{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T06:27:48Z","timestamp":1790317668295,"version":"4.1.0"},"reference-count":44,"publisher":"MDPI AG","issue":"22","license":[{"start":{"date-parts":[[2021,11,18]],"date-time":"2021-11-18T00:00:00Z","timestamp":1637193600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Healthcare systems internationally are working under increasing demand to use finite resources with greater efficiency. The drive for efficiency utilises process improvement methodologies such as Lean Six Sigma. This study outlines a pilot Lean Six Sigma intervention designed to release nursing time to care within a peri-operative environment; this was achieved by collaborating with stakeholders to redesign the process for laparoscopic hernia surgical case preparation (set up) material. Across 128 laparoscopic hernia surgical cases, the pilot resulted in a 55% decrease in overall nursing time spent in gathering and preparing materials for laparoscopic hernia surgical cases, with a corresponding reduction in packaging waste. The major impact of releasing nursing time to care within busy Operating Room environments enabled nurses to focus on continuing to deliver high-quality care to their patients and reduce pressure expressed by the Operating Room nurses. The results have led to an ongoing review of other surgical procedures preparation to further release nursing time and will be of interest to perioperative teams internationally.<\/jats:p>","DOI":"10.3390\/ijerph182212098","type":"journal-article","created":{"date-parts":[[2021,11,18]],"date-time":"2021-11-18T08:53:56Z","timestamp":1637225636000},"page":"12098","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["Releasing Operating Room Nursing Time to Care through the Reduction of Surgical Case Preparation Time: A Lean Six Sigma Pilot Study"],"prefix":"10.3390","volume":"18","author":[{"given":"Patricia","family":"Egan","sequence":"first","affiliation":[{"name":"Beacon Hospital Beacon Court, Bracken Rd, Sandyford Business Park, Sandyford, Dublin 18, D18 AK68 Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony","family":"Pierce","sequence":"additional","affiliation":[{"name":"Beacon Hospital Beacon Court, Bracken Rd, Sandyford Business Park, Sandyford, Dublin 18, D18 AK68 Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Audrey","family":"Flynn","sequence":"additional","affiliation":[{"name":"Beacon Hospital Beacon Court, Bracken Rd, Sandyford Business Park, Sandyford, Dublin 18, D18 AK68 Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4102-7280","authenticated-orcid":false,"given":"Sean Paul","family":"Teeling","sequence":"additional","affiliation":[{"name":"UCD Centre for Interdisciplinary Research, Education & Innovation in Health Systems, School of Nursing, Midwifery & Health Systems UCD Health Sciences Centre, D04 V1W8 Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6638-8461","authenticated-orcid":false,"given":"Marie","family":"Ward","sequence":"additional","affiliation":[{"name":"Centre for Innovative Human Systems, School of Psychology, Trinity College, The University of Dublin, D04 V1W8 Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7257-9654","authenticated-orcid":false,"given":"Martin","family":"McNamara","sequence":"additional","affiliation":[{"name":"UCD Centre for Interdisciplinary Research, Education & Innovation in Health Systems, School of Nursing, Midwifery & Health Systems UCD Health Sciences Centre, D04 V1W8 Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,11,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1016\/j.jss.2016.04.054","article-title":"Efficiency improvement in the operating theatre","volume":"204","author":"Fong","year":"2016","journal-title":"J. Surg. Res."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1589","DOI":"10.1093\/cid\/cix498","article-title":"Naked surgeons? The debate about what to wear in the operating room","volume":"65","author":"Bartek","year":"2017","journal-title":"Clin. Infect. Dis."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1138","DOI":"10.1097\/00000542-199512000-00002","article-title":"Where are the costs in perioperative care? Analysis of hospital costs and charges for inpatient surgical care","volume":"83","author":"Macario","year":"1995","journal-title":"Anesthesiology"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1714","DOI":"10.1097\/BRS.0000000000000480","article-title":"Lean principles to optimize instrument utilisation for spine surgery in an academic medical center: An opportunity to standardize, cut costs, and build a culture of improvement","volume":"39","author":"Lunardini","year":"2014","journal-title":"Spine"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1165","DOI":"10.1001\/archsurg.2010.255","article-title":"Working with a fixed operating room team on consecutive similar cases and the effect on case duration and turnover time","volume":"145","author":"Stepaniak","year":"2010","journal-title":"Arch. