Improvement Initiative Increased Well-Being and Reduced Inefficiencies for Surgical Residents

The researchers conducted a quality improvement project using a hybrid Lean process improvement workshop, identifying systemic inefficiencies and implementing targeted interventions. The project was conducted at UC San Diego Health. It included three Kaizen events—focused workshops that reviewed issues and clearly defined the problems before developing solutions. These workshops included the program director, associate program directors and resident representatives from each post-graduate year. The application of Lean methodology allowed the team to identify areas for improvement, emphasizing data analysis and understanding the motivation of surgical residents.

The results showed that the average number of surgical residents exceeding the 80-hour per week limit significantly decreased after the interventions from 4.4 (12.4%) to 0.8 (2.2%) for a difference of 10.2%. Additionally, the faculty’s perception of resident preparedness improved, with no significant changes in technical skill, clinical judgment, or sense of responsibility.

Implementing the Lean process faced initial challenges, such as concerns that reducing resident hours might increase the burden on faculty. However, the analysis revealed that changes targeting redundant processes improved overall efficiency without impacting patient care or increasing faculty workload. The team also emphasized the importance of a cultural shift, encouraging residents to prioritize their well-being to be more present and energized for their patients.

“Lean methodology was crucial in implementing new processes that ensure compliance with work-hour requirements,” said Garth Jacobsen, M.D., clinical professor and program director of the general surgery residency program at the UC San Diego School of Medicine Department of Surgery and interim chief of the Division of Minimally Invasive Surgery at UC San Diego Health. “We aim to create solutions that have long-term staying power by addressing problems holistically, and this study demonstrates that approach’s success.”

The study highlights the potential of Lean methodology to support compliance and resident well-being while addressing the cultural expectation of extended work hours. Structured, step-by-step improvements using Lean methodology can reduce unnecessary work hours for surgical residents. By systematically assessing the current situation and developing targeted interventions, UC San Diego Health reduced the number of hours residents spend in the hospital, giving them more time for studying and preparation.

“Many surgical departments nationwide face similar challenges,” said Brian Clary, M.D., M.B.A., the study’s senior author and chair of the Department of Surgery at UC San Diego School of Medicine. “By following the framework outlined in our study, other residency programs can replicate our success and uncover opportunities specific to their needs.”

The study serves as a model for other graduate medical education programs, emphasizing that a structured approach can ensure compliance with work-hour policies across all UC San Diego residency programs. By minimizing unnecessary work, the institution demonstrates its commitment to supporting health care providers while delivering efficient, high-quality patient care. This framework offers a cost-effective solution to optimize both resident and institutional outcomes.

Co-authors include: Nicole Goldhaber, Hannah Hollandsworth, Kristin Cox, Ana Maria Dumitru, Christopher A. Longhurst, Jennifer Berumen, and Allison E. Berndtson from UC San Diego, and Beiqun Zhao from the University of San Francisco.

The authors report no external sources of funding or conflicts of interest.