Redesigning the Process for Scheduling Elective Orthopaedic Surgery: A Combined Lean Six Sigma and Person-Centred Approach.

Ailish Daly,Seán Paul Teeling,Nicola Wolfe,Marie Ward,Martin Mcnamara

doi:10.3390/ijerph182211946

Abstract

The Health Service Executive Ireland model of care for elective surgery supports the delivery of elective surgical care in achieving both process and clinical outcomes. This project was conducted in the Orthopaedic Department. Following an outpatient consultation with an orthopaedic surgeon, patients who required surgical intervention were scheduled for their intervention by the administrative team. Prior to commencing this project, the average time from patient consultation to being scheduled for surgery on the hospital system was 62 h/2.58 days. A pre- and post-team-based intervention design employing Lean Six Sigma methodology was applied to redesign the process for scheduling elective orthopaedic surgery. The project was informed by collaborative, inclusive, and participatory stakeholder engagement. The goal was to streamline the scheduling process for elective orthopaedic surgery, with a target that 90% of surgeries are scheduled “right first time” within 48 h/two working days of the outpatient consultant appointment. The main outcome measures showed that 100% of orthopaedic surgeries were scheduled successfully within 2 days of outpatient appointment. Duplication in work between patient services and scheduling teams was eliminated and facilitated a reduction in unnecessary staff workload. This project highlights the importance of collaborative interdisciplinary stakeholder engagement in the redesigning of processes to achieve sustainable outcomes, and the findings have informed further improvements across the hospital’s surgical scheduling system.

Highlights

The setting for this project is a large private hospital in Dublin
This effectively meant that patients scheduled for surgery(Table sooner—allowing effectively meant that were scheduled for surgery to on preparing forpatients their surgery
Applying Lean Six Sigma (LSS) to the process of scheduling patients for elective surgery resulted in improved time to complete surgery scheduling, reduced rework for team members, and a redesign of an improved process, serving the needs of stakeholders at each step of the process

Summary

Introduction

The setting for this project is a large private hospital in Dublin. The hospital has a strong improvement culture, with 250 staff trained in Lean Six Sigma (LSS) methodology by our academic partner University College Dublin. The university program has been instrumental in the development of LSS healthcare education and training nationally [1]. As part of its ongoing LSS improvement work, in 2018 the hospital undertook a review of the process of patient scheduling using the orthopaedic surgery service for an improvement intervention. Lean Six Sigma is a powerful methodology that reduces waste and variation in an organisation, and minimises operating costs, optimises productivity, and maximises customer satisfaction [2]. LSS is the merger of two methods used in process improve-

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