In 2005, Rowena Ponischil, RN, MSN, director of acute care services, telemetry and intermediate care units at Virginia Mason Medical Center (VMMC), participated in a Rapid Process Improvement Workshop (RPIW) to lessen nurses’ burden of work and improve patient care and satisfaction.
Like a Pinball Machine
Before the RPIW began, Ponischil remembers standing on one end of her hospital floor and observing people in motion. “What I saw looked like a pinball machine.”
With the help of staff from VMMC’s Kaizen Promotion Office (a dedicated internal team driving the effort in teaching and implementing Virginia Mason’s Production System), the group began the process of looking at how care on the floor was delivered.
What they found was that the traditional setup with one nursing station and high-acuity patients situated nearby wasn’t working. “Nurses were walking all over the floor caring for their other patients and call lights were going on continually,” Ponischil says.
With everyone’s input in the RPIW, “we simulated on the unit what we thought would be good to replace.” Ideas involving how staff move in relation to their patients were drawn and redrawn and taped to the wall. “We looked at those pages every morning.”
What the group decided upon was a radical shift in the hospital floor’s organization, starting with bringing all services to the patient.
A Culture Change
“We instituted charting at the bedside,” Ponischil explains, “which was a culture change for many of our nurses. In rooms with two beds, one nurse began attending both patients for even care. And at shift change, we instituted handoffs at the bedside and included patients in the discussion about their care. We found that patients liked being a part of the conversation,” she adds.
As a result, “What we created are nursing ‘cells,’” Ponischil says, “containing a virtual nursing station within each one.” Patients are clustered as part of a cell with one nurse and support staff. Now high-acuity patients are spread out on the floor, ensuring a level load of work.
Increased Satisfaction
Both the nurses’ and patients’ satisfaction increased dramatically with the introduction of the new concept. In the RPIW, for example, the group found that the number of footsteps nurses took during their normal shift was 5,818. “That’s a lot of walking,” Ponischil says.
With nursing cells in place, footsteps dropped to 846. The group also had documented that patient dissatisfaction with their care was 21 percent. After the cells were introduced, it dropped to 0 percent.
Importantly, the RPIW found that nursing time spend in indirect care was 68 percent, which dropped to 10 percent with the new organization. In all RN time available for patient care increased from 32 percent to 90 percent.
Broad Interest
Ponischil doesn’t know if the idea of nursing cells on hospital floors is unique, but she has seen broad interest in the VMMC concept. She spoke recently at a Northwest organization of nursing executives about the program and was been invited to speak at the National Patient Safety Board meeting in Tennessee in May.
She also is part of the new hospital design team that is working to implement changes made in RPIWs into blueprints for Virginia Mason’s new hospital, set to open in 2010.
Now, when Ponischil looks down the hallway, instead of a pinball machine, “the floor is quiet, controlled, and relaxed. Our new hired nurses coming in don’t know that it was ever any other way.”
Source: This case study is reprinted with permission from the Spring 2008 issue of VMMC's newsletter Contact, which is available at www.VirginiaMason.org.