Month: December 2014

by Megan Pitkin

While I was working as a bedside nurse, my organization decided to adopt a new way of approaching patient care and improve workflow: Lean. As described in this article about Lean in health care, "Lean is an industrial managerial system that aims to eliminate process waste in the forms of transportation, inventory, motion, waiting, overproduction, over-processing, and defects."

While Lean was originally intended for industrial applications, the article describes the efforts of Dr. M. Peggy Hays, associate professor in the UAH College of Nursing, to bring industrial Lean practices in healthcare.

"Nursing staff today have more and more duties," said Dr. Hays. "How can they make their job more efficient so they can focus on patient care, which is why they got into the profession in the first place?"

According to the article, Dr. Hays said that "healthcare applications [for Lean] include unearthing greater efficiencies in emergency room waiting times, operating room use, use of nursing rounds, medication rounds, processing patient paperwork in administrative offices, and workflow of the staff."

The planning and assessment phase for my unit started with the team receiving Lean education and concluded with a list of probable projects and action items needed for the week. Because the main action item was patient wait times, data was collected for the time it took for call lights to be answered.

An initial assessment found that we walked over five miles each shift between patient rooms for medication delivery, gathering of supplies, locating equipment, and patient care needs. After streamlining workflows, reorganization of the medication rooms, and standardizing equipment processes, my walking was reduced by a mile for my first shift of the implementation week. With the improved processes and reduction in the amount of walking required for the nurses to complete their tasks, there was a significant decrease in call light wait times.         

Seeing how successful Lean was in my unit and throughout the organization, I began to question if the Lean principals could be applied to the materials I used in my Electronic Medical Records (EMR) training classes. While adopting an industrial process in the creation of training materials may sound like a stretch, I'd like to illustrate one simple way that I applied the Lean principles to a PowerPoint presentation I use in my classes.

Since standardization is a key Lean component, I used my organization's approved fonts and colors on my first slide.

I also organized my lesson plan sections and agenda using approved colors, and I used the colors in a very deliberate way. For example, in the image below notice that "Locating the Patient" is a dark purple on my agenda slide.

I used that same dark purple banner on all of the slides in the "Locating a Patient" segment of the course. (One of those slides is shown below.)

Lastly, I color-coordinated the supporting training materials, like pocket guides, so that they match the colors used in the presentation.

As a nurse, it is encouraging for me to see more hospitals doing an excellent job of implementing Lean tools that manufacturing has been evolving for more than half a century. As an Instructional Designer, I have been pleased with the overwhelming positive feedback I have received by adopting these Lean philosophies into the creation of materials for EMR classes.

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