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Related Experiment Video

Updated: May 8, 2026

The Transition to an Anterior-Based Muscle Sparing Approach Improves Early Postoperative Function but is Associated with a Learning Curve

The Transition to an Anterior-Based Muscle Sparing Approach Improves Early Postoperative Function but is Associated with a Learning Curve

Published on: September 7, 2022

Redesigning a joint replacement program using Lean Six Sigma in a Veterans Affairs hospital.

Benjamin Gayed¹, Stephen Black, Joanne Daggy

¹Department of Surgery, Indiana University School of Medicine, Indianapolis.

|September 13, 2013

Summary

Lean Six Sigma methods reduced joint replacement length of stay by 36% and eliminated non-Veterans Affairs (VA) care costs. This process improvement initiative at a VA medical center demonstrated significant efficiency gains and cost savings.

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Published on: August 4, 2022

Area of Science:

Healthcare Management
Surgical Process Improvement
Lean Six Sigma

Background:

Total hip and knee replacements at a VA medical center incurred significant non-VA care costs ($1.4 million) and had a lengthy average stay (6.1 days).
A Joint Replacement Program system redesign was initiated to enhance efficiency, reduce length of stay, and decrease non-VA care expenditures.

Purpose of the Study:

To evaluate the effectiveness of Lean Six Sigma process improvement methodologies within a Veterans Affairs (VA) hospital setting.
To determine the impact of the VA-TAMMCS model on surgical process efficiency and patient care costs.

Main Methods:

The VA-TAMMCS (Vision-Analysis-Team-Aim-Map-Measure-Change-Sustain) model, a Lean Six Sigma approach, was implemented to redesign perioperative processes for joint replacement patients.
A multidisciplinary team identified and eliminated waste in existing processes, focusing on improving efficiency and reducing costs.
Data were collected over a 1-year baseline period and a subsequent 20-month sustainment period.

Main Results:

Overall length of stay for total joint replacements decreased by 36%, from 5.3 days to 3.4 days (P < .001).
Non-VA care costs were completely eliminated for total hip and knee replacement patients.
An estimated annual return on investment of $1 million was achieved, with an increase in the volume of total joint replacements performed.

Conclusions:

The VA-TAMMCS model proved effective for Lean and Six Sigma process improvement in a surgical setting.
The initiative resulted in a sustained 36% reduction in length of stay and the elimination of non-VA care costs for joint replacements.
The program successfully increased the volume of total joint replacements while enhancing operational efficiency and financial outcomes.