Operational Improvement in the OR Utilizing Lean Six Sigma Tools

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

Marilyn Sherrill

[email protected]

765-744-4086