Lean Health Care Case Study Essay Sample

This instance survey focuses on bettering the turnaround clip ( TAT ) and first instance starts ( FCS ) in an operating room of Montgomery Regional Hospital. TAT is defined as the clip between when a sawbones closes a cut of one patient and when he or she makes the first scratch on another patient. FCS measures the clip of any first instances during the twenty-four hours. More specifically. a hold in FCS occurs when a patient enters the surgical room later than the scheduled start clip. Montgomery Regional Hospital’s aim is to diminish TAT by approximately 35 % and to increase FCS by approximately 50 % from its current public presentation ( Glover. et Al ) . The betterment activities occurred from August 2008 to December 2008.

Cardinal Actors

Montgomery Regional Hospital. or MRH. is an investment-based health care establishment that employs 60 full-time staff members in the Operating Room Department ( MRH-OR ) and handles over 6. 500 surgical and endoscopy instances per twelvemonth ( Glover. et Al ) . Its installation includes six Operating Suites and two Endoscopy Rooms ( Glover. et Al ) . In its purpose to better TAT and FCS statistics. MRH formed a procedure betterment squad specifically designed for this intent.

The squad consists of staff members from different sections of the infirmary. These sections include Operation Room. Endoscopy. Central Sterile Staff and Administration ( Glover. et Al ) . Surgeons are besides involved in the procedure through go toing team meetings and supplying inputs for the squad.

General Nature of Problem

Harmonizing to the article. factors responsible for high turnover clip include:
* Recovering Patient 1
* Cleaning the OR from the process
* Obtaining equipment. instruments and supplies needed
* Waiting for the sawbones to get down fixing
* Preparing Patient

Due to the cost of OR clip ( $ 10–30 per minute ) . MRH marks TAT and FCS as their chief beginnings for betterments. Montgomery Regional Hospital wants to cut down cost every bit good as improve capacity.

External Influences

The procedure betterment squads uses a SIPOC diagram to find any providers. inputs. procedures. end products. and clients involved in the procedure. The consequence of the SIPOC diagram is non discussed in the article. Therefore. any stakeholders of the procedure or any external influences are non defined.


Specifying the Target System

In specifying the mark system. the squad uses the SIPOC diagram and cross-functional procedure flow chart to find the range of the undertaking. As mentioned earlier the SIPOC diagram is used to place the providers. input. procedure. end product. clients. and any stakeholders involved in the system. SIPOC helps the squad to acknowledge the impact of altering the procedure has on all persons involved.

The cross-functional procedure flow chart is used map out the turnaround procedure more exhaustively. It elaborates on undertakings the activities by detailing every measure performed. The squad chiefly uses this tool to prioritise each procedure. Through utilizing the flow chart. the squad identifies the most of import undertakings and aims to extinguish unneeded 1s.

Analyzing the Current State

In analysing the current province. the squad uses the cause-and-effect diagram. spaghetti diagram. Pareto chart. staff shadowing and delay/problem logs. The consequences from these charts and diagrams are analyzed by sawboness. anesthetists and specialised doctors involved in the TAT procedure. Since elaborate account these tools are non provided in the article. farther research was done to depict some possible utilizations for these tools.

Cause-and-effect diagram can be used to place the causes of increased TAT and delayed FCS. Once all possible cause-and-effects of the state of affairs are laid out. the squad can place the root causes and cardinal issues of the job. Targeting the root causes and cardinal issues will greatly better the procedure.

Spaghetti diagram illustrates the connexions between equipments and supplies used in the operation procedure. The squad can utilize this tool to reorganise the OR in such a manner that unneeded motions can be avoided in readying of the OR and patients.

Pareto chart can be used to diagrammatically expose numerical informations for better and easier analysis. Staff shadowing and delay/problem logs provide extra information necessity for systemic analysis of the current state of affairs.

