Reducing Changeover Time Between Surgeries Through Lean Thinking: An Action Research Project

Abstract

BackgroundMaximizing the utilization of the operating room suite by safely and efficiently changing over patients is an opportunity to deliver more value to patients and be more efficient in the operating suite. Lean Thinking is a concept that focuses on the waste inadvertently generated during organization and development of an activity, which should maximize customer value while minimizing waste. It has been widely applied to increase process efficiency and foster continuous improvement in healthcare and in the operating room environment. The objective of this paper is to provide insight on how healthcare professionals can be engaged in continuous improvement by embracing Lean Thinking and ultimately reducing changeover time between surgeries.MethodsUsing an action research approach, Lean methodology such as Gemba walks, Process Mapping, Root-Cause-Analysis, and the Single Minute Exchange of Dies (SMED) system was applied to understand the causes of variability and wastes concerning changeovers and improve processes in the context of gynecological- and general surgery. Data were collected and analyzed through observations and video recordings. Problem and issue have been raised to management team attention and included in the annual balanced scorecard of the hospital. This initiative has been also made relevant to the team working in the operating suite and related processes before and after the entry of the patient in the operating suite.ResultsImproved patient flow and inter-professional collaboration through standardized and safer work enabled effective parallel processing and allowed the hospital to reduce changeover time between operations by 25% on average, without changes in terms of infrastructure, technology or resources.ConclusionLean thinking allowed the team to re-evaluate how the whole operating suite performs as a system, by starting from a sub-process as changeover. It is fundamental in order to improve further and obtain sustainable results over time, to act on a system level by defining a common goal between all stakeholders supported by a management and leading system such as visual/weekly management, optimizing planning, implementing standard-works to be followed by every associate and guaranteeing the role of the surgeon as process driver who pull performances.

Effects of Lean Interventions Supported by Digital Technologies on Healthcare Services: A Systematic Review

“…On the contrary, two non-significant increases in TOT after the intervention were reported [ 33 , 93 ]. TOT was measured in various settings, including pediatric facilities [ 69 ], ambulance services [ 125 ], pharmacies [ 33 ], and operating rooms [ 93 , 126 ]. Table 5 depicts the findings of TOT outcomes.…”

Lean, Six Sigma, and Simulation: Evidence from Healthcare Interventions

“…Although TOT has been reported in previous studies as a frequent measure [12,129], we found only two studies reporting a reduction in three TOT outcomes. Both studies utilized lean and simulation in OR [152] or in a general hospital [143]. Similarly, two studies measured the percentage of LWBS with both reporting improvement after the intervention.…”

Six Sigma can significantly reduce costs of poor quality of the surgical instruments sterilization process and improve surgeon and operating room personnel satisfaction

“…This research project was chosen as part of a cyclic and interdisciplinary collaboration process in which team members worked by applying the DMAIC logic through the stages described in Deming's cycle (Plan-Do-Check-Act), which are foundational tools of lean thinking. In addition, we applied the Six Sigma methodology through the application of statistical analysis and monitoring of DPMO 21 .…”