Semester of Graduation

Spring 2019


Master of Science in Industrial Engineering (MSIE)


Industrial Engineering

Document Type



Maintaining quality at an affordable cost has been a major challenge for many healthcare organizations. Healthcare providers are trying to address this issue while protecting the environment, meeting social responsibilities and contributing to sustainable development of systems. Instead of linking quality with just clinical outcomes, healthcare services are trying to view quality and safety as part of professional ethics or “the right thing to do.” In order to provide a framework for quality assessment in healthcare systems, the Institute of Medicine (IOM) pointed out that the system should have the following six aims: safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity.

Sustainability in healthcare can be defined as a balance of the needs of patients, economic concerns, and environmental costs. The concept of sustainability is defined by three main pillars: economic development, social development and environmental protection. This thesis provides an understanding regarding the causal relations between variables that lead to overall long-term sustainability of operating rooms (ORs), which will in turn help hospitals establish a framework to evaluate sustainable development.

The objective of this thesis is to discuss how the variables that occur during a total knee arthroplasty (TKA) procedure can affect quality dimensions: efficiency, effectiveness, safety, patient-centeredness, timeliness and equitability, and illustrate their association with the economic, social, and environmental components of sustainability. This thesis is divided into two papers. The journal paper lists variables observed in an OR during the time of surgery and portrays the cause-effect relationship between the variables and the six quality aims for each component of sustainability by using causal loop diagrams (CLDs). Using the results obtained from the journal paper, all the variables were made into a checklist, which is discussed in the conference paper. It was validated by an expert panel consisting of a surgeon, lean and six sigma expert, and supply chain expert. Therefore, this study identified variables that affect the quality dimensions and thereby, OR sustainability. The checklist can be used to evaluate sustainability of the practices in OR.



Committee Chair

Laura Ikuma