scholarly journals Nurses’ Perspectives on Lean Redesigns to Patient Flow and Inpatient Discharge Process Efficiency

2018 ◽  
Vol 5 ◽  
pp. 233339361881065 ◽  
Author(s):  
Francesca M. Nicosia ◽  
Linda G. Park ◽  
Caroline P. Gray ◽  
Maayan J. Yakir ◽  
Dorothy Y. Hung
Keyword(s):  
Process Improvement ◽  
Patient Flow ◽  
Clinical Care ◽  
Process Efficiency ◽  
Hospital Nurses ◽  
Discharge Process ◽  
Process Improvements ◽  
Improve Efficiency ◽  
Patient Satisfaction Scores ◽  
Professional Roles And Responsibilities

As hospitals around the world increasingly face pressure to improve efficiency, “Lean” process improvement has become a popular approach to improving patient flow. In this article, we examine nurses’ perspectives on the implementation of Lean redesigns to the inpatient discharge process. We found that nurses experienced competing demands and tensions related to their time and professional roles and responsibilities as a result of Lean. Four main themes included (a) addressing the needs of individual patients, while still maintaining overall patient flow; (b) meeting discharge efficiency targets while also achieving high patient satisfaction scores; (c) “wasting time” to save time; and (d) the “real” work of providing clinical care versus the “Lean” work of process improvement. Our findings highlight the importance of soliciting hospital nurses’ perspectives when implementing Lean process improvements to improve efficiency and patient flow.

scholarly journals Nurses' performance on hospital discharge: patients' point of view

2007 ◽  
Vol 20 (3) ◽  
pp. 345-350 ◽  
Author(s):  
Daniele Alcalá Pompeo ◽  
Maria Helena Pinto ◽  
Claudia Bernardi Cesarino ◽  
Renilda Rosa Dias Ferreira de Araújo ◽  
Nadia Antonia Aparecida Poletti
Keyword(s):  
Health Care ◽  
Hospital Discharge ◽  
Health Care Providers ◽  
Clinical Care ◽  
Educational Process ◽  
Discharge Process ◽  
Care Providers ◽  
Discharge Instructions ◽  
Effective Discharge ◽  
Number Of Patients

OBJECTIVE: To know the hospital discharge process in place and the nurses' performance in preparing patients for discharge. METHODS: A descriptive study using semi-structured interviews was used to collect data from 43 patients of medical-surgical units of a major teaching hospital in the state of São Paulo, Brazil. RESULTS: The majority of patients (83.72%) received tailored discharge instructions. However, a great number of patients (72.08%) reported discharge instructions were not given by nurses. Almost a half of patients (48.84%) reported that discharge instructions were given by their physicians. CONCLUSION: The findings of this study provide insights to improve the educational process of new nurses and their preparation to provide effective discharge instructions. There is also a need to design and implement a hospital discharge process that promotes the participation of interdisciplinary health care providers who are involved in patient clinical care. This discharge process might be an effective way to change health care providers' attitude toward discharge instructions.

scholarly journals A patient-centered system in a provider-centered world: challenges of incorporating post-discharge wound data into practice

2016 ◽  
Vol 23 (3) ◽  
pp. 514-525 ◽  
Author(s):  
Patrick C Sanger ◽  
Andrea Hartzler ◽  
Ross J Lordon ◽  
Cheryl AL Armstrong ◽  
William B Lober ◽  
...  
Keyword(s):  
Design Process ◽  
Data Transfer ◽  
Clinical Care ◽  
Healthcare Providers ◽  
Surgical Patients ◽  
Discharge Process ◽  
Post Discharge ◽  
Patient Centered ◽  
Semistructured Interviews ◽  
Present Design

