The Importance Of Lean Methodology In Nursing

In healthcare, throughput refers to the ED process that impacts patient flow (Jarousse 2011). Process and flow began to be scrutinized for opportunities to improve the overcrowding by becoming more efficient. Due to this new process focus, throughput was born. This is also the point where lean flow or lean thinking became prevalent into healthcare from a manufacturing stand point to improve throughput. Lean principles revolve around removing non value added steps and standardizing work flow and processes. When applied aggressively hospital wide, lean principles can have a dramatic effect on productivity, cost, and quality. Numerous books concerning lean healthcare have been published in recent years (Crane & Noon 2011).

Quality improvement is referred to as “the use of data to monitor the outcomes for care processes and use improvement methods to design and test changes to continuously improve the quality and safety of health care” (Sherwood & Barnsteiner, 2012). Data is used as the reflection of quality care that is provided by nurses and presents whether or not improvement is needed. In order for nurses to be mindful of the care that they give, they must be taught a systematic process of defining problems, identifying possible causes of those problems, and methods for trying out new solutions to prevent those problems (Sherwood & Barnsteiner, 2012). Currently, quality improvement measures are being utilized throughout hospitals to reduce the risk of patient falls and fall injuries.

[20] cited (Miller, D., et. al., 2005).”“Adoption of Lean management strategies while not a simple task can help healthcare organizations improve processes and outcomes, reduce cost, and increase satisfaction among patients, providers and staff” . Balle [5] states that: “the adoption of lean in healthcare is very young it started in the late 90s but started to gain a little bit of momentum in the last decade and now in this decade many health organisations are looking at lean principles since it has been proven to be very successful in many cases around the world”.

Nurses work in systems that are complex, rapidly changing, and beleaguered with financial and workforce pressures. One response to these chal­lenges is to find alternative ways to make an insufficient or detrimental system work for the nurse to get the job done and to achieve the desired patient out­come. While perhaps well intention-ed to produce the desired result, workarounds

Throughout this course I have learned about the various challenges that impede productivity and efficiency at today’s hospitals. These issues facing the modern healthcare organization come in varying forms from technological, staffing, and financial to name a few. There are no limits to what hospitals can face in these modern technologically savvy times. Below are the major issues that today’s hospitals are facing, though there are many facets to these topics it will be described as best as possible to meet overall challenges:

The Quality and Safety Education for Nurses (QSEN) Institute developed six core competencies: patient-centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety, and informatics (Quality and Safety Education for Nurses Institute, 2017). At my facility, it is clearly evident that they have adopted these six core competencies to improve patient quality and safety. My facility created the Office of Patient Experience which supports care that is safe, of high quality and high value. Patient satisfaction is a top priority which is why our guiding principle is known as “Patients First”. Through teamwork and collaboration, we deliver care that is patient-centered by working together in multidisciplinary rounds on the inpatient units. Also, the nursing education department supports quality, safety and consistent nursing care through a database of policies and procedures developed using evidence-based research. Lastly, the nursing informatics department is working towards making our EPIC system more patient-centered. They are doing this by decreasing the redundancy in charting for the nursing staff and finding ways to improve processes which automate tasks. This in turn will reduce the time that the nursing staff spends with their computer and increase the time that the nursing staff can spend with their patients.

Inconsistent nurse-patient ratios are a concern in hospitals across the nation because they limit nurse’s ability to provide safe patient care. Healthcare professionals such as nurses and physicians agree that current nurse staffing systems are inadequate and unreliable and not only affect patient health outcomes, but also create job dissatisfaction among medical staff (Avalere Health, 2015). A 2002 study led by RN and PhD Linda Aiken suggests that "forty percent of hospitals nurses have burnout levels that exceed the norms for healthcare workers" (Aiken, Clarke, Sloane, Sochalski & Silber, 2002). These data represents the constant struggle of nurses when trying to provide high quality care in a hospital setting.

