Lean Quality Improvement Helps Surgical Residency Programs

THURSDAY, Jan. 2, 2025 (HealthDay News) — Surgical residency programs can improve working environments using Lean methodology, according to a study published online Dec. 18 in JAMA Surgery.

J. Jeffery Reeves, M.D., from the University of California, San Diego, and colleagues evaluated whether industry-based Lean process improvement techniques could be leveraged to increase compliance with work-hour restrictions within a general surgery residency. The analysis included resident time logs and annual Accreditation Council for Graduate Medical Education resident and faculty surveys for academic years 2019-2020 to 2022-2023 before and after implementation of a quality improvement program that included implementation of 15 multifactorial interventions impacting call and weekend scheduling, work practices and efficiencies, intern and service orientations, and faculty and cultural expectations.

The researchers found that the mean number of residents per block who logged >80 hours per week decreased by 3.6 violations per block, from 12.4 to 2.2 percent. For the 2019-2020, 2020-2021, 2021-2022, and 2022-2023 academic years, perceived compliance with 80 hours on the annual resident survey was 72, 83, 83, and 88 percent, respectively. Faculty perception of resident preparedness for the case increased from a mean of 2.6 to 3.0 over time. No significant differences in technical skill, clinical judgment, sense of responsibility, efficiency, or sense of well-being were seen.

“Results of this quality improvement study suggest that Lean methodology was effective in addressing complex challenges in surgical education, particularly in ensuring compliance with work-hour regulations,” the authors write.

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