Daily management systems in medicine

"Lean" (continuous improvement) organizations make use of daily management systems (DMS) that are designed so that problems can be quickly identified, front-line staff are empowered to fix the problems that they can, and problems that the front-line staff cannot fix are escalated and countermeasures created quickly. Key components of a DMS include leadership standard work, visual controls, and a daily accountability process, as well as discipline involving each of these three components.

Study: Risk of hospital infections increases at end of work shifts

A study published in the Journal of Applied Psychology reveals that nurses, physicians and other hospital workers tend to wash their hands less frequently as their work shift progresses, with a nearly 9 percent drop in compliance with handwashing protocols from the beginning to the end of a 12-hour shift. Researchers studied three years of hand-washing data on 4,157 healthcare workers in 35 U.S. hospitals. They attribute the decline in compliance to mental fatigue and the fact that hand hygiene is considered a low-priority task among health workers.

Developing a cost-effective pressure-ulcer prevention program in an acute-care setting

This article in the Wound Care Advisor is a case study describing a cost-effective pressure-ulcer program in a 350-bed acute-care hospital. The authors report that the program they put in place is saving over $2 million annually.

Can lean tools help crack the medication safety code?

Joanie Ching, RN MN, Administrative Director of Quality and Safety, blogs about how Virginia Mason Hospital in Seattle is abandoning batch administration of medications to improve patient safety. By going to just-in-time medication administration, nursing workload has been leveled, medication errors have been reduced, and nurses are better able to respond to patient needs.
Editor's note: Workload leveling and smaller batch size, like many other "lean tools," are industrial engineering concepts that have been well understood for many decades. It appears that a lean approach has helped Virginia Mason to discover the benefits in this novel application. 

Registered nurses' personality traits and work assignments

This presentation at the 2013 SHS Healthcare Systems Process Improvement Conference addresses the unique set of skills, knowledge and personal attributes for nurses in order to match individual nurses to various nursing roles. More and more, personality measures are being used to assess an individual's fit within various industries. Investigating the traits of registered nurses may provide a means to improving job performance, satisfaction and retention to meet the demands associated with nursing.

Nursing, engineering blend to seek greater healthcare efficiency

"What we're finding is that hospital administrators either learn lean Six Sigma, or they go out and hire people who know lean Six Sigma in order to apply their experience to a hospital setting," Dr. Gholston said. "The goal of the new course would be to train existing administrators and nursing staff to interpret data and implement process changes that improve efficiencies and boost patient satisfaction."

Delivering consistent and lower cost care in the post-acute and long-term care setting

This presentation at the 2013 Healthcare System Process Improvement Conference addresses labor productivity in the post-acute setting. As labor rates continue to rise and represent the highest expense in the post-acute and long term care industries, providers are turning their attention to scheduling solutions that more appropriately align their workforce to patients' need. Traditional Industrial Engineering tools such as work measurement are leveraged to provide a more accurate definition of cost of care as well as staffing models that closely align labor to patient care demands.

Through the eyes of the workforce - creating joy, meaning, and safer healthcare

"Workplace safety is inextricably linked to patient safety. Unless caregivers are given the protection, respect, and support they need, they are more likely to make errors, fail to follow safe practices,and not work well in teams." 

This report addresses what can be done and what is being done to improve the physical and psychological harm to healthcare employees that ultimately impacts the safety and quality of patient care. The report provides a list of strategies and supporting tactics to improve conditions impacting the health and safety of the workforce.

Bound for Flight: Elevating Organizational Excellence Using Lean Leadership

This engaging presentation at the 2013 Healthcare Systems Process Improvement Conference in New Orleans, describes an actionable transformational leadership roadmap for navigating common organizational obstacles using a non-biased Lean approach at Advocate Condell Medical Center in the Greater Chicago area. As a result of embracing an innovative transformational roadmap, the organization experienced a significant turnaround both financially and culturally, including a $50 million dollar financial swing and a top percentile workforce satisfaction rank.

Hybrid field: Nursing and industrial engineering 

In this article, Patti Brennan, the Lillian L. Moehlman Bascom Professor in the School of Nursing and College of Engineering at the University of Wisconsin, discusses the intersecting fields of industrial engineering and clinical care with members of University of Missouri's Industrial and Manufacturing Systems Engineering Department.

Surviving the global healthcare perfect storm

The authors describe the application of operational planning and capacity management methods to improve patient care, improve revenue, and lower costs. Article   

Lehigh Valley Health Network nurses go lean

An online article in American Nurse Today, describes how Lehigh Valley Health Network (LVHN) in eastern Pennsylvania, is working to implement Lean. LVHN calls their approach the "System for Partners in Performance Improvement (SPPI)." The goal of the organization is to discover more efficient ways to provide health care by using lean tools and concepts that reduce waste and repetition. The article provides a detailed description of the five-day rapid improvement event process in use at LVHN.

Central line infection reduction using Lean Sigma at Presbyterian Healthcare Services, Albuquerque, N.M.

A multidisciplinary group at Presbyterian Healthcare Services teamed together to meet the Joint Commission National Patient Safety Goal and to reduce the central line infection rate to less than 1 per 1,000 patient days. The team used a Lean Sigma improvement methodology to identify a number of countermeasures including checklists, education, defined observer, and a standardized central line kit. In the first six months of the project, the central line infection rate was reduced to .22 infections per 1,000 patient days.

Nurse Scheduling: From the Theoretical Modeling to Practical Resolution

In this paper recognized at the SHS 2011 Conference, the authors from the École Polytechnique de Montréal address the difficulty and complexity of nurse scheduling. The authors developed an algorithm to optimize nurse scheduling and also a heuristic model that can be applied without complex computer analysis that results in considerable improvement over the current methodologies. The authors applied the optimization and heuristic models to two different hospitals in Montreal.

