Levels of Evidence

This is part 11 of the Nursing Research Challenge. The following article is not a nursing research article, but rather a case report and serves as valuable nursing evidence.

The Article: Korner, K., Hartman, N., Agee, A., & McNally, M. (2011). Lean tools and concepts reduce waste, improve efficiency: A Magnet organization goes lean, with nurses playing a key role in the culture change. American Nurse Today, 6(3): 41-44.

Big Idea: A Magnet facility in eastern Pennsylvania utilized lean principles derived from the Toyota Production System to eliminate waste (e.g. unused human potential, waiting, inventory, transportation, defects, motion, overproduction, and processing) and improve specific outcome metrics (e.g. glycemic control, overall patient satisfaction, employee satisfaction, cost/adjustment admission, length of stay, emergency department [ED] diversions, time from ED to bed, and time of inpatient physical discharge). The article describes the 5-day Rapid Improvement Event (RIE) process to improve the specific outcome of inpatient physical discharge, which when assessed at the beginning of the project found only 5% of patients left the hospital before 11 AM even though 46% of discharge orders were written/entered before 11 AM.

Survey Says!: The nurses identified the key discharge problems on day 1, determined target goals and applied lean tools to the problem on day 2, tested proposed experiments on days 3 and 4, and evaluated the experiments and target state on day 5. The effort led to waste reduction by reducing length of stay, decreasing emergency room diversions, decreasing wait time from the ED to the bed, and increasing patient satisfaction. In addition, the process allowed nurses to remain at the helm of organizational change, a requirement for Magnet organizations.

Quotable: “Healthcare leaders believe patients are willing to pay for quality care – that they will go to the hospital to be diagnosed, treated, and discharged, but aren’t willing to pay for more than that (deemed waste)” (p. 41). 

“Going lean is a journey – one that allows us to continually improve our health network and the way we provide care to the community” (p. 44).

So What?: Nurse leaders at all levels can learn from this case report to apply lean tools to varying processes and systems to reduce waste and improve efficiency while improving patient care.