Improving first case start times using Lean in an academic medical center

Romina Deldar, Tahereh Soleimani, Carol Harmon, Larry H. Stevens, Rajiv Sood, Tholpady Sunil, Michael W. Chu

Research output: Contribution to journalArticlepeer-review

12 Scopus citations


Background Lean is a process improvement strategy that can improve efficiency of the perioperative process. The purpose of this study was to identify etiologies of late surgery start times, implement Lean interventions, and analyze their effects. Methods A retrospective review of all first-start surgery cases was performed. Lean was implemented in May 2015, and cases 7 months before and after implementation were analyzed. Results A total of 4,492 first-start cases were included; 2,181 were pre-Lean and 2,311 were post-Lean. The post-Lean group had significantly higher on-time starts than the pre-Lean group (69.0% vs 57.0%, P <.01). The most common delay etiology was surgeon-related for both groups. Delayed post-Lean cases were significantly less likely to be due to preoperative assessment (14.9% vs 9.9%, P <.01) and more likely due to patient-related (16.5% vs 22.3%, P <.01) or chaplain (1.8% vs 4.0%, P <.01) factors. Delayed starts occurred more often on snowy and cold days, and less often on didactic days (P <.01). Conclusions Modifying preoperative tasks using Lean methods can improve operating room efficiency and increase on-time starts.

Original languageEnglish (US)
Pages (from-to)991-995
Number of pages5
JournalAmerican Journal of Surgery
Issue number6
StatePublished - Jun 2017


  • Efficiency
  • Lean
  • On-time starts
  • Surgery

ASJC Scopus subject areas

  • Surgery

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