2. Time to Care: Common Ways Nurse Time Is Wasted
Introduction
Brad White
– Title: Operations Improvement Engineer
– Description: Implements Lean Six Sigma at Baptist
Health System
3. Time to Care: Common Ways Nurse Time Is Wasted
Project Definition
Defect
– High nurse turnover & low employee morale
Background
– The tele units at BMC were experiencing high
turnover
– Nurses said the floor was stressful
– Nursing grid was changing from 1-5 to 1-6
Goal
– Retain tele nurses
4. Time to Care: Common Ways Nurse Time Is Wasted
Observation
• First step in observation is learning what to
observe
• Be prepared for the first round of observations
to yield little data
• Find a structured yet flexible way to capture
data
5. Time to Care: Common Ways Nurse Time Is Wasted
Observation Form
6. Time to Care: Common Ways Nurse Time Is Wasted
Convert to Data
• Two basic forms of observation data:
– Process
– Work-Time Study
• Convert observation notes into applicable
data
• Categories the times into various bins
• Ask, is this of value?
7. Time to Care: Common Ways Nurse Time Is Wasted
Categorization
8. Time to Care: Common Ways Nurse Time Is Wasted
Analysis
Time Analysis
Shift Day Night Day Night Average
VA 13.5% 52.8% 7.9% 61.9% 34.0%
Flex 14.0% 7.1% 31.4% 5.4% 14.5%
NVA 72.5% 40.1% 60.7% 32.7% 51.5%
Cost of the Waste $1,530,395/yr
9. Time to Care: Common Ways Nurse Time Is Wasted
Spaghetti Diagram
• Nurses were walking
750 mi. a year
• That’s like walking
from here to
Memphis, TN!
• Represents over
$10,000 per nurse
each year
10. Time to Care: Common Ways Nurse Time Is Wasted
Other Data
• What else can be collected?
– Staff opinion
– Photos
– Video
– Audio
– Anything that can put the environment into
context for your audience
11. Time to Care: Common Ways Nurse Time Is Wasted
Waste Pareto
• Detailed analysis will generate a “Waste
Pareto”
• This becomes the action items for
improvement
12. Time to Care: Common Ways Nurse Time Is Wasted
Data Analysis
Wasted Time Analysis
(In Hours, per nurse each year)
200
180
160
140
120
100
80
60
40
20
0
13. Time to Care: Common Ways Nurse Time Is Wasted
Data Analysis
Wasted Time Analysis
(In Dollars, per nurse each year)
$8,000
$7,000
$6,000
$5,000
$4,000
$3,000
$2,000
$1,000
$-
14. Time to Care: Common Ways Nurse Time Is Wasted
Med Draw Analysis
• Pulling medication was the #1 time waster
(tied with discharging)
• The observed reason for delays:
– Multiple machines required multiple logins
– Centralized location required travel and resulted in
batching
– Medication in bins required the nurse to fill the
prescription
15. Time to Care: Common Ways Nurse Time Is Wasted
Med Draw Solutions
• Re-balance machines to be patient-centric not
drug-centric
• Disperse machines throughout the floor
instead of a central location
• Have pharmacy fill each med pass by patient
• Install med boxes outside each room
16. Time to Care: Common Ways Nurse Time Is Wasted
Discharge Analysis
30%
25% Admit Done
2
20%
1 Discharge Start
15%
Expected Admission
10% 3 Done
5% Expected Discharge
Start
0%
Orders Start to End to
Admit Time to Start End Leave Total
Mean 77 Mean 125 59 36 220
Std. Dev 59 Std. Dev 146 42 63 251
Min 13 Min -155 -55 -10
Max 250 Max 665 205 250
N 22 N 58 80 24
17. Time to Care: Common Ways Nurse Time Is Wasted
Discharge Solutions
• Collect proper information early in the process
• Prepare for discharge by completing patient
education prior to discharge orders
• Eliminate unnecessary paperwork in the
discharge process
18. Time to Care: Common Ways Nurse Time Is Wasted
Key Lessons
• Nurse time not spent at the bed time is waste
– Nurses aren’t happy
– Patients aren’t happy
– Management isn’t happy
• Poor staffing is concealed with busy work so cost
are hidden and a paper profit is shown
• High turnover is expensive, drains morale, and
decreases patient satisfaction and safety
• The answer is rarely more staff or more
equipment, but rather better layout and
processes
19. Time to Care: Common Ways Nurse Time Is Wasted
Is This of Value?
