Lean Healthcare TransformationImproving Operating Room Availability

  • Operating Rooms (OR’s) represent the greatest opportunity for margin and profit impact (positive or negative) of any hospital department, but also represent the greatest expense and risk.
  • Between OR cases (same room/same surgeon), the rooms must be turned over, which includes cleaning, restocking, preparation for the next case, pulling the next patient in…. all within a relatively brief period of time.
  • Without a well-coordinated process, the turnover time can take too long and waste critical OR time.  This can result in fewer cases being completed in a day and/or increased overtime expenses and frustration of staff and physicians.
  • Most OR turnover processes contain infection control, ergonomic, and supply waste opportunities for improvement.
  • This case study is a meta-analysis that explores three OR Quick Turn-Over  (QTO) Kaizen events, with the consistent results validating the impact of this methodology (when facilitated properly)


  • Decrease OR Turnover Time
  • Improve infection control and compliance
  • Decrease staff injury risk
  • Decrease supply costs
  • Improve overall flow and coordination
  • Improve staff engagement


·       Conducted 3 day intensive Kaizen events, with a heavy emphasis on real time experimentation and standard work development & refinement

·       Pre-work included video version of “current state”

·       Focus on orthopedic cases (total hip and knee) as the OR QTO “model line”

·       Single-Minute-Exchange-of-Dies (SMED) methodology, developed by Shigeo Shingo, was used to standardize and decrease OR turnover times, primarily focusing on:  

(1) Separating internal from external setup operations

(2) Converting internal to external setup

(3) Standardizing function and

(4) Adopting parallel operations.

·       Developed standardized turnover process focusing on parallel processes, clear triggers and delineation of duties, visual management, and moving internal to external steps .

·       Continually emphasized to staff that this process was not focused on working faster, but on coordination and teamwork around standardized processes, triggers, and never compromising quality or safety.


·       Decrease overall turnover time (“wheels out” of last patient to “wheels in” of next patient from between 40% to 55% (see detailed results below)

·       Improved infection control risk through standardized process, decreased dwell-time through new antimicrobial solution, and clearly defined sequencing of steps to ensure infection control compliance

·       Decreased staff injury risk through reconfiguration and standardization of case carts (heavy orthopedic trays on top instead of on bottom)

·       Improved communication through better utilization of existing technology

·       Decreased “open but not used” supply waste through pre-picking into “open”  (green) and “have available” (red) bins.

·       Decreased overtime and additional cases added to the schedule.

·       Improved staff engagement and ownership of the process to support ongoing development and continuous improvement.


Case 1 Wheels out to Wheels In Wheels in to Incision Closure to Incision Wheels out to Incision Closure to Wheels Out
Baseline 0:33 0:35 1:16 1:08 0:09
Pilot Averages 0:14 0:25 0:47 0:40 0:05
Time Savings 0:18 0:09 0:28 0:27 0:03
% Improvement 55% 27% 41% 41% 36%
Cases 2 & 3 Case 2:

Wheels out to Wheels In

Case 3:

Wheels out to Wheels In

Baseline 0:38 0:33.5
Pilot Averages 0:22 0:20
Time Savings 0:16 0:13.5
% Improvement 42% 40%



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Director, Solar Turbines - a Caterpillar Company

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