Skip to content Skip to navigation
University of Warwick
  • Study
  • |
  • Research
  • |
  • Business
  • |
  • Alumni
  • |
  • News
  • |
  • About

University of Warwick
Publications service & WRAP

Highlight your research

  • WRAP
    • Home
    • Search WRAP
    • Browse by Warwick Author
    • Browse WRAP by Year
    • Browse WRAP by Subject
    • Browse WRAP by Department
    • Browse WRAP by Funder
    • Browse Theses by Department
  • Publications Service
    • Home
    • Search Publications Service
    • Browse by Warwick Author
    • Browse Publications service by Year
    • Browse Publications service by Subject
    • Browse Publications service by Department
    • Browse Publications service by Funder
  • Help & Advice
University of Warwick

The Library

  • Login
  • Admin

Lean participative process improvement : outcomes and obstacles in trauma orthopaedics

Tools
- Tools
+ Tools

New, Steve, Hadi, Mohammed, Pickering, Sharon, Robertson, Eleanor, Morgan, Lauren J., Griffin, Damian R., Collins, Gary S., Rivero-Arias, Oliver, Catchpole, Ken and McCulloch, Peter (2016) Lean participative process improvement : outcomes and obstacles in trauma orthopaedics. PLoS One, 11 (4). e0152360. doi:10.1371/journal.pone.0152360

[img]
Preview
PDF
WRAP_journal.pone.0152360.PDF - Published Version - Requires a PDF viewer.
Available under License Creative Commons Attribution 4.0.

Download (937Kb) | Preview
Official URL: http://dx.doi.org/10.1371/journal.pone.0152360

Request Changes to record.

Abstract

To examine the effectiveness of a “systems” approach using Lean methodology to improve surgical care, as part of a programme of studies investigating possible synergy between improvement approaches.

Setting

A controlled before-after study using the orthopaedic trauma theatre of a UK Trust hospital as the active site and an elective orthopaedic theatre in the same Trust as control.

Participants

All staff involved in surgical procedures in both theatres.

Interventions

A one-day “lean” training course delivered by an experienced specialist team was followed by support and assistance in developing a 6 month improvement project. Clinical staff selected the subjects for improvement and designed the improvements.

Outcome Measures

We compared technical and non-technical team performance in theatre using WHO checklist compliance evaluation, “glitch count” and Oxford NOTECHS II in a sample of directly observed operations, and patient outcome (length of stay, complications and readmissions) for all patients. We collected observational data for 3 months and clinical data for 6 months before and after the intervention period. We compared changes in measures using 2-way analysis of variance.

Results

We studied 576 cases before and 465 after intervention, observing the operation in 38 and 41 cases respectively. We found no significant changes in team performance or patient outcome measures. The intervention theatre staff focused their efforts on improving first patient arrival time, which improved by 20 minutes after intervention.

Conclusions

This version of “lean” system improvement did not improve measured safety processes or outcomes. The study highlighted an important tension between promoting staff ownership and providing direction, which needs to be managed in “lean” projects. Space and time for staff to conduct improvement activities are important for success.

Item Type: Journal Article
Subjects: R Medicine > RD Surgery
T Technology > TS Manufactures
Divisions: Faculty of Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH): Hospitals -- Medical staff -- Training of , Lean manufacturing, Orthopedic Surgery, Nursing assessment
Journal or Publication Title: PLoS One
Publisher: Public Library of Science
ISSN: 1932-6203
Official Date: 27 April 2016
Dates:
DateEvent
27 April 2016Published
14 March 2016Accepted
28 January 2015Submitted
Volume: 11
Number: 4
Article Number: e0152360
DOI: 10.1371/journal.pone.0152360
Status: Peer Reviewed
Publication Status: Published
Access rights to Published version: Open Access
Funder: National Institute for Health Research (Great Britain) (NIHR)
Grant number: (RP-PG-0108-10020)

Request changes or add full text files to a record

Repository staff actions (login required)

View Item View Item

Downloads

Downloads per month over past year

View more statistics

twitter

Email us: wrap@warwick.ac.uk
Contact Details
About Us