A multidisciplinary team from the Hospital Clínic Barcelona has significantly improved efficiency in the total hip replacement programme thanks to the implementation of the Lean Six Sigma methodology. The study, led by Dr Jenaro Ángel Fernández-Valencia, head of the Hip Section (Clínic Institute of Medical and Surgical Specialties), along with the biomedical engineer, Xavier Buysé, and the participation of professionals from orthopaedic surgery, anaesthesiology, nursing and surgical management, was published recently in the Journal of Healthcare Quality Research. Each year, 400 primary hip replacements and 90 secondary hip replacements are performed at the Clínic Barcelona.
The Lean Six Sigma methodology, known for its ability to optimize processes in industrial settings, has been adapted to hospital management in order to eliminate non-value-adding activities, improving the efficiency of healthcare circuits, including surgical ones. That is why this multidisciplinary team has adopted this methodology with the main aim of increasing the number of surgeries performed in a single morning, going from two to three procedures per surgical module, without compromising the quality of care or patient safety.
To do so, several measures must be implemented, such as the selection of low-complexity cases, in order to carry out highly efficient days in which three hip replacements are performed in the morning, starting the first surgery as early as possible, standardizing surgical routines and the contents of the boxes with material for the operation, reducing changeover times between procedures, administering spinal anaesthesia before entering the operating theatre, using systems that facilitate the surgical procedure, such as more agile and simplified incisions, or using newly designed consumables that allow for the use of static retractor positioners, among other things.
The results show a notable improvement: the average number of procedures per module (operating theatre availability for these surgeries) increased from 1.76 to 2.79, and the feasibility of performing three total hip replacement procedures in one morning was confirmed. Following the study, these highly efficient working days have been maintained to date. So, for example, in 2024 a total of 22 morning modules were completed with a programme of three hip replacements, meaning two high-efficiency sessions per month. According to Dr Fernández-Valencia, “the team’s involvement and determination to improve on a daily basis have been the key to success. In fact, we had been striving to improve our efficiency for some time, but it was through structured methodologies, careful planning and good coordination and effort by all the professionals, that we were able to optimize the use of operating theatres and offer more efficient and sustainable care.”
Despite the good results, the study also identifies outstanding challenges, such as the need for more postoperative beds, linked to discharges from the hospital ward, and the need to standardize and refine certain practices in order to guarantee the sustainability of the model and even improve efficiency in the future. The authors highlight the fact that this experience can serve as a guide for other centres wishing to implement similar strategies.
Surgical treatment of hip dysplasia
Hip dysplasia affects between 1% and 4% of the population. It is estimated that around 50% of people who develop hip osteoarthritis before the age of 50 have untreated hip dysplasia. It is more common in women, possibly due to hormonal and body structure differences. It can be diagnosed in childhood, although the symptoms are more likely to appear during adolescence and young adulthood.
In patients with severe dysplasia or persistent symptoms, periacetabular osteotomy (PAO) is the treatment of choice. This treatment consists of repositioning the acetabulum to better cover the femoral head. This helps to prevent the onset of osteoarthritis and maintain hip functionality. Periacetabular osteotomy has a high success rate. Between 60-80% of patients retain their own hip after 20 years, without the need for implanting a prosthesis.
Recovery time varies, but it generally takes 3 to 6 months to resume daily activities, and up to a year for complete recovery.
