Lean Six Sigma and Cost Savings in Surgery

Hospitals and healthcare systems in general are full of areas just begging for process improvements.  The sophisticated nature of the environment, by virtue of personnel and associated education, expertise, and demand – paired with sophisticated equipment and extremely low tolerance for failures, makes solid process and associated process improvement a high priority.

Lean Six Sigma (LSS) sponsors and project leaders have fertile ground here:  There is much room for elimination of waste, for improved process flow, for higher rates of successful outcomes, and even increased revenues for health organizations by virtue of increased patient flow.

At the same time, within process change and improvements, safety must be maintained and there can be no jeopardy to the quality of results.  When we examine surgery, we can use a very simple example for improvement.

The surgery department has a case-cart for every type of surgery, with a set of tools, instruments and supplies.  New physicians joining a group add their own list of instruments and supplies particular to their specialty and needs.  The list of case-cart elements naturally grows.  Often, when physicians leave the hospital’s employment, no one removes their specialized needs and wants.  Thus, there may be an unwieldy stock of these items, and further, there is considerable time in maintaining, ordering, stocking, and sterilizing these items.  This robs the organization of time and manpower.

Here, we can identify areas for elimination of wasted effort and redundancies.  In a specific case, an observer started by gathering the relevant data:  How many surgeries are performed in a given period?  What types and how often?  Who performs them?

This was followed by observation of the person filling the cart.  Timing of the person’s efforts as they fill the cart for various types of surgeries yielded further data.  Then, a spaghetti chart was created that mapped out the full effort of gathering supplies, over the course of a floor plan of the work area.  As supplies were retrieved and gathered, a line was drawn on the chart to show the areas travelled as each employee walked to obtain those supplies.  An examination of  tangled lines, length of lines, and sub-optimal storage of supplies allowed this hospital to begin to re-order locations of supplies in making retrievals more efficient.

Also, an observer was able to dress in surgical scrubs, and followed the cart into the surgery suites.  Here, it was possible to survey all elements used for various surgeries, over time for a complete view, in determining excess and unnecessary items on the cart.

Eventually, the scope of items was reduced, in concert with physician agreement, and cost savings were significant.  Reductions affected many areas and people:  workers who filled the cart; those who washed, sterilized, and packaged instruments; and people who had to inventory, order and supply the stock – as well as maintain the storage space necessary.

Remember:  LSS can bring improvements to any process and associated sub-processes, while at the same time, setting the organization on a path of continuous improvement and sustained success.

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