JMIR Publications

ABSTRACT

Background:

Surgical scheduling plays a critical role in managing the daily sequence of patient surgeries, directly impacting both patient experience and hospital resources. With operating rooms costing approximately $36 USD per minute, efficient scheduling is vital. Current global practices in surgical scheduling lack uniformity, primarily due to the challenge of accurately predicting individual surgeon times for varying patient conditions. Inspired by the Toyota Production System's efficiency in addressing similar logistical challenges, we applied its principles as detailed in the book "Lean Thinking" by Womack and Jones, which identifies processes that do not meet customer needs as wasteful. This insight is critical in healthcare, where waste can compromise patient safety and medical quality.

Objective:

This study aims to employ lean thinking and Toyota methods to develop a more efficient surgical scheduling system that better aligns with user needs without additional financial burdens.

Methods:

We implemented the five principles of the Toyota system: specifying value, identifying the value stream, enabling flow, establishing pull, and pursuing perfection. Value was defined in terms of meeting the customer's needs, which in this context involved developing a responsive and efficient scheduling system. Our approach included two subsystems: one handling pre-surgery patient data and another for intra-operative and post-operative data. We identified inefficiencies in the pre-surgery data subsystem and responded by creating a comprehensive value stream map of the surgical process. We developed two Excel macros using Visual Basic for Applications. The first calculated average surgery times from intra/post-operative historic data, while the second estimated surgery durations and generated concise, visually engaging scheduling reports from pre-surgery data. We assessed the effectiveness of the new system by comparing task completion times and user satisfaction between the old and new systems.

Results:

The implementation of the revised scheduling system significantly reduced the overall scheduling time from 301 seconds to 261 seconds (P=.016), with significant time reductions in the revised process from 99 seconds to 62 seconds (P<.001). Despite these improvements, approximately 21% of nurses preferred the older system for its familiarity. The new system protects patient data privacy and streamlines schedule dissemination through a secure LINE group, ensuring seamless flow. The design of the system allows for real-time updates and has been effectively monitoring surgical durations daily for over three years. The 'pull' principle was demonstrated when an unplanned software issue prompted immediate, user-led troubleshooting, enhancing system reliability. Continuous improvement efforts are ongoing, except for the pre-operative patient confirmation step, which requires further enhancement to ensure optimal patient safety.

Conclusions:

Lean principles and Toyota’s methods, combined with computer programming, can revitalize surgical scheduling processes. They offer effective solutions for surgical scheduling challenges and enable the creation of a novel surgical scheduling system without incurring additional costs.