Operational Improvement in the OR Utilizing Lean Six Sigma Tools
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Operational Improvement in the OR
Utilizing Lean Six Sigma Tools
Marilyn Sherrill, RN, CNOR, CPHQ
Six Sigma Black Belt and Lean Certified
One Step - Operating Room Set-up
Inputs
• Proper Supplies
• Proper Equipment
• Skilled/Knowledgeable Surgical Staff
• Clean OR Environment
Outputs
• Proper Sterile Set-up For Procedure
• Uncompromised Sterile Set-up
• Timely Set-up
• Minimal Traffic During Room Set-up
Challenges in Healthcare
Every process is supported by multiple sub-processes
Few processes are automated
Multiple variables
Human Factor
• Fast-paced
• Stressful
• Fatigue
• Emotions
No down-time
Lean Defined…
“A systematic approach to identifying and eliminating waste (non-value-added activities) through continuous improvement by flowing the product at the pull of the customer in pursuit of perfection.”
- The MEP Lean Network
“Its goal is to incorporate less human effort, less inventory, less time, and less space to become highly responsive to customer demand while producing top quality in the most efficient and economical manner possible.”
- Expertrating
Lean Goals
Eliminate Waste
Overproduction, Inventory, Defects, Processing, Transportation, Waiting, Motion, People
Reduce Lead Time
Typically, 95% of Total Lead Time (the time it takes to perform a process) is Non Value-Added
Improve Quality
Traditional vs. Lean
Source: ASQ
Common Denominators
Focus:
What is key to the customer?
What is key to quality?
Lean Principles
Define Value - Something the customer is willing to pay
for.
Identify Value Stream - Transform materials or
information to meet customer requirements.
Develop Value Flow without Waste
Pull from the Customer (not push)
Doing it right the first time.
Sorry, I’m
not willing
to pay for
that!
Lean Tools
5S – focus on workplace organization
Poka-Yoke – focus on mistake proofing
Kaizen – focus on incremental improvement
Kanban – optimization of resources using signals
SMED – single minutes exchange of dies – quick
changeovers
Standard Work
5S
Focus is workplace organization
Sort – Remove unneeded
Store or Set – Arrange for ease of use
Shine – Cleanup campaign
Standardize – Maintain the system
Sustain – Make 5S the culture
5S
The benefits of implementation include:
• Delivers significant bottom line results with minimum investment
• Eliminates overstock of unused supplies and equipment, thus reducing costs
• Reduces cycle time by eliminating need for searching through clutter
• Reduces cycle time by eliminating the storage of unused supplies and moving needed supplies closer to the end user
• Culture of pride
• Improves customer satisfaction
5S
5S
5S Barriers to Success
The Human Factor
• Our worst habits as human beings get in the way of
our good intentions.
Discipline comes only from commitment at all levels.
• It takes three weeks of repeated behavioral change to
create new habits.
Path of Least Resistance
5S Application Example
Scenario 1 - OR nightmare
• Increased Time
• Increased Energy
• Increased Mistakes
Scenario 2 – Oh where, oh where?
• Increased Steps – another department
• Increased Mistakes
• Dissatisfaction – staff
Poka Yoke
Utilizes the people doing the work to identify defects
Recognizes both people and machines fail and make
errors
Utilizes any method to prevent mistakes
Design the process, equipment and tools so that it
cannot be performed incorrectly
Poka Yoke
Benefits of implementation include:
• Defect prevention instead of defect detection
• Buy in from the workers
• Ownership in making change
• Standardization of Process
Poka Yoke Application Example
Poka Yoke Application Example
Pareto Chart # Issues Percentile Cumulative%
Culture/People Issues 52 34% 34%
Leadership Issues 26 17% 52% Vital Few
OR Flow Issues 24 16% 67%
SDS Flow Issues 13 9% 76%
Supply/Equip. Issues 11 7% 83%
Communication Issues 10 7% 90%
Staffing Issues 9 6% 96%
Scheduling Issues 6 4% 100%
Kaizen
Optimization of existing processes through incremental changes
Philosophy to admit problems
If you think it isn’t broken, fix it anyway
The best knowledge comes from those performing the work
The goal is not a 100% solution, but a 60%
The process change does not have to be perfect the first time
No idea is a bad idea
Kaizen
Benefits of implementation include:
• Buy-in from the workers
• Ownership in making change
• Making improvements using what you have
• Cost effective
Kaizen Application Example
Improve opportunity – Start procedure “on time”
• Physicians – 33%
• Staff 0%
Defect Identified
• Variation
• Definition of “on time”
0%10%20%30%40%50%60%70%80%90%
100%
Overall On-Time Starts
Kaizen Application Example
Improve opportunity – Staff moving OR beds
• Increases turn-over time
• Increase clutter by storing OR beds in the hall – also
fire hazard
• Decreases staff satisfaction
• Increases potential for injury
Defect identified
• Lack of knowledge on use of new OR beds
Kaizen Application Example
Improve opportunity – All patients arriving at the same
time
Improve opportunity – PACU staffing
Other Lean Applications
Kanban – “visual card”
• Optimization of resources
• Depends on customer demands
• Example ED charts
• Visuals for re-ordering supplies
SMED – single minutes exchange of dies – quick
changeovers
• OR room turnovers
• Time from completion of last task to beginning of next
Other Lean Applications
Standard Work
- Standard work = reduced variation
- Reduced variation = reduced defect levels
- Reduced defects = reduced mistakes
- Reduced mistakes = reduces costs and improves safety!
What’s old is old and new!
Continuous monitoring is key to all improvements Lean
or not
You improve what you measure!
“If you think you are too small to make a difference,
you’ve never been in bed with a mosquito!”
author unknown
ED Bonus!
5S Application Examples
Scenario 1 – Oh where, oh where?
• Increased Steps
• Increased Mistakes
• Dissatisfaction – staff and patient
Scenario 2 – Has my little probe gone?
Standardized Work
Standardized Work
Kaizen Application
Kaizen Application
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