Leveraging Lean Methodology to Improve Compliance With Work-Hour Restrictions

Area of Science:

• Medical Education
• Quality Improvement
• Surgical Residency Training

Background:

• Sustaining compliance with duty-hour regulations presents ongoing challenges for general surgery residency programs.
• Industry-based process improvement techniques offer potential solutions for enhancing compliance.

Purpose of the Study:

• To evaluate the effectiveness of Lean methodology in increasing adherence to work-hour restrictions within a general surgery residency program.

Main Methods:

• A quality improvement project utilizing Lean methodology was implemented in a university-based general surgery residency program.
• Interventions targeted root causes of non-compliance, including scheduling, workflows, and resident/faculty expectations.
• Resident time logs and surveys were analyzed before and after intervention implementation.

Main Results:

• The mean number of residents exceeding 80 work hours per week decreased by 10.2% (from 12.4% to 2.2%).
• Perceived compliance with 80-hour work limits increased from 72% to 88% over the study period.
• Faculty-reported resident preparedness showed a modest increase, though other metrics remained unchanged.

Conclusions:

• Lean methodology can effectively improve working environments and enhance compliance with resident work hours in surgical residency programs.
• Engaging frontline trainees in process improvement initiatives is crucial for successful implementation.