First-case tardiness reduction in a tertiary academic medical center operating room: A lean six sigma perspective

Ramos, Pedro; Bonfá, Eloísa; Goulart, Patrícia Martins; Medeiros, Marion; Cruz, Nélson; Puech-Leão, Pedro; Feiner, Brigitte

doi:10.1016/j.pcorm.2016.12.001

Cited by 6 publications

(12 citation statements)

References 42 publications

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“…6 Hospitals with low FCOTS performance often devise strategies and interventions (expending resources) to correct this situation. 7,8 Performance improvements can then be tracked and judgements can be made on the efficacy of the intervention. 9 However, simply noting and quantifying the improvement do not explain why (or even whether) the process performance improved.…”

Section: Editor's Key Pointsmentioning

confidence: 99%

Does a first-case on-time-start initiative achieve its goal by starting the entire process earlier or by tightening the distribution of start times?

Tiwari

Ehrenfeld

Sandberg

2018

British Journal of Anaesthesia

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Background: We explored whether a previously successful initiative to improve first-case on-time starts succeeded because (i) preoperative steps started earlier (but the process did not necessarily improve) or (ii) the process was brought into better control. Methods: We analysed 35 months of data comprising 28 882 first cases to calculate the difference of the time a patient entered the operating room (OR) vs the scheduled entry time. Median and inter-quartile range were used to evaluate changes in distribution parameters. A statistical process-control methodology was used to compare the differences in performance between the pre-and post-intervention phases. Results: Post-intervention first cases entered the OR on average within 4 min [95% confidence interval (CI): 4e5 min] of the scheduled start time, as opposed to within 8 min (95% CI: 8e8 min) in the pre-intervention period. The median delay decreased from 5 min (95% CI: 5e5 min) to 2 min (95% CI: 2e2 min). The inter-quartile range of the difference between the scheduled start time and the first case in room time decreased from 13 min (95% CI: 13e13 min) to 10 min (95% CI: 9e10 min). Conclusions: The reduction in inter-quartile range demonstrates that improvement in on-time starts resulted from the process being in better control. The start time of preoperative preparatory activities did not move earlier, which means that OR and preoperative staff do not need to arrive at work earlier. Improvements resulting from the process being in control were sustained.

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Section: Editor's Key Pointsmentioning

confidence: 99%

Does a first-case on-time-start initiative achieve its goal by starting the entire process earlier or by tightening the distribution of start times?

Tiwari

Ehrenfeld

Sandberg

2018

British Journal of Anaesthesia

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“…De acordo com Lin et al (2013), o setor de saúde também pode ser caracterizado por alta competição e dinamismo, a qual incentiva hospitais a entregarem maior flexibilidade e qualidade em seus serviços. Diante desse fato, hospitais no mundo todo vêm adotando estratégias inovadoras para melhorar seus 28 processos, visando reduzir seus custos, alinhar sua demanda à capacidade disponível, minimizar a ocorrência de erros médicos e prover atendimentos mais baratos e de maior qualidade (WEBER et al, 2010;FONG;LANGERMAN, 2016;RAMOS et al, 2016).…”

Section: Contextualizaçãounclassified

“…Segundo Souza (2009) O Lean Healthcare já foi adotado em diferentes países e tipos de organização, no setor público e privado (D'ANDREAMATTEO et al, 2015). Estados Unidos FARROHKI et al, 2015;, Canadá (FINE et al, 2009), Reino Unido (RADNOR, 2011) e Brasil (HENRIQUE et al, 2016RAMOS et al, 2016) .…”

Section: Contextualizaçãounclassified

“…Mesmo que amplamente difundido, Souza (2009) defende que análises mais concretas são necessárias para evidenciar os potenciais do Lean Healthcare. Costa et al (2015), Henrique et al (2016), Ramos et al (2016) e Costa e Godinho Filho (2016) defendem que as intervenções de melhoria podem trazer melhores resultados para hospitais de países em desenvolvimento, como no caso do Brasil, mesmo contemplando mudanças simples e de baixo investimento. Karlsson e Åhlström (1996) defendem que o desempenho pode ser melhorado ao se introduzir o Lean.…”

