title: Lean management in academic surgery.
abstract: BACKGROUND
  Lean is a management system designed to enhance productivity by eliminating waste. Surgical practice offers many opportunities for improving efficiency. Our objective was to determine whether systematic implementation of lean thinking in an academic otolaryngology operating room improves efficiency and profitability and preserves team morale and educational opportunities.
  
  
  METHODS
  In an 18-month prospective quasi-experimental study, a multidisciplinary task force systematically implemented lean thinking within an otolaryngology operating room of an academic health system. Operating room turnover time and turnaround time were measured during a baseline period; an observer-effect period in which workers were made aware that their efficiency was being measured but before implementing lean changes; and an intervention period after redesign principles had been used. The impact on teamwork, morale, and surgical resident education were measured during the baseline and intervention periods through validated surveys. A profit model was applied to estimate the financial implications of the study.
  
  
  RESULTS
  There was no difference between the baseline and observer-effect periods of the study for turnover time (p = 0.98) or turnaround time (p = 0.20). During the intervention period, the mean turnover time and turnaround time were significantly shorter than during the baseline period (29 vs 38 minutes; p < 0.001 and 69 vs 89 minutes; p < 0.001, respectively). The composite morale score suggested improved morale after implementation (p = 0.011). Educational metrics were unchanged before and after implementation. The annual opportunity revenue for the involved operating room is $330,000; when extrapolated throughout the operating rooms, lean thinking could create 6,500 hours of capacity annually.
  
  
  CONCLUSIONS
  Application of lean management techniques to a single operating room and surgical service improved operating room efficiency and morale, sustained resident education, and can provide considerable financial gains when scaled to an entire academic surgical suite.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, MI 48109, USA. ryancoll@umich.edu
authors.forename: Ryan M
authors.initials: RM
authors.lastname: Collar
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Shuman
authors.forename: Sandra
authors.initials: S
authors.lastname: Feiner
authors.forename: Amy K
authors.initials: AK
authors.lastname: McGonegal
authors.forename: Natalie
authors.initials: N
authors.lastname: Heidel
authors.forename: Mary
authors.initials: M
authors.lastname: Duck
authors.forename: Scott A
authors.initials: SA
authors.lastname: McLean
authors.forename: John E
authors.initials: JE
authors.lastname: Billi
authors.forename: David W
authors.initials: DW
authors.lastname: Healy
authors.forename: Carol R
authors.initials: CR
authors.lastname: Bradford
mesh_terms: D000046:Academic Medical Centers; D017598:Efficiency, Organizational; D005500:Follow-Up Studies; D006801:Humans; D009873:Operating Rooms / Q000458:organization & administration*; D010036:Otolaryngology; D013517:Otorhinolaryngologic Surgical Procedures; D017064:Process Assessment, Health Care; D011446:Prospective Studies; D013043:Specialties, Surgical / Q000458:organization & administration*; D017749:Total Quality Management / Q000458:organization & administration*