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Southeast Alabama Medical Center Significantly Improves Surgery Productivity

Southeast Alabama, a 370 bed facility located in Dothan, Alabama, was facing serious productivity challenges in its perioperative service. The organization exhibited excessive variation in surgical flow, including late first case start times, slow room turnover and lengthy delays in the Pre-Surgical Testing Clinic (PST). This was driving a decline in patient, physician and staff satisfaction. Previous attempts to address these issues were unsuccessful, causing the Chief of Anesthesia to predict publicly that this initiative would also fail.

Southeast Alabama Deploys Lean-Six Sigma to Launch a 100 Day Surgery Workout

Southeast Alabama's Needs:

  • Increase staff productivity
  • Improve surgeon satisfaction
  • Improve first case start compliance

Southeast Alabama Medical Center engaged Caldwell Butler to support its initiative through the application of Lean-Six Sigma and its 100 Day Workout Productivity Series. Caldwell Butler assisted senior management in identifying potential strategies to yield significant improvements in surgical patient flow. The stated goal was to enhance staff productivity - measured as total cut-to-close hours divided by Circulator and Scrub Tech hours worked - and to improve surgeon satisfaction. A secondary goal was to create efficiency and predictability in first case starts and room turnover, and to solve issues of inadequate capacity in the PST Clinic. During implementation, Caldwell Butler employed proven methods to validate the effectiveness of each change proposed by the workout teams.

Process Flow and Statistical Analysis

Caldwell Butler deployed its expertise in Lean-Six Sigma methodologies to identify and quantify potential opportunities for improving surgery flow and productivity. The statistical analysis revealed that 74% of inpatient and 58% of outpatient first cases started more than 5 minutes late; 63% of room turnovers took longer than 25 minutes; and PST LOS averaged 76 minutes, causing persistent staff overtime. Caldwell Butler used its extensive healthcare experience to identify opportunities for improving surgical process flow. Analysis revealed this change would yield significant gains in satisfaction, capacity and efficiency.

Strategy Development

With support of Caldwell Butler, Southeast Alabama Medical Center organized three multi-disciplinary, sub-process work teams to identify solutions. Each team focused on different areas including pre-admission, pre-op and recovery, and OR flow. The teams began assessing a multitude of possible improvement strategies. Caldwell Butler provided the expertise in process flow analysis to assist each team in determining which Change Concepts would produce the most dramatic improvements.

Change Concepts

  • Develop an ideal value stream process map for on-time starts
  • Create turnover teams with standardized roles
  • Re-sequence process steps in the PST Clinic
  • Match staffing to demand in intra-operative services

Implementation of Rapid Cycle Testing

Caldwell Butler provided its expertise to test and implement each of the identified Change Concepts. Methods of Rapid Cycle Testing were utilized to accelerate the achievement of sustainable improvements. The results of each project were analyzed using advanced statistical techniques to quantify effectiveness.

Demonstrated Statistically Significant Results of Southeast Alabama Implementation

  • The staff productivity metric increased by 17.6% from baseline
  • Surgeon satisfaction improved on all measures in a post-workout written survey
  • First case starts occurred an average of seven minutes earlier
  • Average surgeon turnover time fell from 31 minutes to 18 minutes
  • The PST Clinic LOS dropped from 76 minutes to 46 minutes, creating a 39% increase in capacity with no increase in staffing
  • The outpatient post-recovery LOS declined from an average of 50 to 41 minutes

1st case starts occur seven minutes earlier on average and are more consistent

Chart of first case cut times