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    Elimination of waste: creation of a successful Lean colonoscopy program at an academic medical center

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    Authors
    Damle, Aneel
    Andrew, Nathan
    Kaur, Shubjeet
    Orquiola, Alan
    Alavi, Karim
    Steele, Scott R.
    Maykel, Justin A.
    UMass Chan Affiliations
    Department of Anesthesiology
    Department of Surgery
    Document Type
    Journal Article
    Publication Date
    2015-10-28
    Keywords
    Colonoscopy
    Lean
    Process improvement
    Quality improvement
    Health and Medical Administration
    Health Services Administration
    Health Services Research
    Surgery
    
    Metadata
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    Link to Full Text
    http://dx.doi.org/10.1007/s00464-015-4599-6
    Abstract
    OBJECTIVE: Lean processes involve streamlining methods and maximizing efficiency. Well established in the manufacturing industry, they are increasingly being applied to health care. The objective of this study was to determine feasibility and effectiveness of applying Lean principles to an academic medical center colonoscopy unit. METHODS: Lean process improvement involved training endoscopy personnel, observing patients, mapping the value stream, analyzing patient flow, designing and implementing new processes, and finally re-observing the process. Our primary endpoint was total colonoscopy time (minutes from check-in to discharge) with secondary endpoints of individual segment times and unit colonoscopy capacity. RESULTS: A total of 217 patients were included (November 2013-May 2014), with 107 pre-Lean and 110 post-Lean intervention. Pre-Lean total colonoscopy time was 134 min. After implementation of the Lean process, mean colonoscopy time decreased by 10 % to 121 min (p = 0.01). The three steps of the process affected by the Lean intervention (time to achieve adequate sedation, time to recovery, and time to discharge) decreased from 3.7 to 2.4 min (p < 0.01), 4.0 to 3.4 min (p = 0.09), and 41.2 to 35.4 min (p = 0.05), respectively. Overall, unit capacity of colonoscopies increased from 39.6 per day to 43.6. Post-Lean patient satisfaction surveys demonstrated an average score of 4.5/5.0 (n = 73) regarding waiting time, 4.9/5.0 (n = 60) regarding how favorably this experienced compared to prior colonoscopy experiences, and 4.9/5.0 (n = 74) regarding professionalism of staff. One hundred percentage of respondents (n = 69) stated they would recommend our institution to a friend for colonoscopy. DISCUSSION: With no additional utilization of resources, a single Lean process improvement cycle increased productivity and capacity of our colonoscopy unit. We expect this to result in increased patient access and revenue while maintaining patient satisfaction. We believe these results are widely generalizable to other colonoscopy units as well as other process-based interventions in health care.
    Source
    Damle A, Andrew N, Kaur S, Orquiola A, Alavi K, Steele SR, Maykel J. Elimination of waste: creation of a successful Lean colonoscopy program at an academic medical center. Surg Endosc. 2015 Oct 28. doi: 10.1007/s00464-015-4599-6 [Epub ahead of print] PubMed PMID: 26511122.
    DOI
    10.1007/s00464-015-4599-6
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/49726
    PubMed ID
    26511122
    Related Resources
    Link to article in PubMed
    ae974a485f413a2113503eed53cd6c53
    10.1007/s00464-015-4599-6
    Scopus Count
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