As we all can attest, health care is not inexpensive.  Methods, equipment, and professional skills are enhanced daily with better results but also more cost.  Probably no area of health is costlier than procedures that require an operating room, a skilled surgeon and staff, and the newest equipment and supplies.

I, for one, want the best care available when I require surgery.  So, how do hospitals offer this critical service but in the most cost-effective manner?  It stands to reason that cutting out unnecessary and wasteful activity and time would be a great place to start.  Sounds like a perfect opportunity to apply LEAN/Six Sigma principles and practices!

As our Black Belt Jedi preach, if you don’t measure it – you can’t improve it.   We probably need to start these measurements before the case even gets to the operating room.  The effective scheduling and utilization of the operating room, equipment, and staff will be critical.

Defining measures and tracking progress in items such as:

  • Operating room utilization in comparison to the operating room schedule with breakdowns by operating room, day, specialty and surgeon
  • First-case on-time starts execution by operating room, day, specialty, surgeon, and anesthesiologist (if we don’t start the first case on time, chances are that the remainder of the day will be late)
  • Overall case on-time starts execution by operating room, day specialty, surgeon, and anesthesiologist
  • Case turnover execution and time by operating room, day, and specialty
  • Patient preparation and delivery execution and time by operating room, day, specialty, and surgeon

Analyzing these measures can help identify opportunities for change.  Comparing measures against other hospitals in the system and/or against industry standards will prompt questions, such as:

  • Is the most effective scheduling process being used?
    • Is the approach correct (e.g. “blocking schedule”)?
    • Is the schedule frozen at the proper time? Should it be frozen?
    • Are schedule changes being handled timely and properly?
  • Are patients ready on schedule for the staff in the operating room?
    • Is more standard lead time in prep or is a more in-depth review of the process in order?
  • Are there specific specialties or surgeons which are consistently on-time?
    • Are there best practices which might be shared with others?
  • Are there specific specialties or surgeons who are consistently late?
    • Should these areas be looked at in more detail?
    • Are there sufficient incentives in place to motivate compliance with established standards?

Displaying the critical operating room schedule and utilization measurement results in a dashboard to management, staff, and team members will promote:

  • Visibility to goals, successes, and areas for additional work
  • Creative ideas for productivity changes from those most involved in the delivery
  • A little competitive spirit (which can be a very effective team dynamic)

Maximizing the utilization of the facilities and staff should drive the organization to do more with the cost already incurred or allow unnecessary resources to be trimmed.  Both outcomes translate into the best care at a lower cost.

Stay tuned for the Operating on a LEAN Budget sequel – “The Search for Sutures”.