Objective The proposed Meaningful Use Stage 3 recommendations require healthcare providers to accept patient-generated health data (PGHD) by 2017. Yet, we know little about the tensions that arise in supporting the needs of both patients and providers in this context. We sought to examine these tensions when designing a novel, patient-centered technology – mobile Post-Operative Wound Evaluator (mPOWEr) – that uses PGHD for post-discharge surgical wound monitoring. Materials and Methods As part of the iterative design process of mPOWEr, we conducted semistructured interviews and think-aloud sessions using mockups with surgical patients and providers. We asked participants how mPOWEr could enhance the current post-discharge process for surgical patients, then used grounded theory to develop themes related to conflicts and agreements between patients and providers. Results We identified four areas of agreement: providing contextual metadata, accessible and actionable data presentation, building on existing sociotechnical systems, and process transparency. We identified six areas of conflict, with patients preferring: more flexibility in data input, frequent data transfer, text-based communication, patient input in provider response prioritization, timely and reliable provider responses, and definitive diagnoses. Discussion We present design implications and potential solutions to the identified conflicts for each theme, illustrated using our work on mPOWEr. Our experience highlights the importance of bringing a variety of stakeholders, including patients, into the design process for PGHD applications. Conclusion We have identified critical barriers to integrating PGHD into clinical care and describe design implications to help address these barriers. Our work informs future efforts to ensure the smooth integration of essential PGHD into clinical practice.

New Horizons for Shipbuilding Process Improvement

2005 ◽  
Author(s):  
Bahadir Inozu ◽  
M. J. Niccolai ◽  
Clifford A. Whitcomb ◽  
Brian Brian MacClaren ◽  
Ivan Ivan Radovic ◽  
...  
Keyword(s):  
Process Improvement ◽  
Six Sigma ◽  
Lean Six Sigma ◽  
Defense Contractors ◽  
New Era ◽  
Process Improvements ◽  
New Horizons ◽  
Direct Reports ◽  
Design For Six Sigma ◽  
Strategy Design

“In 2004, we start an Initiative --Lean Six Sigma Initiative to achieve our Op Ex Goals. We will be conducting a number of on boarding sessions for Six Sigma with senior leaders in DOD, NAVY, and most importantly Defense Contractors. We will require Six Sigma training for direct reports.” John Young, ASN (RDA) The announcement of NAVSEA’s Lean Six Sigma initiative has ushered in a new era in the ways that naval combatants are designed, built, and operated. As the Navy’s budgetary constraints increase in the coming years, the challenges they face in the 21st century will grow. New levels of process performance are mandated. This paper first highlights the opportunities that the Lean Six Sigma roadmap brings to shipbuilding process improvement and then details the efforts to adopt Lean Six Sigma and align it with the continuous improvement initiative at NGSS. Aspects of management strategy, Design for Six Sigma, replicating process improvements as part of integrating Lean Six Sigma with Knowledge Management are discussed.

The Development of International Standards to Facilitate Process Improvements for Very Small Entities

2014 ◽  
pp. 1335-1361
Author(s):  
Claude Laporte ◽  
Edgardo Palza Vargas
Keyword(s):  
Software Engineering ◽  
Process Improvement ◽  
Working Group ◽  
International Standards ◽  
Pilot Projects ◽  
Process Improvements ◽  
Enterprise Organization ◽  
Quality Product ◽  
Develop Software ◽  
Engineering Practices

Industry recognizes that Very Small Entities (VSEs) that develop software are very important to the economy. A Very Small Entity (VSE) is an entity (enterprise, organization, department or project) with up to 25 people..Failure to deliver a quality product on time and within budget threatens the competitiveness of VSEs and impacts their customers. One way to mitigate these risks is to put in place proven software engineering practices. Many international standards and models, like ISO/IEC 12207 or CMMI®1, have been developed to capture proven engineering practices. However, these documents were not designed for VSEs and are often difficult to apply in such settings. This chapter presents a description of the development of process improvement international standards (IS) targeting VSEs developing or maintaining software as a standalone product or software as a component of a system. The documents used by ISO/IEC JTC1/SC72 Working Group 24 (WG24), mandated to develop a set of standards and guides, and the approach that led to the development, balloting of the ISs, and TRs (Technical Reports) for VSEs are also presented. The chapter focuses on the ISO/IEC 29110 Standard3, the development of means to help VSEs improve their processes, and the description of a few pilot projects conducted to implement the processes of ISO/IEC 29110 standard.

