Utilizing LEAN methodology to optimize operating room efficiency: A multidisciplinary process-mapping exercise

Abstract

<h3>Objectives</h3> Optimizing surgical capacity while maintaining high quality patient care is an ongoing challenge in the operating room, particularly for complex procedures requiring significant resources, such as robotic hysterectomy. Process mapping is a Quality Improvement (QI) strategy which can identify barriers to surgical efficiency and quality of care by dividing processes into individual components and analysing each step separately. Our aim was to design an ideal-state intraoperative pathway for robotic hysterectomy in order to improve surgical efficiency and minimize case cancellation. <h3>Methods</h3> A "current-state" process map for robotic hysterectomy was developed with input from the intraoperative care team including gynecologists, anesthesiologists and nursing staff. Team members were invited to a meeting where process steps were evaluated and suggestions for improvements were identified. Various QI/Lean methodologies were utilized including affinity diagrams with multi-voting, parallel processing and checklist development. <h3>Results</h3> Output from the exercise included the design of a "future-state/ideal-state" process map incorporating strategies and plans for implementation. In the 12 months following implementation, mean case time decreased by 28 mins (11%) and case cancellation rate decreased by 70%. Case time/cancellation rates will be analyzed in a recurring fashion as part of a plan-do-study-act (PDSA) cycle. <h3>Conclusions</h3> A multi-disciplinary approach allowed for a sharing of responsibility and improved communication between team members. Engagement of all stakeholders is fundamental in ensuring accurate analysis and successful strategy deployment. This process mapping exercise can be easily applied to other surgical procedures and can also be expanded for use in surgical teaching and education.