Emergency Cesarean birth is a high risk procedure.  Lean provided a road map in improving our clinical processes which also included physician involvement.  This presentation will focus on the steps taken to improve our process, including a Value Stream and three Lean events.  The national guideline for emergency cesareans is 30 minute decision to incision time, and we found that this was not being consistently met.  The three Lean events completed included “Streamlining Cesarean Birth Documentation,” “Cesarean Decision to Incision,” and “Defining Roles, Expectations and Training.”  During these week long events, various Lean tools were used, including stakeholder surveys, process mapping, Gemba walk, brainstorming solutions, trialing solutions, developing a current and future state, and monitoring metrics.  Metrics were used to evaluate the effectiveness of changes. This included decreasing steps, eliminating paper forms and reducing total time from decision to incision.  Following the Lean events training of staff and physicians was done. 

A number of lessons were learned in this process.  We found that physician participation and input is critical.  We included physicians as primary stakeholders and surveyed a number of them during the initial Value Stream.  Staff members were coached to be open and invite their comments without becoming defensive.  We also encouraged staff to accept physician feedback and work on what we could change, not try to change our physicians.  It was during these interviews that one of our physicians stated he would like to see our Cesarean process be “less like a hockey game and more like a ballet.”

We found that support from senior administration was critical to our success, and one of our improvement measures included remodeling our Cesarean Birthsuite.  We also received support and guidance from our internal Lean team.  We are continuing to monitor our quality matrix indicators to fine tune our processes.  In doing so, we have continued to find areas where improvement is needed.  We realize quality improvement is truly a journey and not a destination.  Our physicians have responded positively to the results and are active participants.  The hockey game is a thing of the past and we are now refining our ballet.  We believe our process and results could be replicated and would like the opportunity to share our success with others.