2. Describe, in short, how OR process was improved and how this improvement affected the process metrics (flow time, value added time, waste and % value added time)

2. Describe, in short, how OR process was improved and how this improvement affected the process metrics (flow time, value added time, waste and % value added time)

1. For the high level value stream map in figure 1, calculate the following
a) Flow time
b) Value added time
c) Waste
d) Percent value added time , given that % value added time =
Value added time / Flow time

2. Describe, in short, how OR process was improved and how this improvement affected the process metrics (flow time, value added time, waste and % value added time)

Langenbecks Arch Surg (2011) 396:1047–1053 DOI 10.1007/s00423-011-0833-4

ORIGINAL ARTICLE

Lean processes for optimizing OR capacity utilization: prospective analysis before and after implementation of value stream mapping (VSM)
Patrick Schwarz & Klaus Dieter Pannes & Michel Nathan & Hans Jorg Reimer & Axel Kleespies & Nicole Kuhn & Anne Rupp & Nikolaus Peter Zügel

Received: 19 November 2010 / Accepted: 26 July 2011 / Published online: 9 August 2011 # Springer-V erlag 2011

Abstract Background The decision to optimize the processes in the operating tract was based on two factors: competition among clinics and a desire to optimize the use of available resources. The aim of the project was to improve operating
In memoriam: Professor Dr. Jens Witte, 12 June 2003 P . Schwarz Department Block OP , Centre Hospitalier Emile Mayrisch (CHEM), Esch-sur-Alzette, Luxembourg K. D. Pannes Porsche Consulting, Bietigheim-Bissingen, Germany M. Nathan Centre Hospitalier Emile Mayrisch (CHEM), Esch-sur-Alzette, Luxembourg . Zügel H. J. Reimer : N. P Department of Surgery, Centre Hospitalier Emile Mayrisch (CHEM), Esch-sur-Alzette, Luxembourg N. Kuhn : A. Rupp Department Quality and Risk Management, Centre Hospitalier Emile Mayrisch (CHEM), Esch-sur-Alzette, Luxembourg . Zügel A. Kleespies : N. P Department of Surgery, Ludwig-Maximilian University (LMU), Munich-Grosshadern, Germany N. P . Zügel (*) General and Visceral Surgery Unit, Centre Hospitalier Emile Mayrisch (CHEM), Rue Emile Mayrisch, 4005 Esch-sur-Alzette, Luxembourg e-mail: nikolaus.zuegel@chem.lu

room (OR) capacity utilization by reduction of change and throughput time per patient. Setting The study was conducted at Centre Hospitalier Emil Mayrisch Clinic for specialized care (n =618 beds) Luxembourg (South). Method A prospective analysis was performed before and after the implementation of optimized processes. V alue stream analysis and design (value stream mapping, VSM) were used as tools. VSM depicts patient throughput and the corresponding information flows. Furthermore it is used to identify process waste (e.g. time, human resources, materials, etc.). For this purpose, change times per patient (extubation of patient 1 until intubation of patient 2) and throughput times (inward transfer until outward transfer) were measured. VSM, change and throughput times for 48 patient flows (VSM-A1, actual state = initial situation) served as the starting point. Interdisciplinary development of an optimized VSM (VSM-O) was evaluated. Prospective analysis of 42 patients (VSM-A2) without and 75 patients (VSM-O) with an optimized process in place were conducted. Results The prospective analysis resulted in a mean change time of (mean±SEM) VSM-A2 1,507±100 s versus VSMO 933±66 s (p <0.001). The mean throughput time VSMA2 (mean ± SEM) was 151 min (±8) versus VSM-O 120 min (±10) (p <0.05). This corresponds to a 23% decrease in waiting time per patient in total. Conclusion Efficient OR capacity utilization and the optimized use of human resources allowed an additional 1820 interventions to be carried out per year without any increase in human resources. In addition, perioperative patient monitoring was increased up to 100%. Keywords V alue stream mapping . Lean management . OR management

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Langenbecks Arch Surg (2011) 396:1047–10

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