The journey to eliminating preventable harm - Nationwide Children's Hospital

In this presentation at the 2011 Society for Health Systems conference, Cindy Hafer provides a comprehensive look at how Nationwide Children's Hospital in Cincinnati is moving to eliminating all preventable harm to patients through a comprehensive safety initiative.

Purdue industrial engineering researchers investigate using surgeon hand gestures to improve surgery

Vision based recognition of hand gestures is being researched at Purdue University to control a robotic scrub nurse and access images during surgical cases. The research could lead to short case lengths and reduced infections according to the Purdue University News website.

Helping a hospital shine

In an article previously published in Industrial Engineer magazine, industrial engineering researchers at Clemson University assisted Cannon Memorial Hospital in Pickens, S.C., in a number of hospital-wide and service specific improvements resulting in increased efficiency

Patient tracker

A case study of a centralized patient tracking system at Sentara Careplex Hospital in Hampton, Va. The case study shows how Sentara was able to reduce patient registration labor by over 50 percent and save over $300,000 per year.

 Audible alarms and workplace noise in nursing units: An envioronmental factors case study

A case study for reducing workplace noise on a pediatric nursing unit and maintaining appropriate noise levels.

Establishing Safe Staffing Patterns for Nursing 

This presentation was developed for the HIMSS Safe Staffing Work Group. It compares mandated staffing ratios to engineered standards, advocating for the latter. It also shares a high level methodology for establishing standards that focus on the needs of the patient, acuity levels, etc. 

The Importance of Communication for Patient Satisfaction

A discussion of survey results regarding communication between providers and the patient. The visit quality as perceived by the patient increases with fewer communications.

Improving Medical Equipment Availability at Barnes-Jewish Hospital

One hospital details improvements to their medical equipment retrieval, cleaning, and distribution process.

Sustaining VAP Bundle Compliance in the ICU: A Model of CQI

Using Lean Six Sigma tools, a hospital redesigns and implements new ICU protocols for patients on mechanical ventilation. The article details how the initial sustainability effort failed, but was brought back into long-run control.

Optimizing Caregiver Workflow in a PICU

Physician and Nursing roles and responsibilities within a PICU are redefined using lean tools to decrease LOS while increasing outcomes.

5 Projects, 5 Hospitals: Using DMAIC for Rapid Quality Improvements

Pressure Ulcer, Falls, Catheter-Associated UTI, Central Line Infection, and Objects Left in Surgery are addressed using process improvement methodologies.

Pioneers of Industrial Engineering and Health Care: Part 1

This article profiles Frank Gilbreth and Henry Ford.  Gilbreth initiated the study of time and motion in the OR, and Ford was the first to attempt to decrease wasted motion among nursing staff.

 Medication Administration and the Complexity of Nursing Workflow

This article studies the work processes of nurses involved in the administration of medication. The goal is to reduce errors and improve efficiency.

Hospitals Need IE Data to Drive Staffing Decisions

Examples are used to detail the need for use of IE methods in the setting of departmental staffing levels.

SHS Helping a Hospital Shine

Lean tools are used to redesign processes throughout a hospital.

SHS Paging Dr Toyota

Discussion of applications of lean within the OR.

Lollipops for Excellence

System-level quality and effectiveness programs are implemented using Six Sigma at a children's hospital in Washington, D.C.

SHS A Four-Arm Framework To Implement Rapid Response Teams

One implementation of Rapid Response Teams is discussed.

SHS Attacking Waste and Variation Hospital-Wide: A Comprehensive Lean Sigma Deployment

Improvement projects in surgery, nursing and the ED are discussed. The process of moving a hospital towards adoption of lean Six Sigma is also described.

SHS Achieving a Shared Baseline: Implementing Evidence Based Clinical Practices

The authors propose a methodology for shortening the time gap between discovery of new evidence-based clinical results and hospital (provider) utilization of the new practice.

SHS Establishing Nursing Staffing Requirements in an Imaging Environment

A study is done to improve the communication between and expense of the nursing staff associated with all imaging modalities.

SHS Improving Patient Flow from the ED to a Nursing Unit

A lean event focused on patient flow out of the ED was conducted, and results are discussed.

SHS Medication Administration and the Complexity of Nursing Workflow

Task analysis of an RN's shift on a med/surg unit is performed, using spaghetti maps and other lean tools. Integration of a new medicine delivery system is studied to examine how RN efficiency is affected.

SHS Under Pressure - Efforts to Reduce Hospital Acquired Bed Sores

Root cause analysis was conducted to determine reasons for bed sores. This presentation and paper is the result of their team's effort. Sustainability and ongoing improvements are discussed.

SHS Sustaining VAP Bundle Compliance in the ICU: A Model of CQI

The IHI Bundle was implemented; metric changes are documented and discussed. Several nursing practices were also changed.

SHS "Never Events" and HACs - You Break It, You Buy It

Medicare's changes to payment require a higher degree of awareness from hospitals nationwide. This presentation addresses some of the concerns and discusses mitigation efforts currently underway.

SHS Measuring the Success of Hospital Acquired Pressure Ulcer Prevention

Pressure Ulcers are a known issue with long hospitalizations. This presentation deals with several issues surrounding eliminating their occurrence.

SHS Lessons Learned Implementing Lean Sigma in Healthcare

Any organization implementing lean six sigma will experience both success and failure. This presentation describes some of the "growing pains" of one system, as well as a methodical demonstration of the lean tools utilized in their improvement efforts.