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Developing a Cost-Effective Surgical Scheduling System Applying Lean Thinking and Toyota's Methods for

Chien-Chung Lin1,2, Jian-Hong Shen3, Shu-Fang Chen4

  • 1Department of Orthopedic Surgery, Taipei City Hospital, Taipei, Taiwan.

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Lean principles and Toyota methods streamlined surgical scheduling, reducing task times and improving efficiency without added costs. Continuous improvements are ongoing for patient safety and system reliability.

Keywords:
Toyota Production Systemalgorithmcomputational thinkingcontinuous improvementcustomer needslean principlesneedneedsoperating roomproblem solvingprocessvalue stream map

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Area of Science:

  • Healthcare Management
  • Operations Research
  • Industrial Engineering

Background:

  • Surgical scheduling is critical for patient experience and hospital resource management, with operating room costs emphasizing the need for efficiency.
  • Global surgical scheduling practices vary due to difficulties in predicting surgeon times for diverse patient conditions.
  • Lean Thinking principles, inspired by the Toyota Production System, identify and eliminate waste in processes, crucial for improving healthcare quality and patient safety.

Purpose of the Study:

  • To develop a more efficient surgical scheduling system using lean thinking and Toyota methods.
  • To align the scheduling system with user needs without introducing additional financial burdens.
  • To enhance responsiveness and efficiency in surgical workflow management.

Main Methods:

  • Implementation of the 5 Toyota principles: specifying value, identifying the value stream, enabling flow, establishing pull, and pursuing perfection.
  • Development of two Visual Basic for Applications macros in Excel: one for calculating average surgery times and another for estimating durations and generating reports from presurgery data.
  • Creation of a comprehensive value stream map to identify and address inefficiencies in the presurgery data subsystem.

Main Results:

  • Significant reduction in overall scheduling time from 301 to 261 seconds (P=.02) and revised process time from 99 to 62 seconds (P<.001).
  • Despite improvements, 21% of nurses preferred the older system due to familiarity.
  • The new system ensures data privacy, streamlines dissemination via a secure LINE group, allows real-time updates, and has monitored surgical durations for over 3 years.

Conclusions:

  • Lean principles and Toyota methods, integrated with computer programming, offer a revitalized approach to surgical scheduling.
  • This approach provides effective solutions for surgical scheduling challenges, enabling a novel system without additional costs.
  • Ongoing efforts focus on continuous improvement, particularly in the preoperative patient confirmation step, to further enhance patient safety.