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The current profile of action learning in the UK has recently become clearer (Pedler et al., 2005). Using the template of what have been described as "Revans's Classical Principles", fundamental divergences have begun to emerge. Pedler et al. (2005) identified a number of variances from this template--specifically the use of permanent facilitators working with action learning sets and a greater focus on personal, rather than organisational, development. They also noted the emergence of a variant they described as "business-driven action learning" where action learning sets worked on projects identified by senior managers and made recommendations for action which was organisation focused and emphasised problem solving, and which put much less emphasis on personal development. This article describes the use of business-driven action learning as an element in a multi-agency organisation development intervention conducted during 2004-2005 under the aegis of the Local Strategic Partnership in Stoke-on-Trent; it describes the programme and the place of action learning within it and identifies learning from the experience.

To evaluate the effect of deploying a new electronic medical record (EMR) system on first case starts in the operating room. Data on first case start times were collected after implementation of a new EMR (Epic) from June 2015 to May 2016, which replaced a legacy system of both paper and electronic records. These were compared to data from the same months in the three proceeding years. First patient in room (FPIR) on time was true if the patient was in operating room before 7:35 AM (or 9:35 AM on Wednesdays) and first case on time start (FCOTS) was true if completion of anesthetic induction was less than 20 min after the patient entered the operating room (or 35 min for cardiac and neurosurgery). Times beyond these cutoffs were quantified as FPIR and FCOTS delays in minutes. Average delays were compared by month with two-sample t tests and 95 % confidence intervals. There was a significant increase in FPIR delays in the first month (11.07 vs. 3.47 min, p < 0.0001), which abated by the fifth month. Post-implementation FCOTS delays improved by the third month (4.53 vs. 7.10 min, p < 0.0001). Both results persisted throughout the study. First month FPIR delays were not limited to any one specialty. EMRs have the potential to improve hospital workflows, but are not without learning curves. FPIR and FCOTS delays return to baseline after a few months, and in the case of FCOTS, can improve beyond baseline. [ABSTRACT FROM AUTHOR]

Purpose: On time start of the first surgical case improves operating room (OR) utilization, physician, and patient satisfaction and decreases delays in subsequent cases. The goal of our study was to evaluate the effect of a multidisciplinary initiative to improve first patient in the room (FPIR) and first case on time start (FCOTS) metrics in a tertiary care setting. Materials and Methods: A multidisciplinary committee focused on first case start data collection. Reasons for both anesthesia and surgical delays were analyzed. Improvement efforts focused on the timely completion of surgical consent, a requirement of a surgical, anesthesia, and nurse team member presence at the patient's bedside by specific time, and parallel processing in the OR. Results: Over 65,100 OR cases were analyzed between 2007 and 2014. There was a statistically significant improvement in FPIR (82.80% versus 69.60%, p < .0001) and FCOTS (66.60% versus 55.90%, p < .0001). Surgical consent completion rate increased from 35% baseline to 68%-100%, depending on the surgical subspecialty. Improvements appeared sustainable several years following process implementation for both FPIR (84.60% versus 69.60%, p < .0001) and FCOTS (67.60% versus 55.90%, p < .0001). Conclusions: Our study demonstrates a successful targeted, multidisciplinary initiative to improve first case surgical starts in an academic setting. Our approach was organizational rather than punitive or rewarding on an individual basis. Strategies included establishing concrete, time-specific goals and posting them visibly, empowering individuals to fulfill them, and ensuring no compromise in patient safety. In the complex environment of academic medicine including research protocols and teaching in the ORs, our organizational approach proved sustainable over several years. [ABSTRACT FROM AUTHOR]