In the ever changing world of healthcare, healthcare organizations in order to be the most efficient in their delivery of healthcare, streamline their organizational structure to stay competitive, while providing the best patient care possible. This process can place increasingly undue stress onto its staff resulting in nurses having to do more with less available resources which ultimately increases their workload, has them working longer hours due to staff shortage, which contributes to an increase in the nurse burnout rates. This eventually filters down to the patient’s level of care and means less time spent on each

Nurses find themselves in the middle of a complex health care system between the financial side and patient safety. A professional nurse’s goal is to provide safe, quality, patient care. However, nurses often fail to meet this goal due to the variability in patient acuity, the unpredictable workload of nurses, and institutional budget constraints (ANA, 2014). According to the American Nurses Association (2014) research shows that lower staffing levels of registered nurses correlate with poor patient outcomes, as well as negative nurse outcomes, such as physical injury and ‘burnout.’

The health care industry continues to be challenged by daily patient turnover due to the number of admissions, transfers, and discharges (Spader, 2008). The increase in number of admissions, in turn, puts a high demand on nurses in keeping up with the pace resulting in nurse frustration and dissatisfaction. According to Lane (2009), a thorough and comprehensive admission process is critical in providing quality patient care. Completing the admission process in a timely, efficient, and comprehensive manner has

The contrast between an adequately staffed ward and one with a low nursing staffing level is tangible. Staff nurses and patients have expressed how inadequate staffing levels affect them and there is a substantial amount of evidence-based research showing the negative effects of low nursing staffing levels on patient and nursing outcomes. Nursing resource allocation and reallocation of staff nurses is a time consuming and challenging task for nurse leaders, who must ensure safe staffing levels are upheld (Ball et al. 2014). With an increasing constraint on health expenditure, nursing staffing levels in hospitals has become a main target for financial limits and spending reductions. To the extent of which the nursing profession has been called a ‘soft target’, for it is easier to reduce nursing staffing level, as opposed to other means of cutting costs, such as improving efficiency (Aiken et al. 2014b).

Striving for excellent patient care is the cornerstone of nursing. However, delivery of innovative care requires nurses to take initiative in finding issues and concerns in current clinical practices to promote change that leads to optimal patient outcomes. One current issue in clinical practice is the varying patient-to-nurse ratios (PNRs) amongst different hospitals (Aiken et al., 2012). Having high PNRs may lead to nurse burnout, medical errors, and ineffective nursing care (Aiken et al., 2012; Karavasiliadou & Athanasakis, 2014). The solution would be to regulate PNRs, especially in areas such as the emergency room. To initiate this change, a task force would have to be established to use current data and research as evidence to propose the change, implement the change and evaluate its effectiveness.

Hospitals nationwide are experiencing nurse shortage and increased workloads because of shorter hospital stays, fewer support resources and higher acuity in patients (Vahey, D. C., Aiken, L. H., Sloane, D. M., Clarke, S. P., & Vargas, D., 2004). Higher nurse workloads are directly associated with job burnout and job dissatisfaction which in turn causes more voluntary nurse turnover and relates to the increased nursing shortage. According to the Missouri Hospital Association the turnover rate of nurses has increased by fourteen percent in the last five years (Browning M., 2012). Nursing shortage is a real threat to the patient population. According to the Quality Health Outcomes Model by the American Academy of Nursing by Donabedian, effects of the healthcare interventions are characterized by the environment the staff works in (Vahey et al., 2004). Donabedian describes that quality metrics can be divided into three broad categories, structural, process, and clinical.

Healthcare providers strive to improve service quality by implementing various quality management programs. Customers tend to seek for higher quality of care when choosing treatments, providers, and health plans. For healthcare organizations that desire to provide high quality care and compete in the global market, choosing a quality management program to implement is critical for performance and efficiency. Many studies have been conducted to analyze the effectiveness of such programs. Lean, Six Sigma and Total Quality Management (TQM) are three programs that will reviewed by three different case studies in efforts to understand them and to compare and contrast their capabilities.

Currently, nations are keen on cutting down costs, and to achieve this constant layoffs and hiring freezes are common practices. Although, this targets most professions, nursing forms the easiest target given that the profession is one of the largest budgets in the health care profession (Hendren, 2011). This creates fear among nurses and threatens their career as they have to struggle against the overwhelming wave of layoffs and job freezes. It is paramount that organizations get suppler with scheduling and staffing while coming up with innovative ways of reducing costs without compromising the quality of health care that patients get. These organizations should also adopt flexibility and change, which is a useful