Using Lean Techniques to Improve Turnaround Time and First Case Starts in the Operating Room

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Surgical Services

John Skevington
Administrative Resident
Montgomery Regional Hospital

Kevin D. Creehan

What surgeons want most from the surgical team is to start their case on time and to turn the room over in order to get started on the subsequent case. Using LEAN methodology tools, HCA Montgomery Regional sought to improve turnaround time and first cast start metrics with outside expert help and the use of a pilot employee incentive plan.

Montgomery Regional Hospital has defined a business-critical process improvement project in the Operating Room. There is need for Improvement in first case starts times (FCS) and turnaround times (TAT). At the projects genesis TAT averaged 38 minutes and FCS average only 60%. Targets of decreasing TAT to 25 minutes or less and FCS to 90% or more have been established for these metrics. The overall process targeted for potential change includes pre-admission testing through the OR (vs. only focusing on the actual turnaround process). This process has been targeted for improvements due to its initial role in freeing up capacity in the OR for additional cases i.e. volume growth. Hospital and Division leadership wished to utilize a Kaizen Event as part of the overall process improvement project. To encourage employees working in the OR to participate and in improvement efforts MRH and HCA Virginia leadership have developed an incentive plan that will be implemented in the fourth quarter of 2008 and will be measured through March 31, 2009. Employees will be eligible to earn a bonus of up to 10% of their base pay if metrics are achieved.