Redesigning Nursing Care Using Lean

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Lean Six Sigma

Sharon Hickman
Senior Performance Engineer
Premier Inc.

Greg Napps
Administrative Director Operations
Bon Secours Health System

A surgical unit piloted using lean principals to eliminating waste to allow more time for direct care. Successes include: increased patient satisfaction (18.4% excellence ranking to 99.8%); decreased employee turnover (16% to 6.5%), decreased unscheduled absences by 25%, and decreased length of stay (4.5 days to 4.0 days).

St. Mary's Hospital in Richmond, VA is a 350 bed hospital that has recently achieved Magnet Status from the American Nurses' Credentialing Center. It is a center for Bariatric Excellence and has received Gold Seal of Approval" as a Primary Stroke Center from the Joint Commission on Accreditation of Healthcare Organizations, as well as many other national recognized achievements. Part of the magnet journey was to redefine nursing care. St. Mary's chose Jean Watson's theory of caring and relationship based care. The executive team wanted to pilot implementation using lean principals on 5East (surgical unit) to determine if this would be an effective way to transform care. The goal was to eliminate waste to allow more time for hands on patient care. The pilot proved successful by increasing patient satisfaction from 18.4% excellence ranking to 99.8%. Additionally, employee satisfaction scores improved, employee turnover decreased 16% to 6.5%, unscheduled absences decreased by 25%, length of stay decreased from 4.5 days to 4.0 days and time spent on shift report was decreased by 1.5 hours. The methodology was refined and used to implement relationship based care throughout the hospital.