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IJSTR >> Volume 8 - Issue 10, October 2019 Edition

International Journal of Scientific & Technology Research  
International Journal of Scientific & Technology Research

Website: http://www.ijstr.org

ISSN 2277-8616

Implementing Lean In Operating Room Medical Supplies Of RSIA Grand Family

[Full Text]



Acim Heri Iswanto, Gatot Soeryo Koesoemo



lean implementation, waste of inventory, operating room, health service



This research aims to assess the results of lean implementation in reducing the cost of medical supplies in the operating room of a hospital in Indonesia. These results can be used as a motivation to extend implementation to other aspects of overall operating room and hospital management. Resource inventory to build management commitment, willingness to share data, and information of implementation history was the initial stage of research. Furthermore, the research was conducted by applying 5S methodology to medical supplies in the operating room of RSIA Grand Family, Jakarta. The 5S procedure then was evaluated using descriptive and inferential statistics. The inferential statistics used was Wilcoxon Signed Rank test. Lean implementation that was carried out successfully reduced inventory costs to an average of Rp 331,555,768 per month in three months after lean implementation, from Rp 381,140,031 per month in the previous three months before lean implementation. This means that there is a cost reduction of 13.01%. Furthermore, the number of medical supplies items was reduced by an average of 12.45%. This research has a number of limitations. First, this research was conducted on the aspect of medical supplies from the operating room. Second, this research was still on a small scale and only evaluated the cost aspect of medical supplies.



