Quality Improvement to Address Surgical Burden of Disease at a Large Tertiary Public Hospital in Peru

Abstract

Background In resource‐limited settings, there is a unique opportunity for using process improvement strategies to address the lack of access to surgical care. By implementing organizational changes in the surgical admission process, we aimed to decrease wait times, increase surgical volume, and improve patient satisfaction for elective general surgery procedures at a public tertiary hospital in Lima, Peru. Methods During the first phase of the intervention, Plan‐Do‐Study‐Act (PDSA) cycles were performed to ensure the surgery waitlist included up‐to‐date clinical information. In the second phase, Lean Six Sigma methodology was used to adapt the admission and scheduling process for elective general surgery patients. After six months, outcomes were compared to baseline data using Wilcoxon rank‐sum test. Results At the conclusion of phase one, 87.0% (488/561) of patients on the new waitlist had all relevant clinical data documented, improved from 13.3% (2/15) for the pre‐existing list. Time from admission to discharge for all surgeries improved from 5 to 4 days (p<0.05) after the intervention. Median wait times from admission to operation for elective surgeries were unchanged at 4 days (p=0.076) pre‐ and post‐intervention. There was a trend toward increased weekly elective surgical volume from a median of 9 to 13 cases (p=0.24) and increased patient satisfaction rates for elective surgery from 80.5 to 83.8% (p=0.62), although these were not statistically significant. Conclusion The process for scheduling and admitting elective surgical patients became more efficient after our intervention. Time from admission to discharge for all surgical patients improved significantly. Other measured outcomes improved, though not with statistical significance. Main challenges included gaining buy‐in from all participants and disruptions in surgical services from bed shortages.

Implementing Lean Six Sigma in health care: a review of case studies

“…Health care organisations such as Texas Children’s Hospital, Houston (Kovach and Borikar, 2018), Royale North Shore hospital eye clinic, Sydney (Kam et al , 2021), Sharp Grossmont Hospital, Southern California (Gallo et al , 2020), etc., has shown the worthiness of implementing LSS. LSS is compatible with both general improvement methods such as plan do study act (PDSA) (Iverson et al , 2021) as well as health care-specific methods such as diagnostic therapeutic assistance pathway (DTAP) (Scala et al , 2021) to provide better synchronisation. A recent study in a private hospital in Jakarta, Indonesia, also justifies the positive outcome of LSS implementation during the COVID-19 pandemic to reduce inventory and improve profitability (Iswanto, 2021).…”