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.