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Neumología y cirugía de tórax
versión impresa ISSN 0028-3746
Resumen
ALMANZO, Santiago et al. The Lean model on the pulmonary lobectomy process: results and pitfalls of a continuous journey. Neumol. cir. torax [online]. 2020, vol.79, n.4, pp.230-235. Epub 14-Mar-2022. ISSN 0028-3746. https://doi.org/10.35366/97965.
Objective:
Our objective was to describe the course and results of implementing a lean methodology program for lobectomy.
Material and methods:
A hospital initiative to improve efficiency started in 2012, applying the lean model in the general thoracic surgery service. Processes were mapped, eliminating non-value adding steps and identifying improvement opportunities. The impact of the lean implementation was assessed for patients that underwent lobectomy. Three periods were defined and compared: Baseline period 2008 to 2012 (period 1); Lean implementation period 2013 to 2014 (period 2); Full implementation period 2015 to 2018 (period 3).
Results:
178 lobectomies were performed: 70, 29 and 79 patients during each period. Mean age was 60.29 ± 12.25 years; 99-178 (55.6%) were males. Hospital length of stay (LOS) decreased significantly during period 3 (6 versus 8 versus 4 days; p < 0.001). Major complications increased significantly during period 2 (8.6 versus 24.1 versus 7.6%; p = 0.036) and stabilized thereafter. There were no differences in 30-day mortality and readmission rates between periods. Direct economic contribution margin improved significantly (-0.35 to 9.51%; p = 0.002).
Conclusions:
Lean implementation for lobectomy can result in decreased LOS and improved direct contribution margin. Efforts should be directed to minimize the negative impact that changing prevailing standards could have.
Palabras llave : Lobectomy; process improvement; Lean.