scholarly journals Exploring potentials of digital nudging for business processes

2020 ◽  
Vol 26 (6) ◽  
pp. 1329-1347
Author(s):  
Sandra Bammert ◽  
Ulrich Matthias König ◽  
Maximilian Roeglinger ◽  
Tabitha Wruck
Keyword(s):  
Process Improvement ◽  
Business Process ◽  
Process Management ◽  
Business Processes ◽  
Future Research ◽  
Content Type ◽  
Process Improvements ◽  
Business Environments ◽  
Digital Nudging ◽  
Agile Process

PurposeBusiness process improvement is vital for organizations as business environments are becoming ever more volatile, uncertain, complex and ambiguous. Process improvement methods help organizations sustain competitiveness. Many existing methods, however, do not fit emerging business environments as they entail initiatives with long implementation times, high investments and limited involvement of process participants. What is needed are agile process improvement approaches. The purpose of this paper is to explore the potential of digital nudging – a concept offering tools that lead individuals to better decisions – to improve business processes.Design/methodology/approachUsing process deviance as theoretical lens, an online experiment with 473 participants is conducted. Within the experiment, business processes and digital nudges are implemented to examine whether digital nudging can mitigate the weaknesses of existing process improvement methods.FindingsDigital nudging can influence the decisions of process participants and entail positive process deviance that leads to process improvement opportunities. Further, the research gives a first hint on the effectiveness of different digital nudges and lays the foundation for future research.Research limitations/implicationsSince exploring a completely new field of research and conducting the experiment in a synthetic environment, the paper serves as a first step toward the combination of digital nudging, business process improvements and positive process deviance.Originality/valueThe major achievement reported in this paper is the exploration of a new field of research. Thus, digital nudging shapes up as a promising foundation for agile process improvement, a discovery calling for future research at the intersection of digital nudging and business process management.

scholarly journals Improving patient satisfaction by adding a physician in triage

2013 ◽  
Vol 3 (1) ◽  
pp. 7 ◽  
Author(s):  
Jason Imperato ◽  
Darren S. Morris ◽  
Leon D. Sanchez ◽  
Gary Setnik
Keyword(s):  
Patient Satisfaction ◽  
Process Improvement ◽  
Emergency Department Setting ◽  
Patient Satisfaction Scores ◽  
Time Period ◽  
Percentile Rank ◽  
Before And After ◽  
Survey Results ◽  
The Absolute ◽  
Attending Physician

Background: The physician in triage (PIT) model has been proposed as a process improvement to help increase efficiency in the Emergency Department setting. However, its effect on patient satisfaction has not been well established. Methods: An interventional study comparing patient satisfaction scores for the 6-month period before and after implementation of a physician in triage model. In our system an additional attending physician was assigned to triage from 1 p.m. to 9 p.m. daily. Outcome measures were mean scores obtained from respondents to Press Ganey® patient satisfaction surveys for selected questions most likely to be impacted by PIT implementation and those included in the physician section of the survey. Results: Five hundred and eight respondents seen in the six months before the initiation of the PIT team and 458 respondents in the six months after the system change were included in the study. Improvement was noted in the absolute Press Ganey® scores in the Post-PIT time period across all questions analyzed with statistically significant differences noted for 8 of the 10 questions studied. Conclusions: Although seemingly small there was a statistically significant improvement in the absolute patient satisfaction scores after adding a physician in triage. Because small gains in absolute scores can result in large improve- ments on the percentile rank when using Press Ganey® surveys, physician in triage may be of significant benefit to overall patient satisfaction.

