Applying LEAN Six Sigma Strategies to Nursing Sensitive Outcome Reporting

Purpose:
Linking nursing care practices to outcomes is essential to our ability to identify strategies that consistently produce great patient outcomes. Trended, accurate and timely data reports that are easily understood by bedside clinicians allow nurses to make that connection.

Significance:
The cost of “bad” outcomes can be measured in decreased patient satisfaction and non-reimbursed care – a cumulative negative financial impact on the provider. Measuring the effect of nursing actions on outcomes becomes critical to continuously providing excellent cost effective nursing care.

Strategy and Implementation:
Good outcomes depend on nurses understanding the both the risks to patients that exist in their own particular settings and means to mitigate those risks. Our strategy was to use Nursing Unit Outcome Reports to provide trended data on both key process indicators and unit/hospital outcomes. We initiated outcome Reports for Adults, Pediatrics and their Emergency Departments in Q1 ‘08. The reports contained monthly unit and hospital wide data on all Hospital Acquired Conditions (HAC). In March of 2009 LEAN Six Sigma strategies were applied in an effort to improve report turnaround time, accuracy and eliminate waste in report creation related to “re-work” between the involved departments. Through the application of LEAN Six Sigma we were able to create pulled data streams, internal controls and metrics for report generation and error proofing strategies. A control plan ensures consistency and strategies to handle special cause variation.

Evaluation:
Applying LEAN Six Sigma principles: waste elimination, value, flow and pull resulted in a clear cascade of reporting that eliminates the need to release “preliminary data” and gets reports posted on our units predictably by the 4th Wednesday of every month, in color with simple graphs.

Implications for Practice:
Outcome reports are located in a shared drive where they can be accessed by all nursing leadership and management on demand, providing transparency and promoting teamwork in problem solving. Interdepartmental collaboration is achieved through the LEAN Six Sigma process.