Year of Publication


Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Carolyn Williams

Clinical Mentor

Dr. Rajan Joshi

Committee Member

Dr. Dorothy Brockopp



The purpose of this paper is to provide a theoretical framework with practical application for facilitating patient flow through the operative process using the Lean philosophy to minimized delays and cancellations.

Theoretical orientation:

Efficient, quality patient care has always been the hallmark of Nurse Anesthetist practice. Lean healthcare introduces continuous quality improvement (CQI) processes used in Lean manufacturing to the healthcare system. The principal aspect of Lean healthcare is the concept of a value stream where work is standardized, work flow is streamlined and waste is eliminated, thus creating value.

Nature of Review:

In the surgical suite waits, delays and cancellation are endemic. Lean healthcare views these as waste in the system. They must be eliminated to provide value to the patient, who is the ultimate customer. Managing the flow of the patient successfully through this process will increase the quality of patient care ("value"), increase patient and provider satisfaction, increase operating room efficiency and reduce cost. Nurse Anesthetists are uniquely positioned in the operative arena to accomplish this. The greatest opportunity to reduce delays and cancellations is seen with smoothing the inter-daily workload. Successful interventions to accomplish this include: 1) maximizing the preoperative anesthesia assessment, 2) standardizing and streamlining work during the perioperative phase to minimize turn over time, and 3) adequate staffing levels to optimize postoperatively care.

Included in

Nursing Commons