1. Lean culture to improve
operating room efficiency
21th september 2011

2. 2007 operating room fire

3. 2010

5. Safetymanagement Qualitymanagement
Passport NIAZ

6. Under- and overuse of OR resources

7. Gap between planning and reality

8. OR cancellations of elective operations

10. Why also LEAN
in our operating rooms ?
1. Focus on the patient, focus on value
2. Decrease waste (waiting, transportation, overproduction, overstocking)
3. Improve employee engagement and satisfaction
4. Improved OR use: decrease in under- and overuse of OR resources
5. Streamlining the pre-, intra- and postoperative process
6. Reducing OR nonoperative time (turnover times, waiting times)
7. Process standardization

11. LEAN introduction team
Kjeld Aij, head operating rooms
Ellen Duijnhouwer, lean coach
Marjolijn Jungman, lean coach
Stephan Loer, head anesthetic department
Arnoud Orelio, lean coach
Peter Veerman, medical head operating rooms

12. LEAN Pilot operating room
Sterilization department
Acute operations
Daysurgery
ENT-daysurgery
…

13. Value stream map

14. Key performance metrics

15. Invoeringsteam lean op OK - KPI 2: aantal afgezegde electieve operaties per
dag
Kleurcodes reden afzegging:
norm
AOZ (blauw) wk 10-25: 4x
SNIJDER (rood) wk 10-25: 98x
PATIENT (groen) wk 10-25: 67x
GEEN IC/MC (zwart) wk 10-25: 31x
week ma di wo do vr totaal
week 24: 13-6 X II IIII IIIII IIIII 16
week 25: 20-6 III II I II IIIII 13
week 26: 27-6
week 27: 4-7
week 28: 11-7
week 29: 18-7

16. Teaching principles of LEAN
1: Metingen!
! WSA!
! KPI definitie!
! KPIʼs meten! KPI bord!
! Visueel!
! Door het team!
5: Standaarden! 2: Stand-up!
! Vastleggen, visuali- ! Team rapporteert!
seren & verifiëren!
Continu ! Interactie team/
! Trainen! manager!
verbeteren !
Verbeterd!! met betrokken ! Definieer/ Stand-up!
rapporteer acties!
mensen!
top 3!
4: Oplossingen! 3: Problemen !
! Gestructureerd! ! Detectie/identificatie!
! In autonome teams! ! Communicatie!
! Bronoorzaken ! Op basis van feiten!
Verbeter(team)! bepalen en ! Onder controle
bord! oplossen! brengen/ isoleren! 16

18. Bijlage 2

19. Canceled procedures
! 15-16 OR’s
! Time: 8 a.m. - 15.45 p.m.
! Capacity off-hours 4 - 2 OR’s

20. Canceled procedures
! Every day 4 p.m.
! Coordinators and OR management
! Planning staff general surgery
! .....

21. Invoeringsteam lean op OK - KPI 2: aantal afgezegde electieve operaties
per dag
# afgezegde electieve operaties per week
19
18
17 Kleurcodes reden afzegging:
16
15
14
13
norm
12
11
AOZ (blauw) wk 10-25: 4x
10
9
8
7
6
5
SNIJDER (rood) wk 10-25: 98x
4
3
2
1
0 PATIENT (groen) wk 10-25: 67x
10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
GEEN IC/
weeknr
MC (zwart) wk 10-25: 31x
# afgezegde electieve operaties norm (nog te bepalen)
week ma di wo do vr totaal
week 24:
X II IIII IIIII IIIII 16
13-6
week 25:
III II I II IIIII 13
20-6
week 26:
27-6
week 27: 4-7

22. Canceled procedures
! AOZ 10 %
! Patient 25 %
! Surgical/scheduling 65 %

23. Canceled procedures
! Difficult to determine root cause
" Even coordinators don’t know
! Reasons very divers
! Information dissapears rapidly
! Not perceived as problem

24. Process Improvement
Methodologies

25. Why get LEAN?
• Productivity improvements of 20-50%
• Set-up time reductions of 60-80%
• Inventory reductions of 40-75%
• Floor space reductions of 30-50%
• Reduced quality defects by 50-100%
• Improved safety performance of 30-60%
• More efficient procedures
• Survival in the marketplace

27. Surgery is a complex
process where many
resources act together

28. Operating Room Layout

31. Actual LEAN examples

32. Lean lessons learned...
• “Getting lean” takes a long time
• Lean is not a part-time effort
• Lean is more than tools, it’s also behavior
• The journey to lean never ends
• There will be resistance to lean within the
organization

33. Keys to LEAN leadership
• Gothe “production”floor (gemba) time
on
See--senior leaders must spend
• Ask day to uncover the root cause times
every
Why--use the question many
• Show Respect--respect employees,
suppliers, and customers

37. Lean lessons from others
• The top leaders need to lead lean
• Be prepared for the front-end investment
• Lean is not just for manufacturing
• There is a lean “roadmap”, but no lean
“cookbook”
• You cannot just copy another lean
organizations journey

38. Next steps
• Business Assessment
• Call to Action and Commitment
• Align with Policy Deployment
• Training and/or Sensei
• Resource Allocation
• Process Selection
• Begin the “Journey”
• Implement New Metrics
• Review Progress and Adjust as Needed

39. You mustTRANSFORM the
organization to avoid “snap-
back”to the old ways or …
don’t even bother to start.