Perioperative
|
Amato-Vealey et al., 2012(3737 Amato-Vealey EJ, Fountain P, Coppola D. Perfecting Patient Flow in the Surgical Setting. AORN J. 2012;96(1):46-57. https://doi.org/10.1016/j.aorn.2012.03.013 https://doi.org/10.1016/j.aorn.2012.03.0...
)
United States
|
Six Sigma |
Tools: patient flow mapping, brainstorming, multidisciplinary visit.
Population: not specified.
|
The implementation of Six Sigma resulted in improvement in the discharge process and ensured the ability to maintain a continuous flow of surgical patients without incurring financial costs. |
Yes |
VI* |
Montella et al., 2017(99 Montella E, Cicco MVD, Ferraro A, Centobelli P, Raiola E, Triassi M, et al. The application of Lean Six Sigma methodology to reduce the risk of healthcare-associated infections in surgery departments. J Eval Clin Pract. 2017;23(3):530-9. https://doi.org/10.1111/jep.12662 https://doi.org/10.1111/jep.12662...
)
Italy
|
Lean Six Sigma |
Tools: Define-Measure-Analyze-Improve-Control (DMAIC), process mapping, brainstorming and fishbone.
Population: 20,000 patients.
|
The actions resulted in a significant reduction in the average number of hospitalization days (from 45 to 36 days).
There was also a reduction in the percentage of patients colonized by sentinel bacteria (from 0.37% to 0.21%).
|
Yes |
II* |
Ullah et al., 2020(3838 Ullah MF, Fleming C, Fox C, Tewary T, Tormey S. Patient experience in a surgical assessment unit following a closed-loop audit using a Kaizen Lean system. Ir J Med Sci. 2020;189(2):641-7. https://doi.org/10.1007/s11845-019-02105-5 https://doi.org/10.1007/s11845-019-02105...
)
Ireland
|
Lean Healthcare |
Tools: 5s, Kaizen, pull and push systems and process mapping.
Population:
Phase 1: 100 patients and 20 employees (clerical, administrative and staff ) interviewed in order to understand their perspectives on the areas that required attention to improve service delivery and efficiency;
Phase 2: 100 patients.
|
The results show the patient’s “perception” of waiting time.
In phase 2, perception improved with 83% of patients compared to 67% in phase 1; perception of waiting time for medical review also improved significantly, with 26% of patients reviewed in phase 2 compared to 0% in phase 1. Only 7% of patients had a total stay of 6-8h in phase 2 compared to 33% in phase 1.
There was satisfaction in different domains, perceptions of privacy and overall treatment was also improved.
|
It cannot be said that processes have been optimized. |
VI* |
Preoperative
|
Godinho Filho et al., 2015(3939 Godinho Filho M, Boschi A, Rentes AF, Thurer M, Bertani TM. Improving hospital performance by use of lean techniques: an action research project in Brazil. Qual Engineering. 2015;27(2):196-211. https://doi.org/10.1080/08982112.2014.942039 https://doi.org/10.1080/08982112.2014.94...
)
Brazil
|
Lean Healthcare |
Tools: 5s e Single Minute Exchange of Dies (SMED).
Population: quality manager (n=1), quality analyst (n=1), coordinator of the Materials and Sterilization Center (CME) (n=1), head nurse of the operating room (n=1), external consultants (unspecified), solution manager (n=1), consultant analysts (n=2).
|
A significant 94% reduction in the surgical delay rate due to a lack of materials in the Sterilization Materials Center (CME) was observed after the Kaizen event.
Finally, a significant reduction in postoperative infection can be seen due to improved flow and standardized operating procedures, dropping from 1 to 1.5% to 0.21%.
|
Yes |
VI* |
Preoperative and Intraoperative
|
Iverson et al., 2021(4040 Iverson KR, Roa L, Shu S, Wong M, Rubenstein S, Zavala P, et al. Quality improvement to address surgical burden of disease at a large tertiary public hospital in Peru. World J Surg. 2021;45:2357-69. https://doi.org/10.1007/s00268-021-06118-z https://doi.org/10.1007/s00268-021-06118...
)
Peru
|
Lean Six Sigma |
Tools: Plan-Do-Study-Act (PDSA), process mapping and fishbone.
Population:
1- Pre-intervention: 75 patients (53 emergency and 22 elective).
2- Post-intervention: 109 patients (111 emergency and 31 elective).
|
Patients (87%) on the new waiting list had all relevant clinical data documented, a 13.3% improvement on the pre-existing list.
