Abstract:

In order to face the recent challenge of healthcare systems that requires to reduce costs, assuring effectiveness of care and patient safety, lean management has been adopted increasingly, with the aim to improve healthcare performance through the identification of non-value-added activities and waste elimination.

The paper reports the project of reorganization of surgical activity through lean implementation conducted in the Azienda Ospedaliera of Padova (AOP), which is one of the main University Hospitals in Italy delivering almost 50.000 surgical interventions per year. The specific project objectives were the improvement of efficiency, productivity, safety and effectiveness of surgical care involving the complex surgery and all the 13 operating theatres (OTs) of the AOP (47 operating rooms in total).

Considering the international experiences indicating the best way to manage the OTs, four fundamental phases were conceived in the development of the project:
a) Project planning and organization;
b) Training and sharing programme articulated in motivating the project, lean management methodology, training on the job conducting lean projects in each OT;
c) Fixing the improving surgical paths defining new standard operating procedures;
d) Creating a continuous improvements orientation implementing Safety and Quality Walkarounds.

After two years of project implementation, the results obtained include the introduction of an OTs performance measurement system, the improved standard operating procedures definition, the continuous improvement orientation and enhanced communication among all the organization. In more details, the efficiency and productivity performance indicators of 2018, compared to 2016 show: number of inpatient surgical operations increased by 17,6%, total planned session time increased by 5,7% with 5.085 hours more of OT utilization, surgical activity revenues increased by 7,4% with a total increase of € 12,5 million in the two years.

In Italy, the AOP experience is one of the first lean management project characterized by a systemic view, involving all the key figures of the Hospital and all the operating rooms, with the aim to create value in operations throughout the company.

Keywords:

Lean healthcare, Lean training, Operating rooms, surgical procedures, Continuous improvement.