Measuring the Effect of a Lean Process Improvement Initiative on the RN Practice Envirionment and Patient Outcomes

Purpose:
Describe registered nurses' (RNs) perception of the work environment, team work and missed nursing care at an academic medical center before implementation of lean strategies for problem solving on a patient care unit.

Background/Significance:
The relationship between RN satisfaction and patient outcomes has been established. Studies have also shown that RNs do not complete all patient care activities due to inefficiencies in the work environment and lack of teamwork. This study looks at whether decreasing inefficiencies in the practice environment and improving teamwork can lead to increased RN time with patients and less missed opportunities to engage in activities that improve patient care and RN satisfaction.

Methods:
Baseline RN satisfaction data from the NDNQI survey and patient satisfaction data were reviewed for a selected inpatient unit. A self- report survey tool consisting of two validated instruments, The Missed Nursing Care Survey (MISSCARE) and the Nursing Teamwork Survey was administered to all RNs pre implementation of a lean six sigma project to improve the work environment. Descriptive statistics were used to analyze pre-intervention survey responses. Post-interventions survey results along with RN satisfaction scores will be analyzed after intervention is completed to determine effectiveness of the lean strategies for problem solving.

Results:
The pre-intervention survey response rate was 75% (n = 30). Most were female (93%), baccalaureate (94%) or master's (6%) prepared, and employed 5 years or less (67%). The top 3 nursing activities identified as being missed occasionally, frequently, and always were: ambulation 3 times per day or as ordered (93%); feeding patient when the food is still warm (75%); turning patient every 2 hours (60%). Activities missed least were patient assessments performed each shift and bedside glucose monitoring. The main reasons identified for missed care were: medications not available when needed; unexpected rise in patient volume and/or acuity on unit; and inadequate number of staff.

Conclusions and Implications for Practice:
Survey findings are consistent with previously published results. A successful intervention should result in less wasted time and missed patient care. Post implementation results from the 2011 RN satisfaction survey and this survey will be used to evaluate implementation of the program house wide.