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J Am Acad Orthop Surg. 2017 Nov;25(11):e244-e250. doi: 10.5435/JAAOS-D-17-00030.

Using Lean Process Improvement to Enhance Safety and Value in Orthopaedic Surgery: The Case of Spine Surgery.

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From the Neuroscience Institute, Virginia Mason Medical Center, Seattle, WA (Dr. Sethi and Dr. Yanamadala), the Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, KS (Dr. Burton), and the Denver International Spine Center, Denver, CO (Dr. Bess).


Lean methodology was developed in the manufacturing industry to increase output and decrease costs. These labor organization methods have become the mainstay of major manufacturing companies worldwide. Lean methods involve continuous process improvement through the systematic elimination of waste, prevention of mistakes, and empowerment of workers to make changes. Because of the profit and productivity gains made in the manufacturing arena using lean methods, several healthcare organizations have adopted lean methodologies for patient care. Lean methods have now been implemented in many areas of health care. In orthopaedic surgery, lean methods have been applied to reduce complication rates and create a culture of continuous improvement. A step-by-step guide based on our experience can help surgeons use lean methods in practice. Surgeons and hospital centers well versed in lean methodology will be poised to reduce complications, improve patient outcomes, and optimize cost/benefit ratios for patient care.

[Indexed for MEDLINE]

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