title: Use of lean and six sigma methodology to improve operating room efficiency in a high-volume tertiary-care academic medical center.
abstract: BACKGROUND
  Operating rooms (ORs) are resource-intense and costly hospital units. Maximizing OR efficiency is essential to maintaining an economically viable institution. OR efficiency projects often focus on a limited number of ORs or cases. Efforts across an entire OR suite have not been reported. Lean and Six Sigma methodologies were developed in the manufacturing industry to increase efficiency by eliminating non-value-added steps. We applied Lean and Six Sigma methodologies across an entire surgical suite to improve efficiency.
  
  
  METHODS
  A multidisciplinary surgical process improvement team constructed a value stream map of the entire surgical process from the decision for surgery to discharge. Each process step was analyzed in 3 domains, ie, personnel, information processed, and time. Multidisciplinary teams addressed 5 work streams to increase value at each step: minimizing volume variation; streamlining the preoperative process; reducing nonoperative time; eliminating redundant information; and promoting employee engagement. Process improvements were implemented sequentially in surgical specialties. Key performance metrics were collected before and after implementation.
  
  
  RESULTS
  Across 3 surgical specialties, process redesign resulted in substantial improvements in on-time starts and reduction in number of cases past 5 pm. Substantial gains were achieved in nonoperative time, staff overtime, and ORs saved. These changes resulted in substantial increases in margin/OR/day.
  
  
  CONCLUSIONS
  Use of Lean and Six Sigma methodologies increased OR efficiency and financial performance across an entire operating suite. Process mapping, leadership support, staff engagement, and sharing performance metrics are keys to enhancing OR efficiency. The performance gains were substantial, sustainable, positive financially, and transferrable to other specialties.
authors.affiliation: Department of Surgery, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
authors.forename: Robert R
authors.initials: RR
authors.lastname: Cima
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Brown
authors.forename: James R
authors.initials: JR
authors.lastname: Hebl
authors.forename: Robin
authors.initials: R
authors.lastname: Moore
authors.forename: James C
authors.initials: JC
authors.lastname: Rogers
authors.forename: Anantha
authors.initials: A
authors.lastname: Kollengode
authors.forename: Gwendolyn J
authors.initials: GJ
authors.lastname: Amstutz
authors.forename: Cheryl A
authors.initials: CA
authors.lastname: Weisbrod
authors.forename: Bradly J
authors.initials: BJ
authors.lastname: Narr
authors.forename: Claude
authors.initials: C
authors.lastname: Deschamps
mesh_terms: D000046:Academic Medical Centers; D017598:Efficiency, Organizational; D006801:Humans; D009873:Operating Rooms / Q000458:organization & administration*; D019990:Perioperative Care; D017064:Process Assessment, Health Care / Q000458:organization & administration; D058996:Quality Improvement; D013043:Specialties, Surgical / Q000458:organization & administration*; D017749:Total Quality Management / Q000458:organization & administration*