Improving first-case OR start times by utilizing Six Sigma methodologies

Session
Perioperative

Author
Tanner Holst
Systems and Process Consultant
Franciscan Skemp - Mayo Health System

Description
Franciscan Skemp historically had very poor on-time start rates for the first surgical cases of the day. Utilizing the Six Sigma methdology, an internal work group was able to identify the main variables driving on-time starts and within three months post impelmentation they improved on-time starts from 20 to 50 percent.

Abstract
In 2004 Franciscan Skemp (FSH) opened a new state-of-the-art surgical center and has committed to significantly expanding the surgical specialty capacity of the organization. As a result of the expanded capacity, surgical specialty growth and also our organizational goal to reduce cost per unit of service, the FSH surgical service division set some very specific improvement goals.

The first goal tackled was to improve on-time first case starts. A baseline study demonstrated a 20 percent on-time start rate. When this was first presented to our surgical management team the "blame game" began. It was the patient's fault for showing up late, it was anesthesia's fault, it was the surgeon's fault, etc.

Through the use of Six Sigma and the DMAIC methodology and tools, a small subgroup designed a study to determine the variables at the core of achieving on-time starts. The group determined the five primary variables, out of about 50 variables studied, that are the prime drivers for on-time starts.

Once these variables were identified, implementation options were presented to the surgery management team. The initial implementation raised on-time starts from 20 to 50 percdent in the first three months.