Lean healthcare management in optimizing foreign hospital operating room service process_West China Medical Journal

Authors：

ZHOU Jingrong ¹ ,  XIA Ping ^1,2 , LIN Dasheng ³ , CAI Yuqi ¹ , YANG Ziwei ¹ , ZHONG Congjie ¹ , ZHONG Ziyan ¹ , ZHANG Dongmei ^1,2 , HE Haiyan ^1,2 , JIN Juan ^1,2 , LIU Maoling ^1,2 , ZOU Zongfeng ^1,2 , JIE Jianwang ^1,2 , WEI Wei ^1,2

1. School of Public Health, Guangdong Pharmaceutical University, Guangzhou, Guangdong 510006, P. R. China;
2. Centre for Research on Health Economics and Health Promotion, Guangdong Pharmaceutical University, Guangzhou, Guangdong 510006, P. R. China;
3. College of Medical Information Engineering, Guangdong Pharmaceutical University, Yunfu, Guangdong 572322, P. R. China;

Corresponding author：

XIA Ping, Email: xiaping@gdpu.edu.cn

Keywords：

Lean healthcare management; operating room; continuous improvement

DOI：

10.7507/1002-0179.202411115

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Objective To analyze the application of lean healthcare management in optimizing services in foreign operating rooms, and provide a theoretical reference for further optimizing service processes in domestic operating rooms with lean healthcare management. Methods PubMed and Web of Science databases were searched literature about lean healthcare management in optimizing foreign hospital operating room service process. The search period was from the establishment of databases to November 2024. The number of publications, publishing institutions, authors, citation frequencies, keywords, the use of lean management tools and the improvement status were analyzed.Results A total of 71 literatures were included. Among them, 17 literatures were published from 2008 to 2014, and the number of related literatures increased significantly since 2015, with 54 literatures published by 2024; 9 literatures were published by universities and 62 literatures were published by hospitals. In terms of the distribution of countries and regions where the literatures were published, there were 34 literatures from the United States, 12 from the United Kingdom, 5 from Italy, 4 from Switzerland, and 3 from Canada. The keywords basically presented the combination ofthemes related to operating room management and lean healthcare management improvement fields, such as lean six sigma, quality improvement, and operating room efficiency. The five lean tools with the highest frequency of occurrence in the 71 included literatures were value stream mapping, fishbone diagram, A3 report, PDCA cycle management, and 5S. Conclusions There is an imbalance in the development of lean healthcare management research, with the number of publications in developed countries being far higher than that in developing countries. Lean healthcare management is conducive to improving surgical safety, work efficiency, and patient-doctor satisfaction. Lean healthcare management should further adapt to the actual situation, unify the lean management indicators in operating rooms, conduct cross-departmental cooperation, maximize the effectiveness of lean improvement tools, and achieve modern medical management.

Citation： ZHOU Jingrong, XIA Ping, LIN Dasheng, CAI Yuqi, YANG Ziwei, ZHONG Congjie, ZHONG Ziyan, ZHANG Dongmei, HE Haiyan, JIN Juan, LIU Maoling, ZOU Zongfeng, JIE Jianwang, WEI Wei. Lean healthcare management in optimizing foreign hospital operating room service process. West China Medical Journal, 2024, 39(12): 1860-1866. doi: 10.7507/1002-0179.202411115 Copy

