<![CDATA[Nurse performance in managerial functions is essential to effective elective surgery preparation, as process failures may compromise patient safety, operational efficiency, and service quality. At X hospital, 92 surgical delays due to patient unpreparedness were recorded from January to April 2026, indicating gaps in nurses’ planning, organizing, and controlling functions. To analyze the optimization of nurse performance in elective surgery preparation through a Lean Management approach in an inpatient surgical unit. A quality improvement case study integrated the POSAC management framework, Lewin’s Planned Change Model, and Lean Management. Data were collected through interviews, validated and reliable 1–5 Likert-scale questionnaires administered to 15 nurses, direct observation, and document review. Data were analyzed using Value Stream Mapping (VSM), 5-Why Analysis, Fishbone Diagram, and the USG Priority Matrix based on five Lean Thinking principles. Overall nurse managerial performance was categorized as good. SOP compliance had the highest mean score (4.27), while the nurse-to-patient ratio (2.67) and cross-unit coordination (3.20) were the lowest. VSM identified 23 preparation steps, with only 9 (39%) classified as value-added. Implementation of cross-unit SOPs, visual management, and digital preoperative education resulted in 0% preparation defects during 11 days of monitoring, a 53.85% reduction in surgical delays (13 to 6 cases), 75% checklist compliance, and 100% shift-briefing adherence. Lean Management can optimize nurse performance, reduce process defects, and strengthen patient safety in elective surgery preparation. Sustainability requires SOP legalization, hospital information system integration, and periodic audits.]]>