Planing Future State

In planing for future province. the procedure betterment squad conducted a Kaizen event to discourse possible thoughts and to implement the solutions developed. The Kaizen event consists of a cross-functional squad that focuses on reorganising the work country. The squad uses the 5S attack to take any unnecessary supplies and to. overall. better the stuff flow around the OR. The 5S methodological analysis uses the stairss of kind. scene in order. radiance. standardise and prolong to efficaciously form the workspace. Effective organisation allows for fewer unneeded motions and better work flow. Harmonizing to the instance survey. the Kaizen event resulted in:

* Reduction of entire stock list by about $ 22. 000
* Reduction of the physical “foot print” of floor infinite required in the OR for equipment. instruments. and supplies by 38 % * Improvement of truth and feasibleness of stock list degrees * Improvement of layout and flow of instance picking country

* Creation of a structured audit procedure and tool to supervise and prolong the 5S system of organisation ( Glover. et Al ) .

As portion of the sustainability facet of 5S. a meeting is held at least every 2 hebdomads to measure the current state of affairs and the advancement made with the Kaizen event.


Execution considerations. i. e. . possible issues related to the environment such as moralss. ordinances. political relations. funding. civilization. that need to be considered for execution

For this peculiar instance. there are many execution concerns that need to be taken into consideration before the existent execution itself. If some of these factors are non accounted for. so the execution may non be successful and such factors could be damaging to any betterment. External factors associating to the environment such as ordinances. funding. and civilization would wholly be applicable to this peculiar instance survey.

Regulations would be a factor because there might be certain authorities ordinances about where things must be set up in an operating room. and how unfertile they must be kept. This instance analyze utilized a 5S betterment event to reorganise the operating room. It is indispensable that the squad maintain in head any ordinances sing how close points can be located to the operating tabular array. and if certain points are non allowed to be in an operating room. For illustration. if the squad wanted to tape off certain countries to denominate where machines or supplies should travel. they must see if there are any ordinances that might curtail certain types of tape of pigment in an operating room.

Another issue related to the environment would be the issue of funding. This issue was slightly addressed in this instance survey. particularly in the fact that the squad made certain to execute the 5S event on a Friday and Saturday when it would non interfere with day-to-day work. which could hold finally been a major hindrance to the undertaking. The instance survey did present some of the nest eggs they were able to accomplish through the 5S event. However. they did non make a good occupation of warranting the cost to the undertaking or how it would be financed. The instance besides presented a pay-based inducement for doing betterments. but did non explicitly turn to where that money for inducements would come from. This is a really of import issue that should be addressed. because that money for inducements demands to be financed from someplace.

Last. the issue of doing cultural alterations is one that needs to be taken into serious consideration. In this peculiar instance survey. it is presented that the operating suites presently feel that they are runing as rapidly and expeditiously as they can. This means that the clinicians likely do non experience a strong demand to do alterations. and any alteration to the civilization and system would ensue in important opposition if non done articulately. For illustration. in this survey the issue of surgeon penchant and the hierarchy is a cultural issue that must be considered. In an operating room. the sawbones is frequently the 1 with the most influence in power. and might experience that their sentiments should count most in the betterment undertaking. This civilization facet must be considered so that any alterations made will non pique or do any extra perturbations in the operating room. The issue of civilization at a company is a huffy one if alterations and betterments are to be made. but it is indispensable to take into history and come up with the best scheme for implementing betterments in a system.

Effectiveness of the proposed solution

Overall. the proposed solutions and betterments were met with assorted consequences and there is room to better for the solutions proposed in this instance. A batch of the positives came from the fact that clinicians were really involved throughout the full betterment procedure. and the staff involved in the undertaking were actively engaged from the start. This allowed the staff to see an betterment undertaking from start to complete. and they were besides actively involved as stakeholders in the undertaking. From this position. the solution was basically really effectual at learning the staff about possible procedure betterments. and allowed them to use tools that could be effectual for them to utilize in the hereafter.

On the contrary. early appraisals suggest that the pay-based inducement towards doing betterments was non every bit successful as they hoped. The information suggests that any inducement had small to no impact on public presentation in the operating room. In the first two hebdomads that the inducement program was implemented. the turnaround clip ( TAT ) and first instance start ( FCS ) showed no betterment. This could be due to the fact that the undertaking was in the early phases. but however zero betterment in these times is a distressing statistic. The deficiency of betterment from baseline steps could besides propose that the pay-based inducement for betterment was non sufficient on its ain to back up betterment. The operating room was likely operation at a high degree prior to the betterment undertaking. and general. systematic inefficiencies were what was keeping back any betterment. It was one time these systematic issues were addressed that true betterment was achieved.

