Time to Care: Common Ways Nurse Time Is Wasted

Time to CareCommon Ways Nursing Time Is Wasted

Introduction

Brad White– Title: Operations Improvement Engineer– Description: Implements Lean Six Sigma at Baptist

Health System

Time to Care: Common Ways Nurse Time Is Wasted

Project Definition

Defect– High nurse turnover & low employee morale

Background– The tele units at BMC were experiencing high

turnover– Nurses said the floor was stressful– Nursing grid was changing from 1-5 to 1-6

Goal– Retain tele nurses


Observation

• First step in observation is learning what to observe

• Be prepared for the first round of observations to yield little data

• Find a structured yet flexible way to capture data


Observation FormTime to Care: Common Ways Nurse Time Is Wasted

Convert to Data

• Two basic forms of observation data:– Process– Work-Time Study

• Convert observation notes into applicable data• Categories the times into various bins• Ask, is this of value?


CategorizationTime to Care: Common Ways Nurse Time Is Wasted

Analysis

Time Analysis

Shift Day Night Day Night Average

VA 13.5% 52.8% 7.9% 61.9% 34.0%

Flex 14.0% 7.1% 31.4% 5.4% 14.5%

NVA 72.5% 40.1% 60.7% 32.7% 51.5%

Cost of the Waste $1,530,395/yr


Spaghetti DiagramTime to Care: Common Ways Nurse Time Is Wasted

• Nurses were walking 750 mi. a year

• That’s like walking from here to Memphis, TN!

• Represents over $10,000 per nurse each year

Other Data

• What else can be collected?– Staff opinion– Photos– Video– Audio– Anything that can put the environment into

context for your audience


Waste Pareto

• Detailed analysis will generate a “Waste Pareto”

• This becomes the action items for improvement


Data AnalysisTime to Care: Common Ways Nurse Time Is Wasted

Med Draw

Discharge

Charting

SupplyAdmit

Monitor T

ele

Chart Search

Chart Review

Error C

orrecti

on

Decypher

Schedule

Call Button

Board

Phone Re-Calls

Call Transfe

rOther

0

20

40

60

80

100

120

140

160

180

200

Wasted Time Analysis(In Hours, per nurse each year)

Data AnalysisTime to Care: Common Ways Nurse Time Is Wasted

Med Draw

Discharge

Charting

SupplyAdmit

Monitor T

ele

Chart Search

Chart Review

Error C

orrecti

on

Decypher

Schedule

Call Button

Board

Phone Re-Calls

Call Transfe

rOther

$-

$1,000

$2,000

$3,000

$4,000

$5,000

$6,000

$7,000

$8,000

Wasted Time Analysis(In Dollars, per nurse each year)

Med Draw Analysis

• Pulling medication was the #1 time waster (tied with discharging)

• The observed reason for delays:– Multiple machines required multiple logins– Centralized location required travel and resulted in

batching– Medication in bins required the nurse to fill the

prescription


Med Draw Solutions

• Re-balance machines to be patient-centric not drug-centric

• Disperse machines throughout the floor instead of a central location

• Have pharmacy fill each med pass by patient• Install med boxes outside each room


Discharge Analysis

Admit TimeOrdersto Start

Start to End

End to Leave Total

Mean 77 Mean 125 59 36 220Std. Dev 59 Std. Dev 146 42 63 251

Min 13 Min -155 -55 -10Max 250 Max 665 205 250

N 22 N 58 80 24


7:008:00

9:0010:00

11:0012:00

13:0014:00

15:0016:00

17:0018:00

19:0020:00

21:0022:00

23:0023:59

1:002:00

3:004:00

5:006:00

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

Expected Admission Done

Expected Discharge Start

Admit Done

Discharge Start

1

2

3

Discharge Solutions

• Collect proper information early in the process• Prepare for discharge by completing patient

education prior to discharge orders• Eliminate unnecessary paperwork in the

discharge process


Key Lessons

• Nurse time not spent at the bed time is waste– Nurses aren’t happy– Patients aren’t happy– Management isn’t happy

• Poor staffing is concealed with busy work so cost are hidden and a paper profit is shown

• High turnover is expensive, drains morale, and decreases patient satisfaction and safety

• The answer is rarely more staff or more equipment, but rather better layout and processes


Is This of Value?Time to Care: Common Ways Nurse Time Is Wasted

• Questions?

Time to Care: Common Ways Nurse Time Is Wasted

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