Optimization of surgery department operations

The practice is focused on implementing a lean production SMED (Single-Minute Exchange of Dies) system in Ryazan regional clinical hospital. The practice is implemented in order to solve the problem of optimizing (cutting down) the surgery time needed for one patient. 

Use of lean technologies allows for:

• Speed up switching between various process stages;

• Cutting down time and human cost;

• Increasing the number of surgeries done in a day.

The target audience:

• Clinic staff (rational use of human resources);

• Clinic patients (increasing healthcare accessibility, provision time and quality).

Implementation procedure:

1.  Before we implemented the practice, a patient was transported to the surgery department via a common elevator, which led to delays and rescheduling surgery start times for later; 

In the context of the practice we allocated a separate elevator for the surgery department, transporting patient to and from ORs using exclusively that elevator. That ensured cutting down patient transportation time and the time needed to prepare the patient and the staff for surgery.

2. Before we implemented the practice the clinic had no navigation signs which would be easy to understand to both the patients and the staff. That led to time loss; 

In the context of the practice we developed a modern and easily understandable clinic navigation system, with convenient wall signs. That enabled us to organize patient and personnel flows reasonably and ensure transporting patients after surgery to their rooms without getting them in any contact with the patients newly arriving to the clinic. 

3. Before we implemented the practice we started preparing patients for surgery in the OR, and only after the previous surgery was done;

In the context of the practice we outfitted a special room for preparing patients for their surgeries (urinary catheters, intravenous access, spinal anesthesia, various blockades) making us able to synchronize the finish of the previous surgery and the preparation for the next one.

4. Thanks to using the practice we also developed and implemented a patient safety checklist:

• patient identification;

• surgery area marking;

• a pre-surgery concept specifying the surgery start time and patient transfer plan after the surgery is over.

These measures enabled us to organize and optimize business processes for the clinic staff.

Surgery cycle with the practice applied: 

• Consulting the patient safety checklist;

• The OR operations start with preliminary cleaning, preparing a sterile operating table for surgery, the anesthesiologist’s station, and running the equipment check-up;

• Staff members prepare the patient for surgery (venous access, block anesthesia, central catheters);

• The first surgery of the day starts in the OR, while all the following ones start in the pre-surgery room;

• Preparation for the next surgery starts some time before the previous one finishes;

• After finishing the first surgery, the staff disinfects the OR according to the disinfectant’s instruction for use;

• Right after the disinfection the next surgery starts following the cycle described above.