team work
26. Type anaesthetist Superficial Gas Man! Freelancer
27. Staff factors Attitude Training Team work
28. Staff Motivation Discipline Participation and involvement
Time management Morale Skill development Communication
29. Learn the Kaizen way!
30. Operation theatre Design Lighting Air conditioning
31. Operation theatre
32. Equipment Right equipment Working equipment Serviced!
Multi-use
33. Microscope
34. Equipment Micro-instruments double ended High speed micro
drill Good burrs Patent suction tips! Scissors which cut!
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
38. Surgical Approach Endomeatal approach Wide canal
Post-traumatic perforation - > 3 months Central perforation
other aetiology < 3 months.
39. Surgical Approach End-aural approach Narrow Canal Posterior
Central perforation When Cortical mastoidectomy is not planned
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. Cholesteatoma Decision making Only Canal wall down
Obliterate when possible Single stage ossicular reconstruction
Modified Bondys mastoidectomy with obliteration Minimal
cholesteatoma Ossicular chain intact