The use of Lean and Six Sigma methodologies in surgery: A systematic review
The SurgeonPublished 2 September 2014
Sam Mason, Chris Nicolay, Ara Darzi
Citations270
SJR quartileQ2
SJR score0.71
SNIP1.11
Generate an AI Snapshot to get a quick, structured summary of this paper.
Study Snapshot
ObjectiveStudy objective
MethodsResearch methodology
PopulationPopulation studied
Sample sizeSample sizes
OutcomesStudy outcomes here
ResultsStudy results comes here
LimitationsResearch study limitations comes here
A concise AI-generated summary of the paper will appear here once you click Generate AI Snapshot.
TL;DR
Lean and Six Sigma QI methodologies have the potential to produce clinically significant improvement for surgical patients, however there is a need to conduct high-quality studies with low risk of systematic bias in order to further understand their role.
Abstract
Lean and Six Sigma QI methodologies have the potential to produce clinically significant improvement for surgical patients. However there is a need to conduct high-quality studies with low risk of systematic bias in order to further understand their role.
Keywords
MedicineHealth Professions
PLoS MedicineThe PRISMA Statement for Reporting Systematic Reviews and Meta-Analyses of Studies That Evaluate Health Care Interventions: Explanation and Elaboration
27,883 Citations2009Alessandro Liberati, Douglas G. Altman +8 more
The meaning and rationale for each checklist item is explained, and an example of good reporting is included and, where possible, references to relevant empirical studies and methodological literature are included.
Cochrane Handbook for Systematic Reviews of Interventions
24,936 Citations2008
BMJThe PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration
17,710 Citations2009A. Liberati, Doug Altman +8 more
Journal of Clinical EpidemiologyGRADE guidelines: A new series of articles in the Journal of Clinical Epidemiology
3,125 Citations2010Gordon Guyatt, Andrew D Oxman +3 more
This article introduces a 20-part series providing guidance for the use of GRADE methodology that will appear in the Journal of Clinical Epidemiology.
Journal of Clinical EpidemiologyGRADE guidelines 6. Rating the quality of evidence—imprecision
2,506 Citations2011Gordon Guyatt, Andrew D Oxman +18 more
It is suggested that examination of 95% confidence intervals (CIs) provides the optimal primary approach to decisions regarding imprecision and rating down the quality of evidence is required if clinical action would differ if the upper versus the lower boundary of the CI represented the truth.
Journal of the American College of SurgeonsUse of Lean and Six Sigma Methodology to Improve Operating Room Efficiency in a High-Volume Tertiary-Care Academic Medical Center
433 Citations2011Robert R. Cima, Michael J. Brown +8 more
Use of Lean and Six Sigma methodologies increased OR efficiency and financial performance across an entire operating suite and were substantial, sustainable, positive financially, and transferrable to other specialties.
BMJ Quality & SafetyThe SQUIRE (Standards for QUality Improvement Reporting Excellence) guidelines for quality improvement reporting: explanation and elaboration
430 Citations2008Greg Ogrinc, Susan Mooney +17 more
The purpose of the SQUIRE E & E document is to assist authors along the path from completion of a quality improvement project to its publication and provides one or two examples from the published improvement literature, followed by an analysis of the ways in which the example expresses the intent of the guideline item.
British journal of surgerySystematic review of the application of quality improvement methodologies from the manufacturing industry to surgical healthcare
344 Citations2011Chris Nicolay, Sanjay Purkayastha +5 more
The aim of this systematic review was to identify and evaluate the application and effectiveness of quality improvement methodologies to the field of surgery.
Quality Management in Health CareAssessing the Evidence of Six Sigma and Lean in the Health Care Industry
291 Citations2010Jami L. DelliFraine, James R. Langabeer +1 more
It is demonstrated that there are significant gaps in the SS/L health care quality improvement literature and very weak evidence thatSS/L improve health carequality.
Social Science & MedicineOutpatient process quality evaluation and the Hawthorne Effect
266 Citations2006Kenneth L. Leonard, Melkiory C. Masatu
Analysis of data on the quality of care provided by clinicians in Arusha region of Tanzania shows a marked fall in quality over time as new patients are consulted, and strong evidence is shown of the Hawthorne effect.
Implementation ScienceA critical review of the research literature on Six Sigma, Lean and StuderGroup's Hardwiring Excellence in the United States: the need to demonstrate and communicate the effectiveness of transformation strategies in healthcare
214 Citations2009Joshua R. Vest, Larry Gamm
Improved design and analysis can more effectively guide healthcare leaders who are motivated to transform their organizations and convince others of the need to employ such strategies.
