Employing lean six sigma strategies to improve operating room first case on-time starts: A case report

Background: The operating room is a key driver of hospital revenue, making the monitoring of performance metrics crucial for cost reduction. Perioperative leaders often struggle to pinpoint the causes of delays. This article describes how an ambulatory surgical center implemented Lean Six Sigma methodology to identify barriers and implement targeted interventions to improve first-case on-time starts. Methods: A multidisciplinary committee employed the standard process improvement methodology known as define-measure-analyze-improve-control (DMAIC) to assess workflow, identify the root causes of delays, and implement five targeted interventions to improve workflow. Results: Data from 888 cases were examined over a 20-month period in the perioperative department, 180 cases before and 708 cases during and after implementation. First case on-time starts increased from 30 % to 79 % 12 months after the interventions were implemented. Additionally, delays in OR minutes decreased by approximately 49 % during this time frame. Conclusion: A multidisciplinary committee's use of Lean Six Sigma strategies, particularly the DMAIC framework, has effectively identified barriers to on-time first case starts in the OR. This approach established a solid foundation for developing targeted problem-solving interventions. By applying this methodology, the committee improved operational efficiency and reduced delays in the surgical workflow.