While we can explain his efficiency by the many interrelated efforts, over the course of time, he has taken to improve the entire procedure, our job is to focus on two key aspects that help the surgical procedure itself. For this purpose, let us examine these two aspects:
a) Limited Variation:
Dr. Booth, was interested in a high volume business, his goal was to maximize the number of procedures while maintaining the high quality of patient care and highly positive outcomes (Refer to Exhibit 1, Volume of cases, and Re-admission rates). He was able to achieve these spectacular results by controlling variation in every single aspect of his procedure. Some of the methods he used were to achieve the desired variation levels in the operating room:
- Limit procedure types, Dr. Booth decided that he will not perform hip replacements and referred all the hip cases to David Nazarian
- Patient screening was a big step to limit variance, Dr. Booth was very specific about which kind of patients he was willing to accept. Suitability depended on a wide range of criteria like pain, instability, functional limitations, including the type of x-rays he was willing to consider. He also eliminated patients that he didn’t think were mentally ready for the demands of a procedure of this type. As a result, he reduced the risk of malpractice law suits and limited variation. Roughly 75% of the patients were rejected on this basis.
- Standardize parts, wanted mastery of the industry solution by gaining full knowledge on one product.
o Every manufacturer had different set of instruments and methods as an answer to join replacement. There were tradeoffs to each of their solutions, so Dr. Booth, decided to choose Zimmer.
- Simplify instrumentation, Dr. Booth worked with Central supply to make sure that every instrument had a purpose and eliminate redundancy and yet not have any missing instruments.
- Dedicated staff and anesthesiologists. This was very critical in reducing variation....