Lean Approaches for Lasting Improvement

Huamei Deng, RN, director of the operating room and central sterile processing at Guangdong Provincial Hospital of Chinese Medicine in Guangzhou, Guangdong Province, China, often uses Lean methods in her work to continuously improve perioperative care, including support services such as instrument processing. 

“In our ongoing work to make a safer healthcare system, Lean management can be used as a bridge between administrators and frontline medical staff,” Deng shares.

Putting Lean to Work

In 2014, Deng began implementing Lean management to reduce wasted steps taken by nurses moving within the OR and between OR spaces in order to streamline OR traffic and improve nurse satisfaction.

Deng and her team applied a Lean 5S to standardize equipment location, instrument sets, and time to check instrument sets. The 5S, which is based on five Japanese terms for addressing waste, includes actions to: sort, straighten/set, shine/sweep, standardize, and sustain. Using the 5S helped Deng’s team make processes around instrument management more efficient.

She and her colleagues presented this work at AORN’s 2016 annual conference and received a poster of excellence award for clinical improvement and innovation.

Deng has continued to implement Lean methodologies in a number of other improvement initiatives, including for specific clinical procedures.

From 2015 to 2018, to improve instrument management in knee arthroplasty procedures, they applied Lean visualization management principles to streamline instrument use and processing to create a visualized instrument atlas that classifies the instrument to the necessary set, as well as a standby set that is only opened during special situations.

“Before this Lean improvement project, the instrument vendor representative didn’t provide the information about how to classify instruments and so sterile processing staff were processing every instrument they received, creating significant waste,” Deng acknowledges.

One key outcome was a significantly reduced number of required instruments used during the procedure (from 245 instruments to 72 instruments), which also reduced instrument processing time from 545-695 minutes down to 315-430 minutes and improved on-time instrument readiness from 87.4% to 91.7%. This improvement has continued, reaching 96% in 2019.

Through this work the Lean management team also drafted and issued management regulations and standardized procedures that were then applied at other hospitals within the system.

3 Ways to Make the Most of Lean Tools

Time and time again, Deng has found that Lean methodologies provide strategic approaches to address complex issues. Through her experiences applying lean for perioperative improvements she has found these three application strategies can make all the difference:

1. Take time to apply a value stream map to assess your current state, and then develop your goal state so you have a tangible pathway for improvement.
2. Bring together manufacturers with nurses and other frontline staff to develop collaborative solutions when using the 5S to eliminate waste in practices, resources and staff time.
3. Use Lean visualization to break down and better understand practice issues so you and your team can organize complexities in practice that are wasting time and resources at the point of care.

Always be looking for ways to improve how you apply Lean, she stresses. “While Lean methodologies are commonly used in perioperative care, we can always experiment and identify better methods to refine the way we use these tools in our ongoing work to build a culture of improvement.”

AORN Leader Membership

Designed for perioperative nurse leaders who need solutions beyond clinical challenges, like staffing and budgeting, while also supporting your professional passion. Benefit highlights include:

• Free and discounted leadership events
• Free online leadership courses
• ORNurseLink online community leader-only group

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