Operating rooms (OR) within healthcare organizations are expensive to operate and consume extensive resources. They also generate a significant portion of an organization’s operating income, especially when run efficiently. Lean practices are routinely applied to certain types of OR cases, or specific rooms within the OR. This case study looks at the OR, in its entirety to improve overall efficiency and effectiveness. Efforts to increase OR productivity need to be counterbalanced against the impact on patient and staff satisfaction and, most importantly, patient and staff safety and ultimately patient outcomes.
A multidisciplinary surgical process improvement team constructed a value stream map of the entire surgical process, from the decision for surgery to discharge. Each process step was analyzed in three domains: personnel, information processed, and time. Multidisciplinary teams addressed five work streams to increase value at each step: minimizing volume variation; streamlining the preoperative process; reducing nonoperative time; eliminating redundant information; and promoting employee engagement. Each work stream team identified non value-added steps and/or barriers to improving efficiency along the value stream map of the surgical process. Using a Define, Measure, Analyze, Improve, Control approach, interventions were designed and evaluated that addressed the issues identified as barriers to efficiency.
Process improvements were implemented sequentially in surgical specialties. Key performance metrics were collected before and after implementation. Across three surgical specialties, process redesign resulted in substantial improvements in on-time starts and reduction in number of cases past 5 PM. Substantial gains were achieved in nonoperative time, staff overtime, and ORs saved. These changes resulted in substantial increases in margin/OR/day. Use of Lean and Six Sigma methodologies increased OR efficiency and financial performance across an entire operating suite. Process mapping, leadership support, staff engagement, and sharing performance metrics are keys to enhancing OR efficiency. The performance gains were substantial, sustainable, positive financially, and transferrable to other specialties.
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