Lean methodology-based method reduces pointless work hours for surgical residents

Researchers on the College of California San Diego Faculty of Drugs have proven {that a} systemic method to eliminating inefficiencies in surgical residency applications can cut back pointless work hours within the basic residency program at UC San Diego. The approach-;primarily based on Lean methodology-;may positively impression the coaching and general well-being of surgical procedure residents. The outcomes are printed at this time within the Journal of the American Medical Affiliation (JAMA).

Our examine exhibits that with devoted course of enchancment efforts and complex high quality enchancment evaluation, we will improve the working surroundings for surgical trainees and all physicians. Our objective is to eradicate pointless work for physicians, and this examine presents a framework that any establishment throughout the nation can use to research and enhance their programs.”

J. Jeffery Reeves, M.D., corresponding creator and fellow within the Division of Surgical procedure, UC San Diego Faculty of Drugs

The Accreditation Council for Graduate Medical Training launched work-hour restrictions for medical trainees greater than 20 years in the past to reinforce affected person security and resident well-being, and the restrictions have confirmed efficient for his or her said objectives. This examine centered on figuring out whether or not Lean methodology-;a broad set of rules and instruments designed to extend worth by eliminating waste-;might successfully assist surgical procedure residents in adhering to 80-hour-per-week work restrictions. Many residency applications proceed to wrestle with implementing hour restrictions. 

The researchers carried out a high quality enchancment mission utilizing a hybrid Lean course of enchancment workshop, figuring out systemic inefficiencies and implementing focused interventions. The mission was carried out at UC San Diego Well being. It included three Kaizen events-;centered workshops that reviewed points and clearly outlined the issues earlier than creating options. These workshops included this system director, affiliate program administrators and resident representatives from every post-graduate 12 months. The applying of Lean methodology allowed the group to establish areas for enchancment, emphasizing knowledge evaluation and understanding the motivation of surgical residents. 

The outcomes confirmed that the common variety of surgical residents exceeding the 80-hour per week restrict considerably decreased after the interventions from 4.4 (12.4%) to 0.8 (2.2%) for a distinction of 10.2%. Moreover, the school’s notion of resident preparedness improved, with no vital adjustments in technical talent, scientific judgment, or sense of accountability. 

Implementing the Lean course of confronted preliminary challenges, reminiscent of considerations that lowering resident hours may enhance the burden on college. Nonetheless, the evaluation revealed that adjustments concentrating on redundant processes improved general effectivity with out impacting affected person care or rising college workload. The group additionally emphasised the significance of a cultural shift, encouraging residents to prioritize their well-being to be extra current and energized for his or her sufferers.

“Lean methodology was essential in implementing new processes that guarantee compliance with work-hour necessities,” mentioned Garth Jacobsen, M.D., scientific professor and program director of the overall surgical procedure residency program on the UC San Diego Faculty of Drugs Division of Surgical procedure and interim chief of the Division of Minimally Invasive Surgical procedure at UC San Diego Well being. “We intention to create options which have long-term endurance by addressing issues holistically, and this examine demonstrates that method’s success.”

The examine highlights the potential of Lean methodology to assist compliance and resident well-being whereas addressing the cultural expectation of prolonged work hours. Structured, step-by-step enhancements utilizing Lean methodology can cut back pointless work hours for surgical residents. By systematically assessing the present state of affairs and creating focused interventions, UC San Diego Well being lowered the variety of hours residents spend within the hospital, giving them extra time for learning and preparation.

“Many surgical departments nationwide face comparable challenges,” mentioned Brian Clary, M.D., M.B.A., the examine’s senior creator and chair of the Division of Surgical procedure at UC San Diego Faculty of Drugs. “By following the framework outlined in our examine, different residency applications can replicate our success and uncover alternatives particular to their wants.”

The examine serves as a mannequin for different graduate medical teaching programs, emphasizing {that a} structured method can guarantee compliance with work-hour insurance policies throughout all UC San Diego residency applications. By minimizing pointless work, the establishment demonstrates its dedication to supporting well being care suppliers whereas delivering environment friendly, high-quality affected person care. This framework presents a cheap answer to optimize each resident and institutional outcomes.

Co-authors embrace: Nicole Goldhaber, Hannah Hollandsworth, Kristin Cox, Ana Maria Dumitru, Christopher A. Longhurst, Jennifer Berumen, and Allison E. Berndtson from UC San Diego, and Beiqun Zhao from the College of San Francisco.