Lean culture to improve operating room efficiency

21th september 2011

2007 operating room fire

2010

SafetymanagementPassport

QualitymanagementNIAZ

Under- and overuse of OR resources

Gap between planning and reality

OR cancellations of elective operations

Why also LEAN

in our operating rooms ?

1. Focus on the patient, focus on value

2. Decrease waste (waiting, transportation, overproduction, overstocking)

3. Improve employee engagement and satisfaction

4. Improved OR use: decrease in under- and overuse of OR resources

5. Streamlining the pre-, intra- and postoperative process

6. Reducing OR nonoperative time (turnover times, waiting times)

7. Process standardization

LEAN introduction team

Kjeld Aij, head operating rooms

Ellen Duijnhouwer, lean coach

Marjolijn Jungman, lean coach

Stephan Loer, head anesthetic department

Arnoud Orelio, lean coach

Peter Veerman, medical head operating rooms

LEAN Pilot operating room

Sterilization department

Acute operations

Daysurgery

ENT-daysurgery

…

Value stream map

Key performance metrics

norm

Invoeringsteam lean op OK - KPI 2: aantal afgezegde electieve operaties per dag

Kleurcodes reden afzegging:

AOZ (blauw) wk 10-25: 4x

SNIJDER (rood) wk 10-25: 98x

PATIENT (groen) wk 10-25: 67x

GEEN IC/MC (zwart) wk 10-25: 31x

week ma di wo do vr totaal week 24: 13-6 X II IIII IIIII IIIII 16

week 25: 20-6 III II I II IIIII 13

week 26: 27-6

week 27: 4-7

week 28: 11-7

week 29: 18-7

16

KPI bord!

Verbeter(team)!bord!

1: Metingen!!  WSA!!  KPI definitie!!  KPIʼs meten!!  Visueel!!  Door het team!

4: Oplossingen!!  Gestructureerd!!  In autonome teams!!  Bronoorzaken

bepalen en oplossen!

3: Problemen !!  Detectie/identificatie!!  Communicatie!!  Op basis van feiten!!  Onder controle

brengen/ isoleren!

top 3!

2: Stand-up!!  Team rapporteert!!  Interactie team/

manager!!  Definieer/

rapporteer acties!

5: Standaarden!!  Vastleggen, visuali-

seren & verifiëren!!  Trainen!Verbeterd!!

Continuverbeteren !

met betrokken mensen!

Stand-up!

Teaching principles of LEAN

Bijlage 2

Canceled procedures

! 15-16 OR’s ! Time: 8 a.m. - 15.45 p.m. ! Capacity off-hours 4 - 2 OR’s

Canceled procedures

! Every day 4 p.m. ! Coordinators and OR management ! Planning staff general surgery ! .....

# afgezegde electieve operaties per week

0123456789

10111213141516171819

10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31weeknr

# afgezegde electieve operaties norm (nog te bepalen)

norm

Invoeringsteam lean op OK - KPI 2: aantal afgezegde electieve operaties per dag

Kleurcodes reden afzegging:

AOZ (blauw) wk 10-25: 4x

SNIJDER (rood) wk 10-25: 98x

PATIENT (groen) wk 10-25: 67x GEEN IC/MC (zwart) wk 10-25: 31x

week ma di wo do vr totaal week 24: 13-6

X II IIII IIIII IIIII 16

week 25: 20-6

III II I II IIIII 13

week 26: 27-6

week 27: 4-7

Canceled procedures

! AOZ 10 % ! Patient 25 % ! Surgical/scheduling 65 %

Canceled procedures

! Difficult to determine root cause " Even coordinators don’t know

! Reasons very divers ! Information dissapears rapidly ! Not perceived as problem

Process Improvement

Methodologies

Why get LEAN?• Productivity improvements of 20-50%

• Set-up time reductions of 60-80%

• Inventory reductions of 40-75%

• Floor space reductions of 30-50%

• Reduced quality defects by 50-100%

• Improved safety performance of 30-60%

• More efficient procedures

• Survival in the marketplace

Surgery is a complex process where many

resources act together

Operating Room Layout

Actual LEAN examples

Lean lessons learned...

• “Getting lean” takes a long time

• Lean is not a part-time effort

• Lean is more than tools, it’s also behavior

• The journey to lean never ends

• There will be resistance to lean within the organization

Keys to LEAN leadership

• Go See--senior leaders must spend time on the “production”floor (gemba)

• Ask Why--use the question many times every day to uncover the root cause

• Show Respect--respect employees, suppliers, and customers

Lean lessons from others

• The top leaders need to lead lean

• Be prepared for the front-end investment

• Lean is not just for manufacturing

• There is a lean “roadmap”, but no lean “cookbook”

• You cannot just copy another lean organizations journey

Next steps• Business Assessment

• Call to Action and Commitment

• Align with Policy Deployment

• Training and/or Sensei

• Resource Allocation

• Process Selection

• Begin the “Journey”

• Implement New Metrics

• Review Progress and Adjust as Needed

You mustTRANSFORM the organization to avoid “snap-back”to the old ways or …don’t even bother to start.