1.	Osmundsen EB, Pavlovic ZJ, Combs JC. Lessons in level-loading: how lean manufacturing principles can be utilized for fertility clinic optimization. Fertil Steril, 2024, 122(1): 80-81.
2.	Gupta R, Tat Q, O’Brien J, et al. Utilization of lean project management principles and health informatics to reduce operating room delays in a vascular surgery practice. Am J Surg, 2022, 223(1): 176-181.
3.	Mitteregger M, Köhler G, Szyszkowitz A, et al. Increasing operating room efficiency with shop floor management: an empirical, code-based, retrospective analysis. J Med Syst, 2020, 44(9): 168.
4.	叶楚民, 夏萍. 看板管理在医疗服务中应用的文献分析. 华西医学, 2020, 35(12): 1446-1450.
5.	Parks JK, Klein J, Frankel HL, et al. Dissecting delays in trauma care using corporate lean six sigma methodology. J Trauma, 2008, 65(5): 1098-1104.
6.	Scala A, Improta G. Lean six sigma approach to improve the management of patients undergoing laparoscopic cholecystectomy. Healthcare (Basel), 2024, 12(3): 292.
7.	Verolino M, Grassi P, Sosto G, et al. Lean approach to the management of patients undergoing intravitreal injections during COVID-19 pandemic. Ther Adv Ophthalmol, 2021, 13: 25158414211018893.
8.	Nino V, Claudio D, Valladares L, et al. An enhanced kaizen event in a sterile processing department of a rural hospital: a case study. Int J Environ Res Public Health, 2020, 17(23): 8748.
9.	Daly A, Wolfe N, Teeling SP, et al. Redesigning the process for scheduling elective orthopaedic surgery: a combined lean six sigma and person-centred approach. Int J Environ Res Public Health, 2021, 18(22): 11946.
10.	Rosa A, Angela TT, Marolla G, et al. Lean six sigma to reduce the acute myocardial infarction mortality rate: a single center study. TQM J, 2023, 35(9): 25-41.
11.	Amati M, Valnegri A, Bressan A, et al. Reducing changeover time between surgeries through lean thinking: an action research project. Front Med (Lausanne), 2022, 9: 822964.
12.	Gray ML, Chen S, Kinberg E, et al. Using lean to improve patient safety and resource utilization after pediatric adenotonsillectomy. J Patient Saf, 2021, 17(2): 95-100.
13.	Reis LP, Fernandes JM, Silva SE, et al. Managing inpatient bed setup: an action-research approach using lean technical practices and lean social practices. J Health Organ Manag. 2023, 37(2): 213-235.
14.	Sales Coll M, de Castro Vila R, Aguilar AOE, et al. Lean healthcare: improving surgical process indicators through prioritization projects. J Ind Eng Manag, 2023, 16(1): 102-114.
15.	Tanna N, Clappier M, Barnett SL, et al. Streamlining and consistency in surgery: lean six sigma to improve operating room efficiency. Plast Reconstr Surg, 2023, 152(3): 682-690.
16.	Maliszewski B, Whalen M, Lindauer C, et al. Quality improvement in the emergency department: a project to reduce door-to-electrocardiography times for patients presenting with chest pain. J Emerg Nurs, 2020, 46(4): 497-504. e2.
17.	Charlesworth M, Pandit JJ. Rational performance metrics for operating theatres, principles of efficiency, and how to achieve it. Br J Surg, 2020, 107(2): e63-e69.
18.	Warner CJ, Walsh DB, Horvath AJ, et al. Lean principles optimize on-time vascular surgery operating room starts and decrease resident work hours. J Vasc Surg, 2013, 58(5): 1417-1422.
19.	Franklin J, Franklin T. Improving preoperative throughput. J Perianesth Nurs, 2017, 32(1): 38-44.
20.	El-Othmani MM, Crespi Z, Pallekonda V, et al. The implementation of lean six sigma principles to improve the value of care delivery for total joint arthroplasty patients: the perioperative institute of surgical excellence experience. J Am Acad Orthop Surg, 2021, 29(21): e1087-e1096.
21.	Shah PR, Leichtle S, Spencer P. Enhanced recovery after surgery, lean, and claims-based quality databases: how does it all make sense?. Curr Opin Anaesthesiol, 2021, 34(2): 161-167.
22.	Sales Coll M, de Castro R, Ochoa de Echagüen A, et al. Economic impact of lean healthcare implementation on the surgical process. Healthcare (Basel), 2024, 12(5): 512.
23.	Kubala M, Gardner JR, Criddle J, et al. Process improvement strategy to implement an outpatient surgery center efficiency model in an academic inpatient setting. Int J Pediatr Otorhinolaryngol, 2021, 144: 110650.
24.	Herlihy E, Antao B, Fawaz A, et al. Adapting lean methodology towards surgical tray rationalisation in inguinoscrotal day case surgery in the republic of Ireland. J Pediatr Urol, 2023, 19(4): 433. e1-433. e8.
25.	Tresh A, Cohen AJ, Mmonu NA, et al. Resident-driven holistic lean daily management system to enhance care experience at a safety net hospital. Urology, 2020, 140: 56-63.
26.	Tagge EP, Thirumoorthi AS, Lenart J, et al. Improving operating room efficiency in academic children’s hospital using lean six sigma methodology. J Pediatr Surg, 2017, 52(6): 1040-1044.
27.	Godinho Filho M, Boschi A, Rentes AF, et al. Improving hospital performance by use of lean techniques: an action research project in Brazil. Qual Eng, 2015, 27(2): 196-211.
28.	Dos Santos BM, Fogliatto FS, Zani CM, et al. Approaches to the rationalization of surgical instrument trays: scoping review and research agenda. BMC Health Serv Res, 2021, 21(1): 163.
29.	McKnight KN, Smith VJS, MacFadden LN, et al. Wide-awake hand surgery has its benefits: a study of 1, 011 patients. J Hand Surg Glob Online, 2022, 4(6): 394-398.
30.	Lee DJ, Ding J, Guzzo TJ. Improving operating room efficiency. Curr Urol Rep, 2019, 20(6): 28.

