Lean in the OR

Editorial Team / Admin · Jul 21, 2014

Lean in my OR meant not replacing staff when they left. Apparently, productive hours weren't high enough (productive hours defined as those with a patient in the OR; doing other necessary tasks such as picking cases, setting up rooms, and cleaning between cases doesn't count). So now, we don't even have enough staff for all of the rooms. Another thing they did was looking at inventory. So, they opted to reduce par levels of many supplies. Works fine for things that are kept in the hospital storeroom as we can just call for more. Doesn't work for specialty items such as vascular grafts that are ordered on an as-used basis. Nothing like setting up for a case and realizing that you can't proceed because the 2 grafts kept in the OR got used on earlier cases.

Bottom line: yes, the OR needs to find a way to reduce costs. However, that needs to happen in away that doesn't affect patient safety through not enough staff, overworked staff, and not enough supplies.

ORoxyO · Jul 21, 2014

We are doing Lean Daily Management in our hospitals. We have tracked: items opened but not used, # of items flashed, errors on case carts, on time starts, turnover time, # of times the RN had to run for an item, time spent waiting for surgeon to come in the room after the patient is in and asleep, items being sent back to sterile processing unused

LDM has not gone over well! People are annoyed with having to track things and do the paperwork, and also fill out the board. It's just more stuff we have to get done in the same amount of time. They also see it as a punishment rather than informational.

mhy12784 · Jul 21, 2014

We are doing Lean Daily Management in our hospitals. We have tracked: items opened but not used, # of items flashed, errors on case carts, on time starts, turnover time, # of times the RN had to run for an item, time spent waiting for surgeon to come in the room after the patient is in and asleep, items being sent back to sterile processing unused
LDM has not gone over well! People are annoyed with having to track things and do the paperwork, and also fill out the board. It's just more stuff we have to get done in the same amount of time. They also see it as a punishment rather than informational.

Shouldn't a chunk of that already be done anyway?

I mean there should be a log for all items flashed anyway (usually with times and indicators)

On time case starts, (which should be a part of normal or record keeping) turnover time ( you record case end, and case start?)

Errors on case carts which is a legitimate problem

Only things that sound quite annoying would be tracking open unused items, especially if they're minor things

mhy12784 · Jul 22, 2014

Has anyone used any sort of lean (or similar) measures to improve charges ?

I feel like the methodology we use is pretty ineffective and wasteful.

ORoxyO · Jul 23, 2014

Sure things are tracked by our directors and run in daily reports but the whole point is to break down why this happens and how to fix it on a staff level. when you look at the graphs and track it yourself it makes a difference.

It's hard to come up with new ideas....kind why you are here, right?

mhy12784 · Jul 24, 2014

Sure things are tracked by our directors and run in daily reports but the whole point is to break down why this happens and how to fix it on a staff level. when you look at the graphs and track it yourself it makes a difference.
It's hard to come up with new ideas....kind why you are here, right?

Well im more of a noobie to nursing and the OR, and have just been learning about Lean through school (and am incredibly interested in that kind of thing)

So ive trying to find out how many hospitals actually use this kind of stuff, and if it actually works.

Im definitely not a manager or leader or anything trying to come up with ideas.