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Lean Management Helps Improve Surgery Efficiency, Morale

Carol Bradford (University of Michigan)

Carol Bradford (University of Michigan)

Researchers and clinicians from University of Michigan medical school and health system in Ann Arbor adapted lean management concepts from industry to one hospital operating room and found improved efficiency and morale, with implications for increasing hospital capacity and revenues. The results of the study appear online in the Journal of the American College of Surgeons (paid subscription required).

Lean management is an idea with many followers in manufacturing that aims to optimize the the flow of products and services across technologies, assets, and departments to customers. The concept covers the entire value-production process rather than isolated points in the process, and creates methods that require fewer people, less space, less capital, and less time, while responding to changing customer demands.

In the study, the team headed by Carol Bradford (pictured right),  a professor of otolaryngology — head and neck surgery — at Michigan, focused on one operating room in the medical center. The researchers mapped out over nine months the operating room’s normal workflow to identify the critical junctures in that workflow and root causes for efforts that returned no value. The team members also established baseline measurements for:

  • Turnover time, from the departure of one patient to the arrival of the next patient, and
  • Turnaround time, from the final dressing on one patient to the first incision on the subsequent patient

Before instituting lean management changes, the researchers spent three months taking time and methods measurements, to gauge the effect on clinicians of having investigators present. The effects on turnover and turnaround times were negligible.

The lean management concepts, when applied to the operating room, revealed ways of saving time and reducing waste, with little impact on the actual surgeries. For example, the researchers discovered prepping the operating room for the next patient could be done at the same time the patient was being transported to that facility. Likewise, electronic pages sent to maintenance crews while dressings were being applied to the patient would enable the crew to clean the room immediately after removing the patient.

The Michigan team found instituting lean management led to a reduction of one-third in turnover time to 29 minutes, and a 20 percent reduction in turnaround time to 69 minutes. Ryan Collar, head and neck surgeon and lead author of the paper, notes “the amount of time devoted to performing the actual surgery remained almost unchanged,” adding, “The efficiencies we found were in other areas.”

The researchers measured staff morale and teamwork, with measurements of the participants’ feelings of support and thoughts about problem solving on a five-point scale before and after the lean implementation. The results showed higher scores in every category, with a 20 percent increase in the composite score to 3.61 out of 5.00.

The team projected the efficiencies gained from this one experience to all the institution’s operating rooms. “Extrapolating our results from one two-day-a-week surgical practice to U-M’s 35 operating rooms,” says Bradford, “we calculated that lean thinking might be able to create as many as 6,500 hours of new capacity to treat patients each year.” They estimated potential additional annual revenues for the medical center at $330,000.

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