1. Osmundsen EB, Pavlovic ZJ, Combs JC. Lessons in level-loading: how lean manufacturing principles can be utilized for fertility clinic optimization. Fertil Steril, 2024, 122(1): 80-81.
2. Gupta R, Tat Q, O’Brien J, et al. Utilization of lean project management principles and health informatics to reduce operating room delays in a vascular surgery practice. Am J Surg, 2022, 223(1): 176-181.
3. Mitteregger M, Köhler G, Szyszkowitz A, et al. Increasing operating room efficiency with shop floor management: an empirical, code-based, retrospective analysis. J Med Syst, 2020, 44(9): 168.
4. 叶楚民, 夏萍. 看板管理在医疗服务中应用的文献分析. 华西医学, 2020, 35(12): 1446-1450.
5. Parks JK, Klein J, Frankel HL, et al. Dissecting delays in trauma care using corporate lean six sigma methodology. J Trauma, 2008, 65(5): 1098-1104.
6. Scala A, Improta G. Lean six sigma approach to improve the management of patients undergoing laparoscopic cholecystectomy. Healthcare (Basel), 2024, 12(3): 292.
7. Verolino M, Grassi P, Sosto G, et al. Lean approach to the management of patients undergoing intravitreal injections during COVID-19 pandemic. Ther Adv Ophthalmol, 2021, 13: 25158414211018893.
8. Nino V, Claudio D, Valladares L, et al. An enhanced kaizen event in a sterile processing department of a rural hospital: a case study. Int J Environ Res Public Health, 2020, 17(23): 8748.
9. Daly A, Wolfe N, Teeling SP, et al. Redesigning the process for scheduling elective orthopaedic surgery: a combined lean six sigma and person-centred approach. Int J Environ Res Public Health, 2021, 18(22): 11946.
10. Rosa A, Angela TT, Marolla G, et al. Lean six sigma to reduce the acute myocardial infarction mortality rate: a single center study. TQM J, 2023, 35(9): 25-41.
11. Amati M, Valnegri A, Bressan A, et al. Reducing changeover time between surgeries through lean thinking: an action research project. Front Med (Lausanne), 2022, 9: 822964.
12. Gray ML, Chen S, Kinberg E, et al. Using lean to improve patient safety and resource utilization after pediatric adenotonsillectomy. J Patient Saf, 2021, 17(2): 95-100.
13. Reis LP, Fernandes JM, Silva SE, et al. Managing inpatient bed setup: an action-research approach using lean technical practices and lean social practices. J Health Organ Manag. 2023, 37(2): 213-235.
14. Sales Coll M, de Castro Vila R, Aguilar AOE, et al. Lean healthcare: improving surgical process indicators through prioritization projects. J Ind Eng Manag, 2023, 16(1): 102-114.
15. Tanna N, Clappier M, Barnett SL, et al. Streamlining and consistency in surgery: lean six sigma to improve operating room efficiency. Plast Reconstr Surg, 2023, 152(3): 682-690.
16. Maliszewski B, Whalen M, Lindauer C, et al. Quality improvement in the emergency department: a project to reduce door-to-electrocardiography times for patients presenting with chest pain. J Emerg Nurs, 2020, 46(4): 497-504. e2.