Journal of the American College of SurgeonsLean Management in Academic Surgery
171 Citations2012Ryan M. Collar, Andrew G. Shuman +8 more
Application of lean management techniques to a single operating room and surgical service improved operating room efficiency and morale, sustained resident education, and can provide considerable financial gains when scaled to an entire academic surgical suite.
JAMAHow to Use an Article About Quality Improvement
133 Citations2010Eddy Fan, Andreas Laupacis +3 more
This article complements and enhances existing Users' Guides that address the effects of interventions--Therapy, Harm, Clinical Decision Support Systems, and Summarizing the Evidence guides--with an emphasis on issues specific to QI studies.
Journal of the American College of SurgeonsUse of Corporate Six Sigma Performance-Improvement Strategies to Reduce Incidence of Catheter-Related Bloodstream Infections in a Surgical ICU
109 Citations2005Heidi L. Frankel, William B. Credè +4 more
This represents the first successful application of Six Sigma corporate performance-improvement method impacting purely clinical outcomes and CR-BSI reduction was highly substantial and sustained after other traditional strategies had failed.
The Journal of Trauma: Injury, Infection, and Critical CareQuality in Trauma Care: Improving the Discharge Procedure of Patients by Means of Lean Six Sigma
103 Citations2010Gerard C. Niemeijer, Albert Trip +3 more
This study shows that Lean Six Sigma is an effective method to reduce inappropriate hospital stay, thereby improving the quality and financial efficiency of trauma care.
JONA The Journal of Nursing AdministrationDecreasing Turnaround Time Between General Surgery Cases
80 Citations2004Rella Adams, Pam Warner +2 more
Journal of Pediatric SurgeryApplication of lean methods improves surgical clinic experience
78 Citations2010John H.T. Waldhausen, Jeffrey R. Avansino +2 more
Lean methodology may be used to improve clinic efficiency as well as patient and staff's experience in high volume surgery clinics.
Journal of Vascular SurgeryLean principles optimize on-time vascular surgery operating room starts and decrease resident work hours
66 Citations2013Courtney J. Warner, Daniel B. Walsh +5 more
Use of Lean principles allowed rapid identification and implementation of perioperative process changes that improved efficiency and resulted in significant cost savings, which was sustained at 1 year.
Journal of Evaluation in Clinical PracticeThe usefulness of lean six sigma to the development of a clinical pathway for hip fractures
66 Citations2012Gerard C. Niemeijer, Elvira R. Flikweert +5 more
The findings of this study show a successful application of lean six sigma methodology within the development of a clinical pathway and the effect of the use of LSS methodology at clinical outcome and quality of life.
JAMA SurgeryRedesigning a Joint Replacement Program Using Lean Six Sigma in a Veterans Affairs Hospital
65 Citations2013Benjamin Gayed, Stephen Black +2 more
The success of the Joint Replacement Program demonstrates that VA-TAMMCS is an effective tool for Lean and Six Sigma process improvement initiatives in a surgical practice, producing a 36% sustained reduction in length of stay and completely eliminating non-VA care for total hip and knee replacements while increasing total joint replacement volume at this medical center.
BMJEffect of a "Lean" intervention to improve safety processes and outcomes on a surgical emergency unit
61 Citations2010Peter McCulloch, Simon Kreckler +4 more
Lean can substantially and simultaneously improve compliance with a bundle of safety related processes and this strategy might not translate into improvements in safety outcomes unless a system-wide approach is adopted to remove barriers to change.
InjuryLean thinking: Can it improve the outcome of fracture neck of femur patients in a district general hospital?
60 Citations2011Taher Yousri, Z. Khan +3 more
To the knowledge, this is the largest study in the literature where the Lean framework has been successfully employed for the management of a very challenging health-care issue faced by the National Health Service.
Infection Control and Hospital EpidemiologyImplementation of an Industrial Systems-Engineering Approach to Reduce the Incidence of Methicillin-Resistant<i>Staphylococcus aureus</i>Infection
59 Citations2008Robert R. Muder, Candace Cunningham +6 more
Sustained reduction in the incidence of MRSA infection is possible in a setting where this pathogen is endemic and an industrial systems-engineering approach can be adapted to facilitate consistent and reliable adherence to MRSA infections prevention practices in healthcare facilities.
