First-case tardiness reduction in a tertiary academic medical center operating room: A lean six sigma perspective

Abstract

PurposePrevious research has shown that lean six sigma(LSS) may be successful for addressing first-case tardiness (FCT), a delay of the first surgery of the day. However, evidence of its effectiveness in tertiary public academic hospitals in developing countries is still lacking. In this study, we aim to analyze the impact of a process improvement project in a large public tertiary academic hospital with the goal of reducing OR FCT. MethodsWe used the standard LSS framework (DMAIC methodology: define, measure, analyze, improve, control) to address the leading causes of delayed surgery First-case starts. We assessed the effect of our project by comparing FCT on the year prior and after our intervention in our study group of Operating Rooms (OR) and in a control group where we did not implement changes. Primary outcome measures were the proportion of late starts and the mean tardiness in minutes; secondary outcomes included OR raw utilization and cases running after regular hours. FindingsWe found a significant decrease in the proportion of late starts and in the mean tardiness after our intervention: late starts decreased from 62% to 31% and mean tardiness reduced from 56min. to 34min. We also found an increase in OR utilization rates from 70% to 73% and a decrease in the proportion of cases running late from 9% to 7%, but only the latter effect was statistically significant. Practical implicationsThe interventions we have performed in our hospital require simple, low investment actions, which make them especially suitable for being replicated in other public hospitals in developing countries.