17. Charlesworth M, Pandit JJ. Rational performance metrics for operating theatres, principles of efficiency, and how to achieve it. Br J Surg, 2020, 107(2): e63-e69.
18. Warner CJ, Walsh DB, Horvath AJ, et al. Lean principles optimize on-time vascular surgery operating room starts and decrease resident work hours. J Vasc Surg, 2013, 58(5): 1417-1422.
19. Franklin J, Franklin T. Improving preoperative throughput. J Perianesth Nurs, 2017, 32(1): 38-44.
20. El-Othmani MM, Crespi Z, Pallekonda V, et al. The implementation of lean six sigma principles to improve the value of care delivery for total joint arthroplasty patients: the perioperative institute of surgical excellence experience. J Am Acad Orthop Surg, 2021, 29(21): e1087-e1096.
21. Shah PR, Leichtle S, Spencer P. Enhanced recovery after surgery, lean, and claims-based quality databases: how does it all make sense?. Curr Opin Anaesthesiol, 2021, 34(2): 161-167.
22. Sales Coll M, de Castro R, Ochoa de Echagüen A, et al. Economic impact of lean healthcare implementation on the surgical process. Healthcare (Basel), 2024, 12(5): 512.
23. Kubala M, Gardner JR, Criddle J, et al. Process improvement strategy to implement an outpatient surgery center efficiency model in an academic inpatient setting. Int J Pediatr Otorhinolaryngol, 2021, 144: 110650.
24. Herlihy E, Antao B, Fawaz A, et al. Adapting lean methodology towards surgical tray rationalisation in inguinoscrotal day case surgery in the republic of Ireland. J Pediatr Urol, 2023, 19(4): 433. e1-433. e8.
25. Tresh A, Cohen AJ, Mmonu NA, et al. Resident-driven holistic lean daily management system to enhance care experience at a safety net hospital. Urology, 2020, 140: 56-63.
26. Tagge EP, Thirumoorthi AS, Lenart J, et al. Improving operating room efficiency in academic children’s hospital using lean six sigma methodology. J Pediatr Surg, 2017, 52(6): 1040-1044.
27. Godinho Filho M, Boschi A, Rentes AF, et al. Improving hospital performance by use of lean techniques: an action research project in Brazil. Qual Eng, 2015, 27(2): 196-211.
28. Dos Santos BM, Fogliatto FS, Zani CM, et al. Approaches to the rationalization of surgical instrument trays: scoping review and research agenda. BMC Health Serv Res, 2021, 21(1): 163.
29. McKnight KN, Smith VJS, MacFadden LN, et al. Wide-awake hand surgery has its benefits: a study of 1, 011 patients. J Hand Surg Glob Online, 2022, 4(6): 394-398.
30. Lee DJ, Ding J, Guzzo TJ. Improving operating room efficiency. Curr Urol Rep, 2019, 20(6): 28.

West China Medical Journal

Lean healthcare management in optimizing foreign hospital operating room service process

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