Reaching the Core Step One: Eliminate Non-Value Added Nursing Work

Purpose:
Reaching the core of nursing quality requires an understanding of and intention to identify and eliminate non-value added (NVA) nursing work and unnecessary variation. The purpose was to identify, mitigate, and or eliminate NVA nursing work & unnecessary variation within a multi-hospital system

Significance:
The average nurse spend < 30 seconds on > 50% of tasks. Unnecessary task management in nursing contributes negatively to nursing attention and patient care error. Inefficient nursing work environments and complexity impact how nursing time is spent and unnecessary variation in nursing care delivery

Strategy and Implementation:
The innovation was a nurse-led operational improvement program reflecting the vision of the Chief Nurse Executive and in alignment with the nursing strategic plan. The objective was to identify and eliminate non-value added nursing work and to decrease unnecessary variation in nursing practice enabling greater nurse efficiency and consistency in evidence-based nursing practice. Structures, processes, roles, and accountabilities under the leadership of the CNE were designed and executed. The department under nursing emerged and roles were recruited based upon change agent competencies that included relational coordination and lean six sigma tools and techniques. The process of identifying and eliminating waste and decreasing variation in nursing was developed and spread across the nursing enterprise. Projects were in alignment with the nursing strategic plan and nursing goals influencing quality, including nurse-sensitive outcomes benchmarked through NDNQI.

Evaluation:
Outcomes such as throughput efficiencies, elimination of wait times and delays, and decreases in unnecessary variation in nursing practice were achieved. Examples will reflect the simultaneous decrease in waste coupled with excellence in nursing quality including benchmark fall and PU prevention.

Implications for Practice:
1) Intentional design and implementation of structures, processes, roles and accountabilities to achieve nursing work efficiencies 2) Intentional design integrating the voice of direct care practice to identify and eliminate nursing waste negatively influencing excellence in nursing practice