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1097\/QMH.0b013e3181eb140e","article-title":"Assessing the evidence of Six Sigma and Lean in the health care industry","volume":"19","author":"DelliFraine","year":"2010","journal-title":"Qual. Manag. Health Care"},{"key":"ref_7","first-page":"39","article-title":"Lean sigma-will it work for healthcare?","volume":"19","author":"Bahensky","year":"2005","journal-title":"J. Healthc. Inform. Manag."},{"key":"ref_8","unstructured":"Johnston, M.J., Samaranayake, P., Dadich, A., and Fitzgerald, J.A. (2009, January 13\u201317). Modelling radiology department operation using discrete event simulation. Proceedings of the 18th World IMACS\/MODSIM Congress, Cairns, Australia. Available online: http:\/\/mssanz.org.au\/modsim09."},{"key":"ref_9","unstructured":"NHS Institute for Innovation and Improvement (2011). Rapid Impact Assessment of The Productive Ward, Releasing Time to Care NHS Institute."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"10","DOI":"10.3844\/ijrnsp.2020.10.23","article-title":"A discussion of the synergy and divergence between lean six sigma and person-centred improvement sciences","volume":"11","author":"Teeling","year":"2020","journal-title":"Int. J. Res. Nurs."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/S0738-3991(02)00099-X","article-title":"Patient-centred consultations and outcomes in primary care: A review of the literature","volume":"48","author":"Mead","year":"2002","journal-title":"Patient Educ. Couns."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"O\u2019Mahony, L., McCarthy, K., O\u2019Donoghue, J., Teeling, S.P., Ward, M., and McNamara, M. (2021). Using lean six sigma to redesign the supply chain to the operating room department of a private hospital to reduce associated costs and release nursing time to care. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph182111011"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1093\/intqhc\/mzz083","article-title":"Using lean six sigma to improve rates of day of surgery admission in a national thoracic surgery department","volume":"31","author":"Brown","year":"2019","journal-title":"Int. J. Qual. Health Care"},{"key":"ref_14","first-page":"35","article-title":"Zap it track it: The application of Lean Six Sigma methods to improve the screening system of low-grade mucinous neoplasms of the appendix in an acute hospital setting","volume":"31","author":"McGrath","year":"2019","journal-title":"Int. J. Qual. Health Care"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1093\/intqhc\/mzz060","article-title":"Reducing risk of development or exacerbation of nutritional deficits by optimizing patient access to mealtime assistance","volume":"31","author":"Teeling","year":"2019","journal-title":"Int. J. Qual. Health Care"},{"key":"ref_16","first-page":"74","article-title":"Reducing waste in the operating room through inventory-based supply chain optimisation","volume":"31","author":"Schmidt","year":"2019","journal-title":"J. Bus. Behav. Sci."},{"key":"ref_17","unstructured":"Womack, J.P., and Jones, D.T. (2003). Lean Thinking: Banish Waste and Create Wealth in Your Corporation, Free Press."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1016\/j.jamcollsurg.2011.02.009","article-title":"Use of lean and six sigma methodology to improve operating room efficiency in a high-volume tertiary-care academic medical center","volume":"213","author":"Cima","year":"2011","journal-title":"J. Am. Coll. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1504\/IJTM.2007.011800","article-title":"Six sigma: A strategy for supporting innovation in pursuit of business excellence\u2013invited paper","volume":"37","author":"Antony","year":"2007","journal-title":"Int. J. Tech. Manag."},{"key":"ref_20","unstructured":"Jones, D. (2021, September 07). Dan Jones Shares Four Lessons on Lean Healthcare Reducing Waste and Errors: Piloting Lean Principles at Intermountain Healthcare Methods, Tools, and Strategies. Available online: http:\/\/planet-lean.com\/lowdown-on-lean-management-principles-applied-to-healthcare."},{"key":"ref_21","unstructured":"(2021, August 20). Kanbanize. Available online: https:\/\/kanbanize.com\/lean-management\/improvement\/gemba-walk."},{"key":"ref_22","first-page":"1","article-title":"An exploration of person-centredness in practice","volume":"16","author":"McCance","year":"2011","journal-title":"J. Issues Nurs."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1","DOI":"10.19043\/ipdj.102.005","article-title":"Live well after stroke","volume":"10","author":"Connolly","year":"2020","journal-title":"Int. Pract. Dev. J."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1","DOI":"10.19043\/ipdj.111.004","article-title":"Calling time on the \u2018dance of the blind reflex\u2019: How collaborative working reduced older persons \u2018length of stay in acute care and increased home discharge","volume":"11","author":"Donegan","year":"2021","journal-title":"Int. Pract. Dev. J."},{"key":"ref_25","unstructured":"Federico, M., and Beaty, R. (2003). Rath & Strong\u2019s Six Sigma Team Pocket Guide, McGraw-Hill. [1st ed.]