Cutting the fat: Utilizing LEAN methodology to improve rounding efficiency of surgical residents

Marcie Feinman; Angela Ting Wei Hsu; Stephanie Taylor; Laura Torbeck

doi:10.1016/j.amjsurg.2021.12.005

Cutting the fat: Utilizing LEAN methodology to improve rounding efficiency of surgical residents

Am J Surg. 2022 Jun;223(6):1100-1104. doi: 10.1016/j.amjsurg.2021.12.005. Epub 2021 Dec 6.

Authors

Marcie Feinman¹, Angela Ting Wei Hsu², Stephanie Taylor³, Laura Torbeck⁴

Affiliations

¹ Department of Surgery, Sinai Hospital of Baltimore, 2435 Belvedere Ave, Hoffberger Building, Suite 42, Baltimore, MD, 21215, USA. Electronic address: mfeinman@lifebridgehealth.org.
² Department of Surgery, Johns Hopkins University School of Medicine, 600 North Wolfe St, Blalock 607, Baltimore, MD, USA.
³ Department of Surgery, Sinai Hospital of Baltimore, 2435 Belvedere Ave, Hoffberger Building, Suite 42, Baltimore, MD, 21215, USA.
⁴ Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr, EH 543, Indianapolis, IN, 46202, USA.

PMID: 34916037
DOI: 10.1016/j.amjsurg.2021.12.005

Abstract

Background: LEAN was developed by Toyota to provide a systematic way to eliminate waste and standardize processes. We sought to introduce LEAN methodology to surgical residents with the goal of increasing rounding efficiency.

Methods: A Kaizen event was used as a rounding efficiency improvement strategy. A multidisciplinary healthcare team participated in the event; first to identify the current state of rounds, second to create the ideal state. Value-stream maps were created and improved efficiency was seen by increased ratio of productive time to lead time.

Results: Two interventions were prioritized. The first introduced table rounds before walk rounds and the second changed the sign-out tool from Baton to Microsoft Word with file encryption. The ratio of productive time to lead time during morning rounds was higher after implementing these interventions (3.73 vs. 2.03).

Conclusions: This Kaizen event introduced surgical trainees to LEAN and resulted in improved efficiency of morning rounds.

Keywords: Kaizen event; LEAN; Residency; Surgery.

MeSH terms

Efficiency
Efficiency, Organizational
Humans
Internship and Residency*
Teaching Rounds*