Impact of a lean management intervention on waiting time and service efficiency in gynecologic oncology surgical services in a national referral hospital in Indonesia: An interrupted time-series study with lean waste analysis

Abstract

Long surgical waiting times in gynecologic oncology reflect operational inefficiencies and limited operating room capacity, compromising timely care and patient outcomes. This study specifically focuses on gynecologic oncology surgical services at Dr. Hasan Sadikin Hospital, Bandung, a major national referral hospital in Indonesia. It evaluated the impact of lean-based dedicated operating slots on surgical waiting times and service efficiency. A mixed-methods explanatory sequential design was applied. Quantitative data comprised 24 monthly time points (12 pre-intervention and 12 post-intervention) and were analyzed using interrupted time series analysis, while qualitative data were obtained through in-depth interviews with seven key informants to explain operational changes after the intervention. The intervention introduced one specialized operating room and nine weekly elective surgery slots dedicated to gynecologic oncology. The results demonstrated a significant reduction in mean waiting time from 8.16 weeks pre-intervention to 3.64 weeks post-intervention. Interrupted Time Series Analysis (ITSA) showed a significant immediate level reduction following implementation, with an estimated change of -2.87 weeks, indicating an immediate reduction in surgical backlog. Trend analysis further demonstrated a significant post-intervention slope change (0.48), reflecting a modification in waiting time trajectory after implementation. Although a slight upward trend was observed afterward due to surgical throughput, waiting times remained substantially lower than in the pre-intervention period. Lean Waste analysis revealed reductions in waiting, overprocessing, and inter-unit coordination inefficiencies. These findings indicate that lean-oriented dedicated operating slots improve operational efficiency, enhance patient access, and minimize systemic waste in high-volume oncology surgical services. The study provides empirical evidence supporting structured scheduling and lean principles as effective strategies for improving time-sensitive surgical care in tertiary hospitals.