Lean Health Care Case Study

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ISyE 417: Introduction to Health Systems Engineering

Glover, et al on Using Lean Principles to Improve Turnaround Time and First Case Starts in an Operating Room

SITUATION

Background Information

This case study focuses on improving the turnaround time (TAT) and first case starts (FCS) in an operating room of Montgomery Regional Hospital. TAT is defined as the time between when a surgeon closes a cut of one patient and when he or she makes the first incision on another patient. FCS measures the time of any first cases during the day. More specifically, a delay in FCS occurs when a patient enters the surgical room later than the scheduled start time. Montgomery Regional Hospital’s objective is to decrease TAT by about 35% and to increase FCS by about 50% from its current performance (Glover, et al). The improvement activities occurred from august 2008 to December 2008.

Key Actors

Montgomery Regional Hospital, or MRH, is an investment-based healthcare institution that employs 60 full-time staff members in the Operating Room Department (MRH-OR) and handles over 6,500 surgical and endoscopy cases per year (Glover, et al). Its facility includes six Operating Rooms and two Endoscopy Rooms (Glover, et al). In its aim to improve TAT and FCS statistics, MRH formed a process improvement team specifically designed for this purpose.

The team consists of staff members from different departments of the hospital. These departments include Operation Room, Endoscopy, Central Sterile Staff and Administration (Glover, et al). Surgeons are also involved in the process through attending team meetings and providing inputs for the team.

General Nature of Problem

According to the article, factors responsible for high turnover time include: * Recovering Patient 1
* Cleaning the OR from the procedure
* Obtaining equipment, instruments and supplies needed
* Waiting for the surgeon to begin preparing
* Preparing Patient

Due to the cost of OR time ($10–30 per minute), MRH targets TAT and FCS as their main sources for improvements. Montgomery Regional Hospital wants to reduce cost as well as improve capacity.

External Influences

The process improvement teams uses a SIPOC diagram to determine any suppliers, inputs, processes, outputs, and customers involved in the process. The result of the SIPOC diagram is not discussed in the article. Therefore, any stakeholders of the process or any external influences are not defined.

SOLUTION METHOD, TECHNIQUE OR PRINCIPLES

Defining the Target System

In defining the target system, the team uses the SIPOC diagram and cross-functional process flowchart to determine the scope of the project. As mentioned earlier the SIPOC diagram is used to identify the suppliers, input, process, output, customers, and any stakeholders involved in the system. SIPOC helps the team to recognize the impact of changing the process has on all individuals involved.

The cross-functional process flowchart is used map out the turnaround process more thoroughly. It elaborates on tasks the activities by detailing every step performed. The team primarily uses this tool to prioritize each process. Through using the flowchart, the team identifies the most important tasks and aims to eliminate unnecessary ones.

Analyzing the Current State

In analyzing the current state, the team uses the cause-and-effect diagram, spaghetti diagram, Pareto chart, staff shadowing and delay/problem logs. The results from these charts and diagrams are analyzed by surgeons, anesthesiologists and specialized physicians involved in the TAT process. Since detailed explanation these tools are not provided in the article, further research was done to describe some possible uses for these tools.

Cause-and-effect diagram can be used to identify the causes of increased TAT and delayed FCS. Once all possible cause-and-effects of the situation are laid out, the team can identify the root...
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