Lean philosophy and the public hospital

The Toyota Production System or Lean philosophy has been implemented in many facets of medicine from outpatient areas to critical care units to ancillary services. There has been some doubt about the applicability of this process outside of large private medical centers particularly in relationship to operating room services. We describe the success of the Lean process for the surgical services of a public, inner-city hospital.Lean methodology was applied to operating room (OR) performance measures of utilization, on-time starts, turn over time, and same day cancellations. Secondary measures of OR minutes used, OR cases completed, individual service cancellations for emergencies, and cross service bumping for emergencies were also evaluated. One years worth of data prior to the start of Lean was compared to one year after the completion of Lean. Improved performance was consistently demonstrated in all measures except same day cancellations.