[1] Shanafelt TD, Dyrbye LN, West CP. Addressing Physician Burnout: The Way Forward. JAMA. 2017;317(19):901-902. doi:10.1001/jama.2017.0076
[2] Weaver SJ, Dy SM, Rosen MA. Team-training in healthcare: A narrative synthesis of the literature. BMJ Qual Saf. 2014;23(5):359-372. doi:10.1136/bmjqs-2013-001848
[3] Nicholson P, Grif P, Gillis S, Wu M, Dunning T. Measuring nursing competencies in the operating theatre : Instrument development and psychometric analysis using Item Response Theory. Nurse Educ Today. 2013;33:1088-1093. doi:10.1016/j.nedt.2012.04.008
[4] Balaras CA, Dascalaki E, Gaglia A. HVAC and indoor thermal conditions in hospital operating rooms. Energy Build. 2007;39:454-470. doi:10.1016/j.enbuild.2006.09.004
[5] Sisson J, Elshennawy A. Achieving success with Lean: An analysis of key factors in Lean transformation at Toyota and beyond. Int J Lean Six Sigma. 2015;6(3):263-280. doi:10.1108/IJLSS-07-2014-0024
[6] Shamah RAM. Measuring and building lean thinking for value creation in supply chains. Int J Lean Six Sigma. 2013;4(1):17-35. doi:10.1108/20401461311310490
[7] Moore D, Blick G, Leggott J, Bloodworth K. Assessment of the Implementation of the Productive Ward and Productive Operating Theatre Programmes in New Zealand. Wellington; 2013.
[8] Sunder VM. Synergies of Lean Six Sigma. IUP J Oper Manag. 2013;12:21-31.
[9] 9. Wang L, Ming XG, Kong FB, Li D, Wang PP. Focus on implementation : a framework for lean product development. J Manuf Technol Manag. 2011;23(1):4-24. doi:10.1108/17410381211196267
[10] Holden RJ. Lean thinking in emergency departments: A critical review. Ann Emerg Med. 2011;57(3):265-278. doi:10.1016/j.annemergmed.2010.08.001
[11] Tamás P. Application of value stream mapping at flexible manufacturing systems Péter TAMÁS. Key Eng Mater. 2016;686:168-173. doi:10.4028/www.scientific.net/KEM.686.168
[12] Dal Forno AJ, Pereira FA, Forcellini FA, Kipper LM. Value Stream Mapping : a study about the problems and challenges found in the literature from the past 15 years about application of Lean tools. Int J Adv Manuf Technol. 2014;72(5-8):779-790. doi:10.1007/s00170-014-5712-z
[13] Joosten TOM, Bongers I, Janssen R. Application of lean thinking to health care : issues and observations. Int J Qual Heal Care. 2009;21(5):341-347.
[14] Papadopoulos T, Radnor Z, Merali Y. The role of actor associations in understanding the implementation of Lean thinking in healthcare. Int J Oper Prod Manag. 2011;31(2):167-191. doi:10.1108/01443571111104755
[15] Shazali NA, Habidin NF, Ali N, Khaidir NA, Jamaludin NH. Lean Healthcare Practice and Healthcare Performance in Malaysian Healthcare Industry. Int J Sci Res Publ. 2013;3(1):1-5.
[16] Andreamatteo AD, Ianni L, Lega F, Sargiacomo M. Lean in healthcare : A comprehensive review. Health Policy (New York). 2015. doi:10.1016/j.healthpol.2015.02.002
[17] Aij KH. Lean Leadership Health Care : enhancing peri-operative processes in a hospital. 2015.
[18] Aij KH, Simons FE, Widdershoven GAM, Visse M. Experiences of leaders in the implementation of Lean in a teaching hospital — barriers and facilitators in clinical practices : a qualitative study. BMJ Open. 2013;3:e003605. doi:10.1136/bmjopen-2013-003605
[19] Meredith JO, Grove AL, Walley P, Young F, Macintyre B. Are we operating effectively ? A lean analysis of operating theatre changeovers. Oper Manag Res. 2011;4(3-4):89. doi:10.1007/s12063-011-0054-6
[20] Muder RR, Cunningham C, McCray E, et al. Implementation of an Industrial Systems-Engineering Approach to Reduce the Incidence of Methicillin-Resistant Staphylococcus aureus Infection. Infect Control Hosp Epidemiol. 2008;29(8):702-715. doi:10.1086/589981
[21] Nicolay CR, Purkayastha S, Greenhalgh A, et al. Systematic review of the application of quality improvement methodologies from the manufacturing industry to surgical healthcare. Br J Surg. 2012;99:324-335. doi:10.1002/bjs.7803
[22] Robinson S, Radnor ZJ, Burgess N, Worthington C. SimLean: Utilizing Simulation in the Implementation of Lean in Healthcare. Eur J Oper Res. 2012;219(1):188-197.
[23] Mazzocato P, Savage C, Brommels M, Aronsson H, Thor J. Lean thinking in healthcare : a realist review of the literature. Qual Saf Heal Care. 2010;19:376-382. doi:10.1136/qshc.2009.037986
[24] Radnor ZJ, Holweg M, Waring J. Institutional Repository Lean in healthcare : the unfilled promise ? Soc Sci Med. 2012;75(3):364-371. doi:10.1021/acsphotonics.7b00904
[25] RSIA Grand Family. Company_profile_grand_family.Pdf.; 2018.
[26] Kovacevic M, Jovicic M, Djapan M, Zivanovic-Macuzic I. Lean Thinking in Healthcare: Review of Implementation Results. Int J Qual Res. 2016;10(1):219-230.
[27] Venkateswaran S. Implementing lean in healthcare warehouse operations - evaluation of 5S best practice. 2011.
[28] Eslaminasab Z, Dokoohaki T. ABC inventory classification withmultiple -criteria using weighted non-linear programming. In: The First Regional Conference on the Advanced Mathematics and Its Applications. Vol 1. ; 2012:242-251. doi:10.5899/2012/cjac-001-028
[29] Chiarini A. Risk management and cost reduction of cancer drugs using Lean Six Sigma tools. Leadersh Heal Serv. 2012;25(4):1751-1879. doi:10.1108/17511871211268982
[30] Portioli-Staudacher A. Lean healthcare. An experience in Italy. In: Koch T, ed. IFIP International Federation for Information Processing. Vol 257. Boston: Springer; 2008:485-492. doi:10.1007/978-0-387-77249-3_50
[31] Bhasin S, Burcher P. Lean viewed as a philosophy. J Manuf Technol Manag. 2006;17(1):56-72. doi:10.1108/17410380610639506
[32] Katayama H, Bennett D. Lean production in a changing competitive world : a Japanese. Int J Oper Prod Manag. 1996;16(2):8-23.
[33] Mor RS, Singh S, Bhardwaj A. Learning on Lean Production : A Review of Opinion and Research within Environmental Constraints. Oper Supply Chain Manag. 2016;9(1):61-72.
[34] Niemeijer GC, Trip A, Ahaus KTB, Does RJMM, Wendt KW. Quality in Trauma Care : Improving the Discharge Procedure of Patients by Means of Lean Six Sigma. J Trauma. 2010;69(3):614-619. doi:10.1097/TA.0b013e3181e70f90
[35] Agarwal BB, Ali K, Goyal K, Gupta S, Gupta M. Single-incision laparoscopic surgery (SILS): Current practice-based concerns. Ganga Ram J. 2012;2(3):172-181.
[36] Catchpole K, de Leval M. Identifying and Reducing Erros in the Operating Theatre. Contemp Ergon. 2004:346-350.
[37] Undre S, Sevdalis N, Healey AN, Darzi SA, Vincent CA. Teamwork in the operating theatre : cohesion or confusion ? J Eval Clin Pract. 2006;12(2):182-189. doi:10.1111/j.1365-2753.2006.00614.x
[38] Angelis J, Conti R, Cooper C, Gill C. Building a high-commitment lean culture. J Manuf Technol Manag. 2011;22(5):569-586. doi:10.1108/17410381111134446
[39] Celik J. Decreasing Preoperative Delays-A Rapid Process Improvement Project. AORN J. 2003;77(4):737-741.
[40] Burkitt KH, Mor MK, Jain R, et al. Toyota Production System Quality Improvement Initiative Improves Perioperative Antibiotic Therapy. Am J Manag Care. 2009;15(9):633-642.
[41] Waldhausen JHT, Avansino JR, Libby A, Sawin RS. Application of lean methods improves surgical clinic experience. J Pediatr Surg. 2010;45(7):1420-1425. doi:10.1016/j.jpedsurg.2009.10.049