Improving operating room efficiency in academic children's hospital using Lean Six Sigma methodology

J Pediatr Surg. 2017 Jun;52(6):1040-1044. doi: 10.1016/j.jpedsurg.2017.03.035. Epub 2017 Mar 18.


Background/purpose: Lean Six Sigma (LSS) is a process improvement methodology that utilizes a collaborative team effort to improve performance by systematically identifying root causes of problems. Our objective was to determine whether application of LSS could improve efficiency when applied simultaneously to all services of an academic children's hospital.

Methods: In our tertiary academic medical center, a multidisciplinary committee was formed, and the entire perioperative process was mapped, using fishbone diagrams, Pareto analysis, and other process improvement tools. Results for Children's Hospital scheduled main operating room (OR) cases were analyzed, where the surgical attending followed themselves.

Results: Six hundred twelve cases were included in the seven Children's Hospital operating rooms (OR) over a 6-month period. Turnover Time (interval between patient OR departure and arrival of the subsequent patient) decreased from a median 41min in the baseline period to 32min in the intervention period (p<0.0001). Turnaround Time (interval between surgical dressing application and subsequent surgical incision) decreased from a median 81.5min in the baseline period to 71min in the intervention period (p<0.0001).

Conclusion: These results demonstrate that a coordinated multidisciplinary process improvement redesign can significantly improve efficiency in an academic Children's Hospital without preselecting specific services, removing surgical residents, or incorporating new personnel or technology.

Study type: Prospective comparative study, Level II.

Keywords: Efficiency; Lean Six Sigma; Operating room; Process mapping; Total quality improvement.

Publication types

  • Clinical Trial

MeSH terms

  • Academic Medical Centers / organization & administration*
  • Academic Medical Centers / statistics & numerical data
  • California
  • Child
  • Efficiency, Organizational / standards*
  • Hospitals, Pediatric / organization & administration*
  • Hospitals, Pediatric / statistics & numerical data
  • Humans
  • Operating Rooms / organization & administration*
  • Operating Rooms / statistics & numerical data
  • Perioperative Care / standards*
  • Perioperative Care / statistics & numerical data
  • Process Assessment, Health Care
  • Prospective Studies
  • Quality Improvement / organization & administration*
  • Quality Improvement / statistics & numerical data
  • Time Factors
  • Total Quality Management*