Applying Lean Problem-Solving Techniques to Improve the Efficiency of an Operating Room Team Performing Scheduled Procedures in the Labor and Delivery Department [347

Abstract

INTRODUCTION: As a result of growing surgical volume, the University of Michigan implemented a dedicated surgical team to perform scheduled procedures in the labor and delivery department with the goals of starting at 8 AM, reducing case delays, and preventing cancellations. Despite implementation, health care providers at the frontline continued to observe inefficiencies. Lean problem-solving methods were used to develop a current-state analysis and to identify measures to improve efficiency (Lean problem solving has been adapted from processes applied in the manufacturing setting, where processes are examined, areas of waste are uncovered, and interventions are implemented by front-line workers). METHODS: Using Lean, the current state of the scheduled operating room team was analyzed between August and January 2013 by determining average operating room start times, performing an operating room “gemba” visit, and surveying frontline workers about observed problems and suggestions. A root-cause analysis was completed to identify key areas requiring improvement for the first plan-do-check-act cycle of quality improvement. RESULTS: Review of operating room start times for scheduled procedures was found to be 47 minutes after a goal start time of 8 AM. Lack of anesthesia availability was identified as the leading cause of delays (17.5%). Other identified areas include nursing (15.4%), preoperative laboratory completion (12.3%), operating room turnover time (12.3%), team dynamics (9.2%), addition of add-on cases (7.7%), communication (7.7%), preoperative workup (7.7%), lack of on-start time (6.2%), and other (3.1%). CONCLUSION: Application of Lean principles allowed for a systematic review of the current state of the operating room team and identification of key areas contributing to inefficiency. Consequently, targeted measures have been implemented. In this case, a dedicated anesthesia faculty has been implemented as part of the first plan-do-check-act cycle with a plan to review efficiency in 6 months.