Applying LEAN Healthcare in Lean Settings: Launching Quality Improvement in Resource-Limited Regions

Pavithra K. Rao, Aaron J. Cunningham, Daniel Kenron, Philip Mshelbwala, Emmanuel A. Ameh, Sanjay Krishnaswami

Research output: Contribution to journalArticlepeer-review


Background: Lean methodology is frequently utilized in high income settings to maximize capacity and operational efficiency during process improvement (PI) initiatives. To date there has been little published on the application of these techniques in low- and-middle-income countries (LMIC) despite the potential benefits in resource limited settings. We describe a pilot project developed in 2018 to promote sustainable operating theater efficiency at two hospitals in Abuja, Nigeria. This study details the first known attempt to use Lean techniques to improve surgical care systems in LMIC. Methods: Perioperative committees were established at two Nigerian institutions to evaluate current processes, identify problems, and compile a list of priorities. A physician champion and a PI specialist in conjunction with local physician-partners held a workshop to teach practical applications of PI methodology as part of an ongoing collaboration. Pre and post-workshop surveys were administered, and theme coding was used to categorize free responses. Results were compared with a chi-square test. Results: In total, 42 individuals attended the PI workshop. After the workshop, 37 respondents reported the workshop as valuable both personally and for the perioperative committee (P < 0.001), and all reported that PI methodology could benefit the institution overall. Conclusions: By identifying stakeholders, holding a workshop to teach tools of PI, and establishing a committee for ongoing improvement, it is possible to implement quality improvement techniques at LMIC hospitals, which may be of future benefit. Sustainability in this project will be facilitated by tele mentoring, and future efforts include expansion beyond the perioperative setting.

Original languageEnglish (US)
Pages (from-to)398-404
Number of pages7
JournalJournal of Surgical Research
StatePublished - Oct 2021


  • Academic global surgery

ASJC Scopus subject areas

  • Surgery


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