Using lean Six Sigma to reduce surgery cancellation rate

Session
Perioperative

Authors
Kathleen Exline
Patient Care Director for Surgical & Neuro Services
Deaconess Hospital

Vicki Martin
Operating Room Manager
Deaconess Hospital

Abstract
Representing considerable revenue generation, the growth of surgical services is frequently listed among the strategic objectives for many hospitals. Deaconess Hospital in Evansville, Ind. had experienced surgical growth of 7 to 10 percent for two years and expected this trend to continue.

Hospital leadership sought to accommodate continued growth in surgical services without adding new rooms and resources. They had started a lean Six Sigma program in 2004, and were confident this approach would help improve throughput, maximize resources and increase efficiencies in the operating room. The goal was to maximize operating room capacity and resources without jeopardizing physician, staff, or patient satisfaction. Through the introduction of lean Six Sigma Deaconess Hospital was able to significantly reduce surgery cancellations and thereby increase capacity.

A team consisting of four green belts, surgery managers, same day surgery manager, laboratory staff, surgery staff, surgeons, and anesthesiologists was chartered. The vice president of operations served as project champion and the director of surgery served as project sponsor. The team developed the following problem statement: Based on customer feedback, opportunities exist to improve operating room throughput. By optimizing current processes, the OR will increase customer satisfaction, reduce delays, and facilitate growth.

A high-level process map for the day of surgery was created and broken into four sub-processes: patient registration, same day patient preparation, holding room, and operating room. The team brainstormed reasons for delays, collecting data to identify the most significant factors. The primary cause was determined to be lack of required diagnostic testing prior to the day of surgery. Upon further analysis, the team found an overall surgery cancellation rate of 13.9 percent, nearly double the national benchmark of seven to eight percent; 25 percent occurred the day of surgery resulting in lost revenue and reduced physician and patient satisfaction. The number one reason for cancellations day of surgery was determined to be test results (28 percent).

Based on these findings, project goals were redefined as:

Twenty-five percent reduction in day of surgery cancellations due to tests
Twenty-five percent of all patient test results complete 48 hours prior to surgery
Pre-admission testing location for surgery identified 72 hours in advance of surgery for 75 percent of patients

The green belt team planned and conducted two Work-Outs^TM with frontline staff and developed the following improvement strategies:

Integrated process for determining surgery readiness regarding tests 72 hours in advance
Development of a shared database file used by process owners to evaluate and follow-up on patient preparedness 48 hours in advance
Contingency plan for flexing staff to match workload to assess patient readiness

A six-week pilot of the new process was completed, staff was trained, process documentation completed, and necessary process adjustments made. To sustain improvements, the team developed a plan that included control charts of the cancellations day of surgery due to tests and patient readiness at 48 hour and 72 hour prior to surgery for the process owner to monitor the process and outcomes.

By optimizing processes, surgical services was able to increase customer satisfaction, reduce delays, and facilitate growth.