Section: Justificativasunclassified

“…Tempo de turnover (27) (2010)) ou pelo tempo de atraso para início de cirurgias (e.g. Ramos et al (2016)). Indicadores focados nos resultados do paciente também foram reportados (e.g.…”

Section: Otimização No Tempo De Processos Cirúrgicosunclassified

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Estruturação de um Sistema de Medição de Desempenho em centros cirúrgicos para apoiar iniciativas de >i<Lean Healthcare>/i<

Ulhôa¹

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como o mapeamento do fluxo de valor e quadros de gestão visual). Assim, um framework para SMD pode ser estruturado, unindo aspectos teóricos e práticos da pesquisa, de modo a alinhar e promover a medição, melhoria e gestão das operações e estratégias de um centro cirúrgico.Além do framework, um roteiro de seis fases para sua implementação foi desenvolvido, de modo a apoiar futuras replicações do SMD. Espera-se que a presente pesquisa apoie novos estudos teóricos e práticos sobre a gestão de operações na área da saúde, em especial no centro cirúrgico, de forma a aprimorar as práticas atuais e promover benefícios para pesquisas futuras.Palavras-chave: Lean. Sistema de medição de desempenho. Indicador de desempenho. Centro Cirúrgico. Sala cirúrgica.The use of Lean can improve production in order to increase process efficiency and quality.Systems, such as hospitals, have been using an approach named Lean Healthcare to create more value to their services delivered to patients, to reduce process wastes and to increase quality of care. In this setting, improvement opportunities in surgical centers and operating rooms, which are responsible for a relevant volume of hospital procedures and a significant share of revenue and costs structure, can be identified. In this context, performance measurement, as well as performance indicators management, have been shown as a tough task, and studies highlighted its relevance in Lean healthcare initiatives, which could support process improvement and provide relevant decision making based on precise and reliable information. From this premise, this research proposes the structuring of a Performance Measurement System (PMS) to support Lean practices introduction in surgical centers. This PMS was supported by a conceptual model based on eight requirements coming from theoretical aspects, such as literature reviews about the relationship of surgical centers management with Lean and performance measurement practices. The conceptual model made it possible to exemplify the requirements through a case study in a surgical center of a Brazilian hospital. Based on this case, practical aspects were observed and used to ground the proposed PMS, such as the development of five performance indicators categories (surgical volume, surgical processes, financial sustainability, resource management and stakeholders) and Lean practices tests (such as value stream mapping and visual management boards). Then, a PMS framework was structured, joining theoretical and practical aspects of the research, in order to align and to promote measurement, improvement and management of a surgical center's operations and strategies. Besides the framework, a sixphase implementation guide was developed, in order to support future replications of this PMS.It is expected that this research supports theoretical and practical studies in healthcare operations management, in order to improve the current practices and promote benefits for future research.

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Operating Room Performance Optimization Metrics: a Systematic Review

et al. 2023

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Literature proposes numerous initiatives for optimization of the Operating Room (OR). Despite multiple suggested strategies for the optimization of workflow on the OR, its patients and (medical) staff, no uniform description of ‘optimization’ has been adopted. This makes it difficult to evaluate the proposed optimization strategies. In particular, the metrics used to quantify OR performance are diverse so that assessing the impact of suggested approaches is complex or even impossible. To secure a higher implementation success rate of optimisation strategies in practice we believe OR optimisation and its quantification should be further investigated. We aim to provide an inventory of the metrics and methods used to optimise the OR by the means of a structured literature study. We observe that several aspects of OR performance are unaddressed in literature, and no studies account for possible interactions between metrics of quality and efficiency. We conclude that a systems approach is needed to align metrics across different elements of OR performance, and that the wellbeing of healthcare professionals is underrepresented in current optimisation approaches.

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First-case tardiness reduction in a tertiary academic medical center operating room: A lean six sigma perspective

Cited by 6 publications

References 42 publications

Does a first-case on-time-start initiative achieve its goal by starting the entire process earlier or by tightening the distribution of start times?

Does a first-case on-time-start initiative achieve its goal by starting the entire process earlier or by tightening the distribution of start times?

Estruturação de um Sistema de Medição de Desempenho em centros cirúrgicos para apoiar iniciativas de >i<Lean Healthcare>/i<

Operating Room Performance Optimization Metrics: a Systematic Review

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