What Continuous Improvement Looks Like in a Hospital OR: Lean at ThedaCare

Many hospitals are adopting the lean methodology for improving efficiency and safety. When used in the operating room, lean may speed turnover times, improve first case on-time starts and reduce the risk of infection. Appleton, Wis.-based ThedaCare began working with Simpler Consulting to implement lean manufacturing in the OR in late 2002. In 2008, John S. Toussaint, MD, CEO emeritus of ThedaCare, created the ThedaCare Center for Healthcare Value to teach lean management. Dr. Toussaint, who is president and CEO of the center, explains how two principles of lean — continuous improvement every day and respect for people — is improving ThedaCare's OR efficiency.

Continuous improvement
At least once a day, OR group members huddle for about 10-15 minutes to identify problems that occurred in the last 12-24 hours. They write a problem, when it was observed and possible solutions on small pieces of paper and post them to a large visual tracking board. The group then identifies high-impact issues and delegates the issues to staff and physicians for them to solve during the day as they have time. "Rather than sending somebody home because they don't have any surgeries to participate in for a couple hours, put that person on one of the problems to solve," Dr. Toussaint says.

While staff and physicians often have sufficient downtime during the day to work on solving the problem, sometimes the project is extended for a longer period of time or to additional people. This immediate response to an identified problem is part of a "just do it" philosophy of lean at ThedaCare. "We're solving [the problems] in real time, we're not waiting six weeks to go through a committee," Dr. Toussaint says. Using this philosophy, frontline people have implemented approximately 70 solutions each month, according to Dr. Toussaint.  

One high-impact problem the OR staff identified was an instance where a patient's name was spelled wrong during admission. When the patient pack was delivered to the OR, staff had to stop the case because they thought they had the wrong patient. As a result of the huddles, OR staff and physicians worked with office staff to create a process in which a patient's name is triple checked, which prevented the problem from reoccurring.

Respect for people
A key aspect of lean management in the OR is respect for people, which recognizes frontline workers' value to the process and trusts them to solve the problems. Having frontline workers take responsibility for process improvement initiatives benefits the OR not only by ensuring improved processes, but also by increasing employee and physician engagement. OR staff and physicians complete a survey that yields an engagement score — how enthusiastic they are about their work. This score "dramatically improved," according to Dr. Toussaint. "They are more engaged and interested in coming to work because they know their opinions matter," he says.

Respect for people also helps gain the buy-in from frontline workers. "They are skeptical at the beginning [and think] it's another management trick," Dr. Toussaint says. "Until you build a system where people are taught how to solve problems and you have respect for them to solve the problems, you don't get buy in. It's a cultural change. It takes time and is difficult. [But] if you persevere and are humble about it, it will happen."

Related Articles on OR Efficiency:

8 Ideas on How to Use Efficiency Metrics to Improve the OR
How Should ORs Measure Efficiency? 8 Responses

10 Experts Share the One Behavior They Believe Cripples an OR

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