With looming provider shortages, hospitals need to reconsider management strategies now more than ever. Here are four considerations for implementing lean management in a hospital system, along with evidence of how lean management transformed the nursing staff of Covenant Hospital in Lubbock, Texas.
1. Elimination of top-down management problems. The nurses of Covenant Hospital worked with Simpler Consulting to implement the Simpler Business System, their lean management philosophy. Nurses at Covenant became involved in the process, suggesting ways to eliminate wasteful processes. “We let the nurses design the style and they changed the documentation process,” says Karen Baggerly, RN, CNO of Covenant. By reducing the number of charting forms, nurses reduced overall paperwork by 40 percent. “There is tremendous ownership from direct caregivers that they provided the input, authority and had autonomy to make these decisions,” says Ms. Baggerly.
The strategy not only brought on change in performance, but also in culture, since all levels of the organization became engaged in the process. “It’s not the minds of five or six people, but everyone,” says Mike Chamberlain, president of Simpler North America. “It’s a two-fold system. From a strategic perspective, all efforts are aligned to meet the objectives of the organization. But the improvements themselves happen at process level at the front lines,” says Mr. Chamberlain.
2. Improved ability to recruit and retain nurses. Since going lean, Covenant nurses have gained three hours of freed time per 12 hour shift, and the hospital has seen an increase in retention rates. Ms. Baggerly calls Covenant’s new management system a “positive recruiting tool,” in that it allows nurses additional time at the bedside, increasing job satisfaction and giving them a sense of purpose about their job that became lost in redundant paperwork. “A lot of nurses leave because they’re burned out or don’t feel they have the time or capability to take care of patients,” says Ms. Baggerly. By bringing nurses back to the bedside, “they’re getting to do what they really enjoy."
3. Reaching an effective nurse-to-patient ratio. “The primary retention criteria for nurses is the hospital’s maintenance a reasonable nurse-to-patient ratio,” says Ms. Baggerly. Covenant determines these ratios based on the acuity of the patient and the experience of the staff, but lean management eliminated unnecessary tasks and documentation that burdened these ratios. Prior to going lean, nurses were spending 50 percent of their time on documentation that did not add value. Another time waster for nurses is simply the time spent looking for items or retrieving something that wasn’t easily accessible. Simpler’s studies reveal 90 to 95 percent of hospital documentation processes do not add value, according to Mr. Chamberlain, which means it’s time for hospitals to reexamine processes.
4. More direct communication between staff. “Specific to lean, one of the biggest gains is the leadership rounding by the nurse managers, nursing directors and myself,” says Ms. Baggerly. Covenant’s nurses now have opportunities to let upper-level staff know about staffing needs, equipment needs and specific patient care issues. “It saves time for them when they know they can relay that information to us at 8:30 everyday. They don’t have to spend a lot of time following up,” says Ms. Baggerly. The lean strategy also improved communication between shift handoffs, according to Mr. Chamberlain. “Instead of spending all your time doing paperwork, you’re communicating with your peers. Now there’s a new standard for work,” says Mr. Chamberlain.
Learn more about Simpler Consulting.
Read more about lean management in hospitals:
-Common Pitfalls of "Lean" Management With Craig Deao of Studer Group
-3 Best Practices for Implementing Lean Processes at Your Hospital With the Author of Lean Hospitals
-5 Key Principles for Hospitals From Toyota's Lean Production System
1. Elimination of top-down management problems. The nurses of Covenant Hospital worked with Simpler Consulting to implement the Simpler Business System, their lean management philosophy. Nurses at Covenant became involved in the process, suggesting ways to eliminate wasteful processes. “We let the nurses design the style and they changed the documentation process,” says Karen Baggerly, RN, CNO of Covenant. By reducing the number of charting forms, nurses reduced overall paperwork by 40 percent. “There is tremendous ownership from direct caregivers that they provided the input, authority and had autonomy to make these decisions,” says Ms. Baggerly.
The strategy not only brought on change in performance, but also in culture, since all levels of the organization became engaged in the process. “It’s not the minds of five or six people, but everyone,” says Mike Chamberlain, president of Simpler North America. “It’s a two-fold system. From a strategic perspective, all efforts are aligned to meet the objectives of the organization. But the improvements themselves happen at process level at the front lines,” says Mr. Chamberlain.
2. Improved ability to recruit and retain nurses. Since going lean, Covenant nurses have gained three hours of freed time per 12 hour shift, and the hospital has seen an increase in retention rates. Ms. Baggerly calls Covenant’s new management system a “positive recruiting tool,” in that it allows nurses additional time at the bedside, increasing job satisfaction and giving them a sense of purpose about their job that became lost in redundant paperwork. “A lot of nurses leave because they’re burned out or don’t feel they have the time or capability to take care of patients,” says Ms. Baggerly. By bringing nurses back to the bedside, “they’re getting to do what they really enjoy."
3. Reaching an effective nurse-to-patient ratio. “The primary retention criteria for nurses is the hospital’s maintenance a reasonable nurse-to-patient ratio,” says Ms. Baggerly. Covenant determines these ratios based on the acuity of the patient and the experience of the staff, but lean management eliminated unnecessary tasks and documentation that burdened these ratios. Prior to going lean, nurses were spending 50 percent of their time on documentation that did not add value. Another time waster for nurses is simply the time spent looking for items or retrieving something that wasn’t easily accessible. Simpler’s studies reveal 90 to 95 percent of hospital documentation processes do not add value, according to Mr. Chamberlain, which means it’s time for hospitals to reexamine processes.
4. More direct communication between staff. “Specific to lean, one of the biggest gains is the leadership rounding by the nurse managers, nursing directors and myself,” says Ms. Baggerly. Covenant’s nurses now have opportunities to let upper-level staff know about staffing needs, equipment needs and specific patient care issues. “It saves time for them when they know they can relay that information to us at 8:30 everyday. They don’t have to spend a lot of time following up,” says Ms. Baggerly. The lean strategy also improved communication between shift handoffs, according to Mr. Chamberlain. “Instead of spending all your time doing paperwork, you’re communicating with your peers. Now there’s a new standard for work,” says Mr. Chamberlain.
Learn more about Simpler Consulting.
Read more about lean management in hospitals:
-Common Pitfalls of "Lean" Management With Craig Deao of Studer Group
-3 Best Practices for Implementing Lean Processes at Your Hospital With the Author of Lean Hospitals
-5 Key Principles for Hospitals From Toyota's Lean Production System