Once systematic issues were attended to. both the TAT and FCS showed betterment. After systematic betterments from a Kaizen event and 5S. the FCS showed an betterment of approximately 25 % after execution. The betterment shown can be attributed to alterations made in programming and installation layouts in the operating suites. Additionally. a smaller betterment of approximately 5 % was shown in the turnaround clip. It should be noted that great betterments were seen in single squads of sawboness and nurses who displayed a greater sense of committedness to bettering their Cheapness. The betterments in this facet could hold been better sustained. and steps should hold been taken to guarantee that all surgical squads were committed and onboard to the betterment undertaking.

Drawbacks of the solution methodological analysis

The solutions proposed and implemented for betterment were non without any drawbacks or defects. One of the most blazing drawbacks had to make with the pay-based inducement towards betterments made. This basically was meant to supply a fiscal wages to the surgical squads that embraced betterment schemes to better their turnaround clip and first instance start clip. Using fiscal inducement like this are non ever unsuccessful. but normally they are non the best scheme to utilize to actuate betterment. In this peculiar instance. many of the operating suites were already working at optimum timing. given the fortunes of the organisation and current system. It is really likely that many of the surgical squads felt they were executing every bit best as they could. given their current resources.


Discussion of alternate ISyE tools that could hold been used ( if there exists any )

A broad scope of industrial technology tools were used in this instance survey. but there are a few that could hold been used. and even added to the success of the undertaking. We both worked on a 5S betterment undertaking at UW-Hospital and utilized a few different tools that could hold been applicable in this instance survey. One thing that this instance survey did non use much were questionnaires. interviews. or concentrate groups to discourse the undertaking before execution. These are all effectual tools to utilize before get downing a undertaking. and can truly assist to guarantee that the staff’s desires are reflected in any alterations that are being proposed.

Another industrial technology tool that could hold been used in this instance survey is the tool of simulation. Much like simulation was used for an exigency room betterment undertaking. A simulation theoretical account of the operating suites could hold been built and utilized before the existent undertaking was implemented. For illustration. the theoretical account could hold been used to demo how certain betterments in the layout and organisation would hold impact the turnaround and first instance start times. This simulation could hold provided added motive and support to turn out that the execution of the program was traveling to be utile.

Overall rating of the survey

We believe that this instance survey presented a reasonably effectual execution and solution program to better efficiency in an operating room. The prosodies to better upon were carefully chosen and provided an chance to demo true betterments. Additionally. the survey utilized many tools and did non hold excessively narrow of a focal point. The instance survey besides efficaciously used teamwork. but the motive behind betterment was missing. The survey could hold done more to demo how the betterments might impact the public presentation of the surgical squads. This instance survey proved that pay-based inducements entirely are normally non plenty to actuate workers to alter. and other systematic inefficiencies should be coupled with pay-based inducements. The instance survey besides somewhat lacked in accounting for some environmental factors such as funding and cultural alteration. These facets could hold been better accounted for.

The specific 5S undertaking was performed good. and made certain to turn to the concluding S in sustain which is frequently times the one most unmarked. but indispensable to guarantee that the advancement made is non lost in the hereafter. They made sure to hold bi-weekly meetings after the 5S event. and supported the squads after betterments were made. Having performed a 5S betterment undertaking ourselves. we found both similarities and differences that contributed to the success of this instance survey. Overall. the betterment in first instance start clip was noteworthy. but the betterment in turnaround clip was minimum at best. In decision. we believe that the survey could hold made usage of extra tools. and taken into account extra factors to better upon their success.


Glover. Wiljeana J. . Eileen M. Van Aken. Kevin Creehan. and John Skevington. II. “Glover. et Al on Using Thin Principles to Better Turnaround Time and First Case Starts in an Operating Room. ” Society for Health Systems Conference and Expo ( 2009 ) . Print.

Ahlostrom. Janice. “Using the 5S Thin Tool for Health Care. ” hypertext transfer protocol: //www. wipfli. com/resources/images/5024. pdf ( March 2007 ) . Online.

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