The time from admission to discharge for all surgeries improved from 5 to 4 days (p<0.05) after the intervention.
|
Yes |
II* |
Intraoperatório
|
Amati et al., 2022(4141 Amati M, Valnegri A, Bressan A, Regina DL, Tassone C, Piccolo AL, et al. Reducing changeover time between surgeries through lean thinking: an action research project. Front Med. 2022;9:822964. https://doi.org/10.3389/fmed.2022.822964 https://doi.org/10.3389/fmed.2022.822964...
)
Switzerland
|
Lean Healthcare |
Tools: Gemba walks, process mapping, root cause analysis and Single Minute Exchange of Dies (SMED).
Population: multidisciplinary team (a chair of anesthesia, a nurse anesthetist, a surgical technician, a housekeeper, an operating room administrative secretary, two surgeons and two head nurses, representing the gynecology and general surgery specialties).
|
The changeover time between operations was reduced by 17 minutes for gynecology and 15 minutes for general surgery (25% on average), with no changes in terms of infrastructure, technology or resources. |
Yes |
VI* |
Leu et al., 2013(4242 Leu JD, Ku HL, Chung K P. “Six sigma” as an effective process for reducing waiting time in surgery patients. Adv Mat Res. 2013;718-720:2533-8. https://doi.org/10.4028/www.scientific.net/AMR.718-720.2533 https://doi.org/10.4028/www.scientific.n...
)
Taiwan
|
Six Sigma |
Tools: process mapping.
Population: Phase 1: 1246 patients.
Phase 2: 1266 patients.
|
The reduction in waiting time for each study group was 0.54, 4.23 and 7.82 minutes, respectively.
The average surgery turnover time also decreased significantly for each group (11.98, 16.4 and 19.72 minutes, respectively).
The Six Sigma quality indicator changed from 3.35δ to 3.46δ, a difference of 0.11δ.
|
Yes |
II* |
Post-surgery
|
Blouin-Delisle et al., 2018(4343 Blouin-Delisle CH, Drolet R, Gagnon S, Turcotte S, Boutet S, Coulombe M, et al. Improving flow in the OR: how Lean process studies can lead to shorter stays in the recovery ward. Int J Health Care Qual Assur. 2018;31(2):150-61. https://doi.org/10.1108/IJHCQA-01-2017-0014 https://doi.org/10.1108/IJHCQA-01-2017-0...
)
Canada
|
Lean Healthcare |
Tools: Define-Measure-Analyze-Improve-Control (DMAIC), Kaizen workshop, process mapping.
Population: Project Care Unit professionals: head nurse (n=2), nurses (n=3), clerical assistant (n=1), head of admissions (n=1), head of surgical ward (n=1), agent responsible for implementing Lean concepts (n=1).
|
Hospital 1: The length of stay in the recovery ward was reduced by 62 minutes (68% reduction) and there was an increase of around 25% of all admissions made during the day after the project compared to the period before the project.
Hospital 2: For the HEJ Lean project, time in the recovery ward was reduced by 6 minutes (29% reduction).
|
Yes |
VI* |
Bouras, 2015(4444 Bouras A. Quality tools to improve the communication level in the surgery department at a local hospital. Comput Human Behav. 2015;51(B):843-51. https://doi.org/10.1016/j.chb.2014.11.066 https://doi.org/10.1016/j.chb.2014.11.06...
)
Saudi Arabia
|
Six Sigma |
Tools: process mapping, fishbone, root cause analysis, cause and effect diagram, brainstorming.
Population: not specified.
|
The results show a reduction in cycle time, impacting the reduction in the time needed to contact doctors; minimizing the time needed to carry out urgent cases and the patient referral process; reducing the delay time before starting the execution of the treatment plan. |
Yes |
IV†
|
McCulloch et al., 2010(4545 McCulloch P, Kreckler S, New S, Sheena Y, Handa A, Catchpole K. Effect of a “Lean” intervention to improve safety processes and outcomes on a surgical emergency unit. BMJ. 2010;341:c5469. https://doi.org/10.1136/bmj.c5469 https://doi.org/10.1136/bmj.c5469...
)
United Kingdom
|
Lean Healthcare |
Tools: 5S, process mapping, visual management and Plan-Do-Check-Action (PDCA).
Population:
1- Pre-intervention: 607 patients.
2- Post-intervention: 602 patients.
|
Focus on establishing safe processes and better results.
The proportion of patients requiring transfer to other wards fell from 27% to 20%. Length of stay proved to be the most important risk factor for patient safety incidents.
|
It cannot be said that processes have been optimized. |
IV* |