From SHS: Ohio Health Reduces Surgical Site Infections Using Lean


A few weeks back, I attended the Society for Health Systems (SHS) Conference in Orlando, where I chaired the Patient Flow track. There were a lot of great speakers and I have a lot of notes and ideas to share.

Today, I'm going to share some notes from a talk by representatives of the Process Improvement department within Ohio Health, where they shared some outstanding results from Lean efforts to reduce surgical site infections for cardiac surgery patients.

Christian Rizo was the main presenter for the session. In his opening remarks, he mentioned how there are 700,000 open heart surgeries in the U.S. each year and there is a Surgical Site Infection (SSI) in 2 to 5% of those cases (between 1400 and 3500 infections a year). One particular type of infection is called Mediastinitis, which brings with it some nasty pictures (not for the squeamish). With this preventable infection comes a serious risk of dying.

Ohio Health's target was ZERO infections, the only proper goal (as explained so well by Paul O'Neill).

For their 3-day improvement event, they created a current state value stream map from decision to do the surgery through discharge.

One thing they observed was the lack of standardized work for things such as:

  • Pre-op evaluation
  • Antibiotic dosing
  • Chlorohexidine treatment

There was great variation in the work, including 14 different pre-printed order sets for the same type of procedure.

The surgeons and and anesthesiologists agreed on the right / best way to do things, including whether to use clippers or razors for hair removal as well as how and when to clean the patient before surgery. The process of creating standard order sets “took weeks” as the group talked through the alternatives and gained consensus. It was emphasized that:

Standard work is for the patient.

Meaning that the team would:

Make changes that are best for the patient rather than the provider.

The new process was implemented in December of 2009. The managers started managing the process, not just results, by doing frequent “gemba walks to see what was happening, being proactive about providing feedback, coaching, and following up on opportunities the same day.

After the new process was put in place, they went 11 straight months without mediastinitis. SSI rates, as a whole, fell 63% because of the general infection control procedures put in place.

When they did have one infection, that became an opportunity to review the process to see what happened – not blaming individuals.

Congratulations to Ohio Health and thanks to them for sharing their results. Lean truly can make a big difference regarding patient outcomes and quality of care. It's not all about organizing supply stations…

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Mark Graban
Mark Graban is an internationally-recognized consultant, author, and professional speaker, and podcaster with experience in healthcare, manufacturing, and startups. Mark's new book is The Mistakes That Make Us: Cultivating a Culture of Learning and Innovation. He is also the author of Measures of Success: React Less, Lead Better, Improve More, the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, and the anthology Practicing Lean. Mark is also a Senior Advisor to the technology company KaiNexus.


      • I worked in the Lean Office at Jefferson Healthcare. We worked so hard to pull the hospital out of near financial disaster. The Lean Office started small, with several 5S Events in some areas, like the Nurses station on the floor. We learned by 5Sing our own office! Then we did a huge RPI in the laundry department! It was awesome, saved those who worked there tons of time and steps, streamlined the entire process, and saved so much money that LEAN was accepted throughout the facility. It reduced push back and led us to working on doctors offices, and many other processes throughout.


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