Anesthesia & AnalgesiaSix Sigma Methodology Can Be Used to Improve Adherence for Antibiotic Prophylaxis In Patients Undergoing Noncardiac Surgery
57 Citations2006Brian M. Parker, J. Michael Henderson +12 more
Six Sigma methods were used to successfully improve the process for timing of perioperative antibiotic prophylaxis before surgical incision and an electronic anesthesia record keeping system is a useful tool to monitor this process improvement.
Journal of Quality TechnologyReducing Start Time Delays in Operating Rooms
55 Citations2009Ronald J. M. M. Does, T.M.B. Vermaat +3 more
After introducing a new planning process, the hospitals involved were able to gain substantial cost savings, increased efficiency, and substantial reductions of the delay in start times for surgery.
JAMAFrom Waste to Value in Health Care
54 Citations2008Thomas F. Boat
This paper focuses on the use of nonpharmaceutical interventions in the context of the Influenza Pandemic Operations Plan, which aims to provide a guide for the rapid implementation of these strategies in the United States.
Langenbeck s Archives of SurgeryLean processes for optimizing OR capacity utilization: prospective analysis before and after implementation of value stream mapping (VSM)
52 Citations2011Patric Schwarz, Klaus Dieter Pannes +6 more
Efficient OR capacity utilization and the optimized use of human resources allowed an additional 1820 interventions to be carried out per year without any increase in human resources.
The Annals of Thoracic SurgeryKaizen Method for Esophagectomy Patients: Improved Quality Control, Outcomes, and Decreased Costs
47 Citations2011Mark D. Iannettoni, William R. Lynch +2 more
Utilizing lean manufacturing techniques and continuous process evaluation, a 43% reduction in cost per case has been achieved with a significant increase in contribution margin for esophagectomy using a continuous process improvement methodology.
BMJ Quality & SafetyEfficacy and efficiency of a lean cataract pathway: a comparative study
44 Citations2010Ellen Joan van Vliet, Walter Sermeus +3 more
The challenge for healthcare teams is not to improve care delivery by using lean pathways as opposed to using traditional pathways, but to strive for optimal performance by consistently adhering to the specifications of the lean pathway.
Journal for Healthcare QualityThe Utilization of Six Sigma and Statistical Process Control Techniques in Surgical Quality Improvement
43 Citations2010Jeffrey D. Sedlack
Process control methods were applied to surgeon waiting time between cases, and to length of stay (LOS) after colon surgery, finding poor overall control of the room turnover process.
PubMedToyota production system quality improvement initiative improves perioperative antibiotic therapy.
40 Citations2009Kelly H. Burkitt, Maria K. Mor +9 more
The use of TPS methods resulted in a QI intervention that was associated with an increase in appropriate perioperative antibiotic therapy among surgical patients, without affecting LOS.
International Journal of Health Care Quality AssuranceApplication of Six Sigma methodology to a cataract surgery unit
36 Citations2013Mehmet Tolga Taner
Six Sigma measurement and process improvement can become the impetus for cataract unit staff to rethink their process and reduce malpractices, as shown in this first Six Sigma ophthalmology study in Turkey.
Anesthesiology Research and PracticeSuccessful Implementation of a Perioperative Glycemic Control Protocol in Cardiac Surgery: Barrier Analysis and Intervention Using Lean Six Sigma
35 Citations2011Elizabeth A. Martinez, Raul Chavez‐Valdez +7 more
The use of the Lean Six Sigma methodology is described to implement a perioperative insulin protocol in a cardiac surgical intensive care unit (CSICU) in a large academic hospital.
BMJQuality of care in the NHS of England
28 Citations2004Sheila Leatherman, Kim Sutherland
The quality agenda was characterized as being the “most ambitious, comprehensive, systemic and intentionally funded effort to create predictable and sustainable capacity for improving the quality of a nation's health care system.”
PubMedApplication of Six Sigma towards improving surgical outcomes.
24 Citations2008Parul J. Shukla, Savio George Barreto +1 more
This study represents one of the first clinical applications of Six Sigma in the surgical field and has an opportunity to transfer a very successful management philosophy to facilitate the identification of key steps that can improve outcomes and ultimately patient safety and the quality of surgical care provided.
Journal of Perioperative PracticeOne-Stop Cholecystectomy Clinic: An Application of Lean Thinking - Can it Improve the Outcomes?
13 Citations2012Khurram Siddique, Sameh Effat Abd Elsayed +3 more
AORN JournalDecreasing Preoperative Delays—A Rapid Process Improvement Project
6 Citations2003Judith Celik
A 7% reduction in delays occurred as a result of the implementation of rapid process improvement methodology, which was not statistically significant, but clinically significant.
