Elimination of waste: creation of a successful Lean colonoscopy program at an academic medical center.
Lean processes involve streamlining methods and maximizing efficiency. Well established in the manufacturing industry, they are increasingly being applied to health care. The objective of this study was to determine feasibility and effectiveness of applying Lean principles to an academic medical center colonoscopy unit.



Lean process improvement involved training endoscopy personnel, observing patients, mapping the value stream, analyzing patient flow, designing and implementing new processes, and finally re-observing the process. Our primary endpoint was total colonoscopy time (minutes from check-in to discharge) with secondary endpoints of individual segment times and unit colonoscopy capacity.



A total of 217 patients were included (November 2013-May 2014), with 107 pre-Lean and 110 post-Lean intervention. Pre-Lean total colonoscopy time was 134 min. After implementation of the Lean process, mean colonoscopy time decreased by 10 % to 121 min (p = 0.01). The three steps of the process affected by the Lean intervention (time to achieve adequate sedation, time to recovery, and time to discharge) decreased from 3.7 to 2.4 min (p < 0.01), 4.0 to 3.4 min (p = 0.09), and 41.2 to 35.4 min (p = 0.05), respectively. Overall, unit capacity of colonoscopies increased from 39.6 per day to 43.6. Post-Lean patient satisfaction surveys demonstrated an average score of 4.5/5.0 (n = 73) regarding waiting time, 4.9/5.0 (n = 60) regarding how favorably this experienced compared to prior colonoscopy experiences, and 4.9/5.0 (n = 74) regarding professionalism of staff. One hundred percentage of respondents (n = 69) stated they would recommend our institution to a friend for colonoscopy.



With no additional utilization of resources, a single Lean process improvement cycle increased productivity and capacity of our colonoscopy unit. We expect this to result in increased patient access and revenue while maintaining patient satisfaction. We believe these results are widely generalizable to other colonoscopy units as well as other process-based interventions in health care.
Department of General Surgery, University of Massachusetts Medical Center, 55 Lake Avenue North, Worcester, MA, 01655, USA. aneel.damle@umassmemorial.org.
Aneel
A
Damle
Division of Colon and Rectal Surgery, University of Massachusetts Medical Center, Worcester, MA, USA.
Nathan
N
Andrew
Department of Anesthesiology, University of Massachusetts Medical Center, Worcester, MA, USA.
Shubjeet
S
Kaur
Department of Anesthesiology, University of Massachusetts Medical Center, Worcester, MA, USA.
Alan
A
Orquiola
Division of Colon and Rectal Surgery, University of Massachusetts Medical Center, Worcester, MA, USA.
Karim
K
Alavi
Division of Colon and Rectal Surgery, University Hospitals-Case Medical Center, Cleveland, OH, USA.
Scott R
SR
Steele
Division of Colon and Rectal Surgery, University of Massachusetts Medical Center, Worcester, MA, USA.
Justin
J
Maykel
D000046:Academic Medical Centers / Q000458:organization & administration*; D000328:Adult; D003113:Colonoscopy / Q000193:education / Q000379:methods; D015179:Colorectal Neoplasms / Q000000981:diagnostic imaging*; D017598:Efficiency, Organizational / Q000592:standards*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D061646:Operative Time; D010043:Outcome and Process Assessment, Health Care / Q000379:methods*; D017060:Patient Satisfaction; D016730:Program Development / Q000379:methods; D058996:Quality Improvement; D017749:Total Quality Management / Q000458:organization & administration*
Colonoscopy; Lean; Process improvement; Quality improvement