Process Improvements to Reform Patient Flow in the Emergency Department

2016 ◽  
Vol 19 (1) ◽  
pp. 29-35 ◽  
Author(s):  
Shawn Whatley ◽  
Alexander Leung ◽  
Marko Duic
Keyword(s):  
Emergency Department ◽  
Patient Flow ◽  
Process Improvements

Reducing infusion wait time: Redesigning medication order verification workflow at a comprehensive cancer center.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 129-129
Author(s):  
Michael D Kearney ◽  
Rachel A Wolfberg ◽  
Mark Sudol ◽  
Shital Shukla ◽  
Barbara Fine ◽  
...  
Keyword(s):  
Process Improvement ◽  
Patient Flow ◽  
Wait Time ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Drug Preparation ◽  
Medication Order ◽  
Throughput Time ◽  
Reduced Order ◽  
Dana Farber Cancer Institute

129 Background: Many factors contribute to long wait times for cancer patients on the day of their infusion. At Dana-Farber Cancer Institute (DFCI), a contributing factor is patient flow between exam and infusion. Order verification affects patient flow and begins when the following two criteria are met: provider signed an order and the patient’s scheduled infusion appointment arrives. Patients often check-in to infusion before their scheduled infusion appointment. Order verification has three sequential steps: nurse verification, pharmacist 1 verify (V1), and pharmacist 2 verify (V2). Methods: A team of pharmacists, nurses, providers, and process improvement leads designed a pilot in which V1 moved before nurse verification, concurrent with patient check-in to infusion. Further, V1 began as soon as an order was signed; the pharmacist did not wait for a patient’s scheduled infusion appointment. Nurse verification and V2 occurred in sequence after V1. Timestamp data were extracted from Epic and analyzed via Tableau to assess reduction in verification throughput, defined as time between infusion check-in and V2. Fourteen providers and one pharmacist joined a 6-week pilot to adopt the redesigned workflow beginning 4/23/18. Results: At baseline, time between check-in and V2 was consistent for pilot and non-pilot orders. During the pilot, time between check-in and V2 was shorter for pilot orders, showing a sustained decrease of approximately 10 minutes. The table below provides time in minutes between infusion check-in and V2 for pilot and non-pilot orders at baseline (3/12/18-4/20/18) and following workflow redesign (4/23/18-6/1/18). Conclusions: Implementing the pilot workflow reduced order verification throughput time and enabled drug preparation to begin sooner. Expanding this workflow to all medication orders can decrease infusion wait time at DFCI.[Table: see text]

Accurate Weight Documentation

2020 ◽  
pp. 15-21
Author(s):  
Sonali Muzumdar
Keyword(s):  
Real Time ◽  
Process Improvement ◽  
Human Factor ◽  
Preventive Measures ◽  
Expiration Date ◽  
Staff Education ◽  
Improvement Project ◽  
Safe Medication ◽  
Process Improvements ◽  
Improvement Plan

Background: The Institute for Safe Medication Practices (ISMP) has recommended that health systems implement preventive measures to decrease weight-based dosing errors. Problem: Despite a process improvement project that was implemented to meet ISMP’s goals, weight documentation discrepancies continue to occur. Methods: The weight documentation process was reviewed and safety gaps were identified. Pharmacists were notified when patients had greater than 15% weight documentation discrepancy. Notifications were tracked before, during, and after process improvements within the electronic health record (EHR). Interventions: Streamlining of weight documentation fields within nursing assessments, locking of bed scales, setting an expiration date for the weight documentation field, including a minimum and maximum on height and weight fields, real-time alert for nursing staff upon documentation, and staff education were part of the process improvement plan. Results: Average monthly weight documentation errors decreased from 115 to 60 per month over the process improvement period. Conclusion: Human factor errors can result in weight documentation discrepancies despite implementing ISMP’s targeted safety goals around weight documentation. A real-time pharmacy notification of weight documentation discrepancies should be required for hospital pharmacists to prevent weight-based dosing errors.

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