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Applying “Lean” to the perioperative environmentBy Brianna M. Davis
AORN Journal Assistant Editor
It takes a dynamic, cross-sectional team to implement positive change through the Lean Six Sigma methodology for process improvement, said Er Ralston, BS, MBA, vice president of Juran Healthcare, and Carol Applegeet, RN, MSN, CNOR, NEA-BC, FAAN, director of Perioperative Services, St. Mary’s Hospital and Medical Center in Grand Junction, Colo. The people doing the work are the ones that need to be involved in identifying key changes, stressed Ralston, known as the “Sensei” (master) of Lean.
During an education session, “Lean Six Sigma in the Perioperative Setting,” presented during AORN’s Congress in Denver, Ralston and Applegeet highlighted the important principles of Lean Six Sigma, a collection of process improvement tools originating in the automotive and electronics industries that are used to eliminate waste and find value in order to achieve breakthrough performance at a higher level for a longer period of time.
Understanding Lean
Ralston, who used the term “Lean” when referring to the combined Lean Six Sigma tools, provided background and information on the Lean and Six Sigma methodology. Lean is a very “people-engaging” type of approach to performance improvement. If other approaches are used, staff members may not be engaged in actually making changes. “Having leadership on board is also a key factor contributing to the success of a project,” he said.
Applying the five key principles of Lean thinking is “hard work because it changes the way people think about doing the work. It’s a long-term commitment,” Ralston said. He also explained that the concept of value is at the core of each of the five principles that encompass Lean methodology, including:
Specify value in the eyes of the customer. The very first thing you do when applying Lean is to determine what is important to the individuals we provide services to. Lean is about learning to see what is value-added and what it is that customers/stakeholders really want. When identifying value, it is important to be aware of eight deadly wastes. Over-production, waiting, transport, poor process design, inventory, motion, defects, and under-utilized resources pose a threat by contributing non-value.
Identify the value stream. A value stream is the flow of activities we must follow to provide value. A value stream map is used to analyze activity flow and identify areas where there is added value. According to Ralston, a process flow diagram or flow chart is similar to a value stream map. The only difference is the extra step of identifying where value and non-value occur within the process flow.
Make value flow without interruptions. It is important to eliminate any bottlenecks or dams that keep things from flowing smoothly. One example Ralston gave was that of eliminating batch and queue systems. “While batching more than one or two items at a time may be efficient for the worker, it is not for the overall flow.”
Let customers pull the value. Looking through the eyes of the customer, it is important to identify whether or not value is being delivered at exactly the time and place it needs to be provided.
Pursue perfection—improving with projects. “In order to achieve results, we need to pull together a cross-functional team, and we need leadership support to do it,” Ralston said. The bigger improvement you want to make, the more support tools you will need. This is where Lean Six Sigma comes into play.
Applying Lean
Applegeet shared real-world experience with the Lean processes her OR team has applied. Two key projects that Applegeet’s team focused on were reducing operating room turnover times and improving the patient identification and registration process to comply with regulations (ie, the Federal Trade Commission’s Red Flag Rule). While completing their “current state” value stream map, they identified steps that were non-value added. Some of these steps they could get rid of, and others they were required to keep. The “future state” value stream map showed less complexity and an improvement in process flow. Applegeet verified this with results (see image).
Applegeet shared positive outcomes from a Lean event related to OR room turnover.
By applying Lean Six Sigma concepts and using the appropriate tools, Applegeet’s team identified areas for improvement and took steps towards making the necessary changes. The involvement from all levels of staff, especially the support from leadership, is what contributed to successful outcomes on both of these projects, she explained. “Unsuccessful Lean projects happen when the right people are not involved. Sometimes we are so focused on efficiency and process that we forget about the patient in the middle,” Applegeet concluded.
Learn more
Juran Healthcare
http://www.juran.com/
Lean Enterprise Institute
www.lean.org
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