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
Time to Care: Common Ways Nurse Time Is Wasted
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
Time to Care: Common Ways Nurse Time Is Wasted
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?
Time to Care: Common Ways Nurse Time Is Wasted
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
Time to Care: Common Ways Nurse Time Is Wasted
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
Time to Care: Common Ways Nurse Time Is Wasted
Waste Pareto
• Detailed analysis will generate a “Waste Pareto”
• This becomes the action items for improvement
Time to Care: Common Ways Nurse Time Is Wasted
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
Time to Care: Common Ways Nurse Time Is Wasted
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
Time to Care: Common Ways Nurse Time Is Wasted
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
Time to Care: Common Ways Nurse Time Is Wasted
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
Time to Care: Common Ways Nurse Time Is Wasted
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
Time to Care: Common Ways Nurse Time Is Wasted
Is This of Value?Time to Care: Common Ways Nurse Time Is Wasted
• Questions?