​What is the Kaizen Changeover Method?

What is the Kaizen Changeover Method?

The Quick Changeover method can easily be described in three phases: Separating, Converting, and Streamlining. We could never hope to cover everything about Quick Changeover in this blog. For more information, we refer you to Quick Changeover in the OR by Gerard Leone.

[For reference we will be using the activity done to make an operating room ready for a next case.]

What is the Kaizen Changeover Method?

Separating. The first step is all about Preparation, where you Separate the Internal Steps from the External Steps. An Internal Step is work that must be done while the room is empty and not in use. An External Step can be done while the room is in use. Look closely at the team’s Staff Working Document (SWD) to identify all the External Steps that can be done before it is time to start the Internal Steps. The External Preparatory Changeover Steps can take place while the prior procedure is still going on.

Examples of Separating:

    • Developing a kit of items for resetting the OR table. One of our clients created a kit, wrapped it up in a blanket, and named it “the burrito.”
    • Staging the next case cart. Bring the next case cart near the OR Suite before starting the Changeover, to save retrieval time.
    • Staging the bed right outside the OR suite. A great time saver!

As soon as the Separating step is completed, it’s time to move to the second step of the Quick Changeover methodology, Converting.

Converting. The second step is looking at your SWD for Internal Steps that can be converted into External Steps. The term “convert” is used because it usually requires that procedure changes be made. Converting is the most challenging phase of the Quick Changeover process because it requires modifications to current operations. Some ideas may not be implemented immediately because you lack resources, and that is okay. Go ahead and document the improvements and make any changes that can be made before formally starting the Kaizen Event.

A Few Examples of Converting:

    • Garbage Bin Exchange System. Cleaning up and re-lining garbage bins is a typical Internal Step in the OR. What if an extra set of bins was staged outside the door while the prior case was taking place, and during the Changeover you exchanged them? This has been done, and it has saves time!
    • OR Table Strap Exchange. The same as above with the added benefit of a more thorough cleaning of the straps done in a utility room.
    • Setting up a kit with all items for a Wilson Frame. Applies to any OR suite equipment made up of several pieces. In one case, the team found an unused Bovie cart and used it to assemble a kit with all items required to attach a Wilson Frame. Again, a substantial amount of time was saved.

Now that you have Separated and Converted, it’s time to move to the last step, Streamlining.

Streamlining. Think of a race car pit crew that can get the car back on the track within the recommended fifteen-second time frame and still manage to shave a few hundredths/thousandths of a second off the next try. How is this possible? Practice! Before practicing, a clear definition of what to practice must be defined. In an OR suite turnover, specific tasks or steps are internal by nature, like cleaning the OR Suite. You must relentlessly look for an opportunity to covert internal steps into external steps.

Look at the SWD and identify steps or groups of steps that can be made more efficient or Streamlined. Pay attention to the details as minimization, elimination, rearrangement, or other minor changes will save time in the OR suite changeover, and it does not matter how small, saved time is saved time. In the case of an OR Turnover kaizen team, they will be looking through the steps, or series of steps, that were set aside during the first two phases (separate and convert) of the Quick Changeover project with a fine-tooth comb.

Examples of Streamlining:

    • The OR Suite Cleaning Sequence. Start with the definition of what supplies belong in the cleaning cart. Continue with the initial positioning. Finish with the actual cleaning sequence.

OR Suite Equipment Location. Define the most efficient location for the microscope, the bovies, and the stealth, to minimize the number of steps to store and position them.

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Written for Metro by:



Co-Founder and Principal of Lean Hospital Practice

Gerard's experience in the Hospital world started with a project in a Cardiology department that was featured in Cath Lab Digest for its impressive results. Since then he has become a nationally renowned expert in the design of procedure-intensive departments specializing in Perioperative Services, Cardiac Catheterization Labs, Endoscopy Labs, Interventional Radiology Labs, and many more. Gerard is one of very few Lean experts to have ever designed an Invasive Center. In fact, he's been credited with the design of three Invasive Centers.

Gerard has also supported Materials Process design projects coupled with ERP implementations for hospital systems. His vision of Materials Management for hospitals is one that eliminates shortages while drastically reducing inventory and reducing waste for Clinicians.

Gerard is a sought-after speaker and lecturer, having presented at several conferences, including AORN, OR Manager, and Healthcare Architecture on case studies and full classes on topics related to Process Improvement. He is the co-author of Roadmap to the Lean Hospital, along with five other Lean Hospital books.

Originally from Buenos Aires, Argentina, his bilingual skills in Spanish and English have been valuable in spreading Lean Hospital ideas around the world. He taught Statistics at the University of Buenos Aires and Production Management at Colorado State University.

Contact Gerard at gleone@leonardogroupamericas.com