Lean Healthcare TransformationImproving Operating Room Availability

or-photo
  • 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)

challenge

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

solution

·       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.

results

·       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%

 

 

how can we help you?

Contact us at the Consulting WP office nearest to you or submit a business inquiry online.

“LEAN and the Toyota Way is less about tools, as it is a Mindset of Continuous Improvement and Rapid Learning…Involve the people closest to the work, use simple metrics, trust that the best solutions will be revealed and tremendous engagement will result”

mikefitzpatrick
Mike Fitzpatrick
Director, Solar Turbines - a Caterpillar Company

Looking for a First-Class LEAN Consultant?