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Domain #5: Process

When staff spend enormous amounts of time in unnecessary and duplicative activities labor waste occurs. Identifying, targeting and overcoming this waste is pivotal to reducing both the fixed and variable expenses that labor represents. The average nurse (survey of 12,381 RN's in 2008) spends over 90 minutes PER SHIFT in labor waste from just 2 sources:

  • Hunting/shopping for needed equipment
  • Completing redundant/obsolete paperwork

These two process challenges alone account for up to 15% of all nursing labor expense in some hospitals.

This section allows an organization to assess the level of performance is has achieved in identifying and remediating these pivotal and expensive process challenges.

Components of the Process Self Assessment are listed below.

Reduced redundancy in nursing paperwork

  • Have identified redundancies in current nursing paperwork & labor waste associated with redundancies
    The organization has completed a "field mapping" exercise that has identified duplicate forms and the duplicate fields of forms and has calculated the labor waste associated with the redundancies associated with their completion.
  • Have optimized existing forms (electronic or paper)by reviewing each form for continued need, and organization & efficiency
  • Have automated top 3 paper forms for each area
    No explanation needed.
  • Have created "auto-fill" scripts for top 3 forms for each area
    The organization has written software scripts that auto-fill the redundant fields from existing data for the top three used forms in each department.

Reduced time spent "hunting for equipment"

  • Have identified top 4 pieces of "hunted for" equipment & labor waste associated with "hunting behavior"
    Nurses frequently "hide" equipment they know they will need again. This forces other nurses to go "shopping" for equipment when they need it. This wastes labor and increases capital budget requirements (makes it seem as if the organization does not have "enough" of certain pieces of equipment). The organization has identified the top pieces of equipment that nurses consistently "shop" for and have calculated the labor and capital equipment waste associated with overcoming this challenge.
  • Have developed a process for delivering needed equipment to the bedside
    No explanation needed.
  • Have determined "who" should own equipment delivery function
    The organization has determined who should be responsible for delivering the top 4 pieces of equipment to nurses at the bedside (IE: transportation, bio-med, volunteers, etc…).
  • Have implemented "check in/check out" scanning technology
    The organization has developed a system (preferably software driven) that allows it to track WHERE each of the top 4 pieces of equipment are at any moment.
  • Have developed rules, service agreements and process for 3 types of equipment delivery: routine, urgent & stat
    The organization has developed a process that identifies different levels of speed and urgency with which equipment is to be delivered.

Improved role clarity & cooperation

  • Have identified "messiest hand-offs" & "other department's jobs completed by nurses"
    The organization has surveyed the nursing and ancillary workforce and determine where/when the most wasteful "hand-offs" of patients occur within the facility. They have also established what additional yet unnecessary duties nurses have accumulated from other departments over the years.
  • Have clarified roles and responsibilities at the point of patient hand-off
    The organization has identified methods of improving "messy hand-offs" and have developed policies & expectations and communicated them to all participants in the hand-off's.
  • Have clarified roles and responsibilities of work not needing to be done by nursing (IE emptying trash, transporting patients, etc . . .)
    The organization has identified duties often performed by nursing that belong in other departments and where/when possible have ensured that those duties are performed by a less expensive component of the workforce.

Reporting & Performance

  • Have reduced "Time spent away from the bedside" from redundant paperwork by 50%
    No explanation needed.
  • Have reduced "Time spent away from the bedside" from equipment hunting by 50%
    No explanation needed.
  • Have improved hand-offs between departments
    No explanation needed.
  • Are reporting paperwork and equipment hunting waste monthly by: "hours per department"
    The organization is reporting monthly of the number of hours each inpatient nursing department (and other departments where germane) spends "shopping" for needed equipment.
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