• Frederique Elisabeth Simons, Kjeld Harald Aij, Guy A M Widdershoven, and Merel Visse.
• Department of Innovation & Quality, Zaans Medical Center, Koningin Julianaplein 58 (room 4.66), 1502 DV Zaandam, The Netherlands.
• Int J Qual Health Care. 2014 Aug 1;26(4):366-71.

IssueResearch has often stressed the significance of reducing door movement during surgery for preventing surgical site infections. This study investigated the possible effect of a lean A3 intervention on the reduction of door movement during surgery in a university medical center in the Netherlands.Initial AssessmentA digital counter recorded door movement during 8009 surgical procedures during 8 months. The number of door movements per surgical procedure ranged from 0 to 555, with a mean of 24 door movements per hour across 26 specialisms.Choice Of SolutionWe aimed to reduce door movement in one operating room for orthopedic surgery by a lean A3 intervention. This intervention was executed by means of an A3 report that promotes structured problem solving based on a Plan-Do-Check-Act cycle.ImplementationThe steps of the A3 report was followed and completed one-by-one by a multidisciplinary team. The effect of the changes was monitored over the course of 12 months.EvaluationThe use of a lean A3 intervention resulted in a sustainable decrease of door movements by 78%, from a mean of 24 to a mean of 4 door movements per hour during orthopedic surgery at one OR.Lessons LearnedThis paper shows the relevance of and the possibility for a reduction of door movement during surgery by lean management methods in general and an A3 intervention in particular. This intervention stimulated dialogue and encouraged knowledge-sharing and collaboration between specialized healthcare professionals and this resulted in a thorough root-cause analysis that provided synergy in the countermeasures-with, according to respondents, a sustainable result.© The Author 2014. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

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