Targeting waste is one of the key principles of “lean” organizations like Summa Health System, which aim to reduce or simplify activities that don’t add value.
Work design is a process the organizations can use to examine and transform the ways that staff members work. It involves several steps, including the following:
- Gather information through observation and interviews.
- Review data, such as patient and nurse satisfaction, organizational charts, job descriptions, and error reports.
- Identifying problem areas through methods like root-cause analysis. In root-cause analysis, staff asks questions to uncover the cause of a problem: Why is this process inefficient? What factors or processes are adding to the problem?
Leaders at Summa suggest the following advice for organizations that want to redesign their work flow:
Involve those closest to the work. Get bedside nurses involved in the work redesign process in the beginning. They can help diagnose problem areas, create solutions, and build buy-in throughout the organization.
Standardize when possible. Using order sets is one way that hospitals can help prevent errors and ensure consistent, efficient care delivery. Simple protocols and checklists for dressing changes, wound care, IV insertion, and other nursing tasks can help reduce nurse decision time and cut documentation. Flow sheets that streamline documentation are used by hospitals that “chart by exception.” In such environments, the focus is on documenting exceptions to normal illness or disease progression. In other words, nurses make additional documentation when the unexpected happens.
Realize that you can’t always build consensus. Not everyone is going to accept a change initially.
Identify areas where there’s waste. For example, consider the time nurses spend waiting, looking, or delivering supplies. A recent study in The Permanente Journal found that the average nurse wasted 36.6 minutes on a 10-hour shift waiting and doing “hunting and gathering” activities.
Recognize that work redesign requires ongoing effort. Pre- and post-implementation evaluations can help you monitor performance and collect feedback to help the organization retool as needed.