."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"131","DOI":"10.24867\/IJIEM-2017-3-114","article-title":"Managing customer touchpoints and customer satisfaction in B2B mass customization: A case study","volume":"8","author":"Aicher","year":"2017","journal-title":"Int. J. Ind. Eng. Manag."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"29","DOI":"10.12927\/hcq.2014.23880","article-title":"The largest Lean transformation in the world: The implementation and evaluation of lean in Saskatchewan healthcare","volume":"17","author":"Kinsman","year":"2014","journal-title":"Healthc. Quart."},{"key":"ref_28","unstructured":"(2021, September 07). TIMWOODS. Available online: https:\/\/www.ucd.ie\/agile\/resources\/agileguideto-timwoods\/UCD."},{"key":"ref_29","unstructured":"(2021, July 16). American Society for Quality. Available online: https:\/\/asq.org\/quality-resources\/dmaic."},{"key":"ref_30","unstructured":"(2021, September 07). Schuchart, Wendy. PICK Chart (Possible, Implement, Challenge and Kill Chart) Tech Target. Available online: https:\/\/searchcio.techtarget.com\/definition\/PICK-chart-Possible-Implement-Challenge-and-Kill-chart."},{"key":"ref_31","unstructured":"Rastogi, A. (2021, September 08). A Brief Introduction to Lean, Six Sigma and Lean Six Sigma. 30 December 2020. Available online: https:\/\/www.greycampus.com\/blog\/quality-management\/a-brief-introduction-to-lean-and-six-sigma-and-lean-six-sigma."},{"key":"ref_32","unstructured":"(2021, September 07). 5S Tool. Available online: https:\/\/asq.org\/quality-resources\/lean\/five-s-tutorial."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1177\/1476750317723965","article-title":"Patient involvement 2.0: Experience-based co-design supported by action research","volume":"17","author":"Gustavsson","year":"2016","journal-title":"Action Res."},{"key":"ref_34","first-page":"936","article-title":"Lean thinking in Finnish healthcare","volume":"29","author":"Jorma","year":"2015","journal-title":"Leadersh. Health Serv."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1108\/17410400910938878","article-title":"Lean information management: The use of observational data in health care","volume":"58","author":"Castle","year":"2009","journal-title":"Int. J. Prod. Perform. Manag."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"546","DOI":"10.1097\/NNA.0b013e3182378d37","article-title":"Nursing works: The application of lean thinking to nursing processes","volume":"41","author":"Jones","year":"2011","journal-title":"J. Nurs. Admin."},{"key":"ref_37","unstructured":"Johnston, M.E. (2013). Organisational Effectiveness Employing a Lean Team Leadership Structure in Health Care: A Case Study. [Ph.D. Thesis, University of Phoenix]."},{"key":"ref_38","unstructured":"(2021, September 08). Jones and Woodhead. Building the Foundations for Improvement. London: The Health Foundation. Available online: www.health.org.uk\/publication\/building-foundations-improvement."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1093\/intqhc\/mzp036","article-title":"Application of lean thinking to health care: Issues and observations","volume":"21","author":"Joosten","year":"2013","journal-title":"Int. J. Qual. Health Care"},{"key":"ref_40","unstructured":"Heath, C., and Heath, D. (2010). Switch: How to Change Things When Change Is Hard, Random House of Canada, Limited."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1016\/j.jpurol.2017.08.002","article-title":"Reduction and standardization of surgical instruments in paediatric inguinal hernia repair","volume":"14","author":"Koyle","year":"2018","journal-title":"J. Pediatr. Urol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1843","DOI":"10.1016\/j.jpedsurg.2012.11.045","article-title":"Standardization of operative equipment reduces cost","volume":"48","author":"Avansino","year":"2013","journal-title":"J. Pediatr. Surg."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"2435","DOI":"10.1016\/j.jpedsurg.2020.05.010","article-title":"Surgical tray reduction for cost saving in paediatric surgical cases: A qualitative systematic review","volume":"55","author":"Dekonenko","year":"2020","journal-title":"J. Paediatr. Surg."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1181","DOI":"10.1016\/j.jpedsurg.2018.02.081","article-title":"Improving the value of care for appendectomy through an individual surgeon-specific approach","volume":"53","author":"Robinson","year":"2018","journal-title":"J. Pediatr. Surg."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/22\/12098\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:32:05Z","timestamp":1760167925000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/22\/12098"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11,18]]},"references-count":44,"journal-issue":{"issue":"22","published-online":{"date-parts":[[2021,11]]}},"alternative-id":["ijerph182212098"],"URL":"https:\/\/doi.org\/10.3390\/ijerph182212098","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,11,18]]}}}