Redesigning the Process for Scheduling Elective Orthopaedic Surgery: A Combined Lean Six Sigma and Person-Centred Approach

Abstract

The Health Service Executive Ireland model of care for elective surgery supports the delivery of elective surgical care in achieving both process and clinical outcomes. This project was conducted in the Orthopaedic Department. Following an outpatient consultation with an orthopaedic surgeon, patients who required surgical intervention were scheduled for their intervention by the administrative team. Prior to commencing this project, the average time from patient consultation to being scheduled for surgery on the hospital system was 62 h/2.58 days. A pre- and post-team-based intervention design employing Lean Six Sigma methodology was applied to redesign the process for scheduling elective orthopaedic surgery. The project was informed by collaborative, inclusive, and participatory stakeholder engagement. The goal was to streamline the scheduling process for elective orthopaedic surgery, with a target that 90% of surgeries are scheduled “right first time” within 48 h/two working days of the outpatient consultant appointment. The main outcome measures showed that 100% of orthopaedic surgeries were scheduled successfully within 2 days of outpatient appointment. Duplication in work between patient services and scheduling teams was eliminated and facilitated a reduction in unnecessary staff workload. This project highlights the importance of collaborative interdisciplinary stakeholder engagement in the redesigning of processes to achieve sustainable outcomes, and the findings have informed further improvements across the hospital’s surgical scheduling system.

A Case Study of a Whole System Approach to Improvement in an Acute Hospital Setting

“…Members of the EMT were committed to attending training events and acting as executive sponsors as projects emerged. This confirmed leadership commitment through walking the walk, getting involved, and supporting the project [50][51][52][53][54][55][56].…”

“…Redesigning the Process for Scheduling Elective Orthopaedic Surgery: A Combined Lean Six Sigma and Person-Centred Approach [52].…”

The Use of Lean Six Sigma Methodology in the Reduction of Patient Length of Stay Following Anterior Cruciate Ligament Reconstruction Surgery

“…The objective of this study was to redesign and improve the process for the postoperative care of patients who have undergone ACLR surgery. We used LSS methodology due to its demonstrable impact on patient outcomes and patient experiences of care in healthcare settings, in both clinical and non-clinical areas [29,30], and its successful use within the study site previously [7,26,28,31,32]. To facilitate our improvement approach, we posed the question 'Can the application of LSS to the process for ACLR post-operative surgery care reduce patient LOS?'…”

“…The hospital's experience of utilising LSS for improvement, supported by the literature of its successful use in surgical pathways, was, therefore, a key determinant in our choice of methods. Our colleagues in the hospital have used LSS methodologies to achieve the completion of 100% of scheduled, elective orthopaedic surgeries within two working days of an outpatient appointment, as per their study goal [26]. Egan et al (2021) used LSS methodologies to optimise the process involving the operating room nursing time assigned to prepare for surgeries and to maximise the nursing time available for patient care [27].…”

“…As with other LSS project work within the study site [26][27][28], a project team was established to carry out the intervention. This team consisted of a chartered physiotherapist, a data analyst, and a project coordinator, all of whom undertook this study as part of their work toward the academic award of an LSS Green Belt.…”