Our Patient Safety Tips of the Week October 11, 2011 “ ” and May 1, 2012 “More LEAN Successes” highlighted some of the successful applications of LEAN thinking in improving workflows in the lab, emergency department, OR, etc. LEAN, borrowed largely from Taiichi Ohno and Kiichiro Toyoda and the Toyota Production System, is both a performance improvement tool and a unique culture.
Now another LEAN success story demonstrates a significant improvement in OR turnover time (TOT) and turnaround time (TAT) that provides a significant opportunity for additional revenue and led to improvement in OR morale in an academic hospital (Collar 2012). They assembled a multidisciplinary team made up of scrub nurses, circulating nurses, anesthesiologists, surgical technicians, surgeons, scheduling personnel and administrators. After flowcharting they identified “muda” (waste) and steps that added no value from the perspective of the customer.
Examples they found of waste included delays in arrival of supervising anesthesiologists, delays in preparing instrumentation for subsequent cases, incomplete paperwork (eg. H&P’s, consents, etc.), and poor synchronization between arrival of the patient and the rest of the surgical team in the OR. Some of their solutions were simple, such as implementation of automated paging systems to summon the relevant parties at the right times. Another included having faculty complete 100% of the documentation at the last clinic visit prior to scheduled surgery and making that document readily identifiable by perioperative personnel.
The project resulted in a mean reduction in TOT of 9 minutes and about a 20 minute reduction in TAT. In addition, the frequency of cases finishing after 5 PM was cut in half. They did not measure the savings in overtime compensation but the opportunity for new revenue created was estimated to be $330,000 annually for a single OR. A survey of staff revealed improvement in morale and surgical residents noted no change in their educational experience.
The article also describes a tool we have not previously commented on – the swim lane diagram (Green 2010). Such a diagram plots workflows as they may typically occur in silos and gives you a good picture of what workflows are often going on in parallel. Arrows between lanes can show where the processes in one “lane” can impact the flow in another “lane”. It is thus helpful in showing you how such workflows can give rise to bottlenecks in other “swim lanes”.
See our previous columns on LEAN for good references and resources to get you started learning about how LEAN can help transform your work.
Collar RM, Shuman AD, Feiner S, et al. Lean Management in Academic Surgery. J Am Coll Surg 2012; 214(6): 928-936
Green B. How to Create a Swim Lane Diagram. The Lean Logistics Blog.
September 1, 2010