The Spirit of Improvement

Nursing at the Bedside

On Tuesday morning at the Quality & Safety Meeting, we have a weekly agenda of ongoing work in Clinical Effectiveness, Operational Effectiveness and Service Excellence.  This week, the update was about some exciting work ahead of us in Nursing.  An Operational Effectiveness (OE) Team has been appointed to improve the work flow of the nurse at the bedside by removing wasted steps and motion.  The goal or desired state of the work will be to create a patient care process that allows the nurse to guide the patient through ‘milestones’ in care that ensure quality and safety for the patient and efficiency for the staff.  The effectiveness of this improvement work will be measured by:  (1) increased time for the nurse with the patient, (2) a reduction in rework for the nurse and patient, and (3) a more efficient length of stay for the patient.

Recently, a team assembled to define the scope and nature of this improvement work.  This part of our process in Operational Effectiveness is called a ‘Value Stream Analysis’ (VSA).  The Value Stream defines the parameters of the improvement work in a particular process.  The Value Stream also identifies the bottlenecks and potential places of waste in a process.  Next, the Value Stream Analysis plans for a series of month-after-month Rapid Improvement Events (RIEs).  These RIEs seek to remove the bottlenecks and waste in the process.  This Value Stream for Nursing at the Bedside will be referred to as ‘Excellence in Bedside Care.’ After the VSA was complete, the team recommended twenty-three (23) RIEs, one per month.  The RIEs will carefully examine the processes and move toward improvement in each step.

The ‘gap’ between the present state and the desired state is defined by the VSA team in the following sentences: The current patient care process does not flow well.  The process includes multiple rework loops and redundancy in both work and documentation by the nurse. There is the need for more Standard Work in the patient care process.  Many ‘Milestones’ are not transparent nor used to plan the work so that it can be more efficient.  We need to stabilize the process, standardize where possible and improve the process.

The VSA team includes: Leanne Huminski, Kelley Prevatte, Todd Hazzard, Cecilea Wingate, Sabrina Capell, Bradley White,  Trena Addison, Lisa Hagberg, Shamika Goodson and Will McLeod.  Many more people will be involved in the twenty-three (23) monthly RIEs over the next two years.  A team of nine will be assembled the third week of January 2010 to work on the first RIE: ‘Supplies at the Point of Use.’  Over the next twenty-three (23) months, an RIE team will be assembled each month to improve various parts of the patient care process.  This work is being modeled after a national project, ‘Transforming Care at the Bedside.’

Below is a process map of a Value Stream Analysis.

as is

The 'yellow and pink' notes define the parameters and steps of the improvement work in a particular process. The slips also identify any bottlenecks or waste in a process. This tool is used by the VSA team to identify and track the work plan over time.

Thanks for all your work and dedication to efficiency and excellence in patient care.


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