RESUMO
PURPOSE: This article describes how a targeted application of Lean methodology in a high-volume brachytherapy department can result in significant and sustained change that benefits patients and staff. METHODS AND MATERIALS: In November 2013, staff and physicians carried out a 3-day Kaizen (rapid improvement) Event with three identified goals: to reduce same-day patient wait times, to reduce staff-hours spent scheduling patients, and to increase the utilization of the brachytherapy operating room (OR). RESULTS: At the Lean Event, staff drew up a future state that included a standard booking process (standard booking times for procedures, a booking guideline, and OR schedule reviews) and shortly after the event, time checks, or procedure checkpoints, were introduced to make teams aware of how each case proceeds through key milestones. The implementation of these changes led to a reduction in the average same-day wait times for patients by 37 minutes and 2 seconds and eliminated the need for a team of seven to eight staff to meet weekly to create a feasible OR schedule. Instead, a team of two to three reviews the schedule with the goal of optimizing the utilization of the OR on anesthesia-staffed days and, as a result, OR utilization has gone from 59% to 97%. CONCLUSIONS: By using Lean methodology and by emphasizing the Lean concepts of measurement, standardization, simplification, and staff participation, the Brachytherapy Leadership team was able to address barriers to change and improve the department's quality metrics. If an institution has to choose between starting on a small-scale project with Lean or not at all, organizations are encouraged to start with a targeted application of Lean and then expand by conducting research on quality and/or striking a quality improvement committee.
