By January 20, 2008 4 Comments Read More →

The Life of a Nurse: Waste and Workarounds

Care and Chaos on the Night Nursing Shift – WSJ.com

Free Version via CareerJournal.com

The linked article is a virtual “gemba walk” for those of you who have asked how and why Lean is helpful and necessary in a hospital environment.

When you read the description of a nurse’s day and activity, you’ll notice waste and workarounds galore.

With Lean, the focus in hospitals is reducing non-value-added activity and waste so that nurses and other caregivers can spend more time with patients, providing care and treatment. Not being able to find needed supplies — that takes nurses away from patients, delaying care and causing frustration. Missing medications, missing physician orders all create distractions, rework, and delays.

I’ve spent just a little time in the nursing gemba. I couldn’t imagine doing their job for a 12-hour shift… if you think factory work is grueling, follow a nurse around for 12 hours. It’s quite an eye opener.


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Mark Graban's passion is creating a better, safer, more cost effective healthcare system for patients and better workplaces for all. Mark is a consultant, author, and speaker in the "Lean healthcare" methodology. He is author of the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, as well as The Executive Guide to Healthcare Kaizen. His most recent project is an eBook titled Practicing Lean that benefits the Louise H. Batz Patient Safety Foundation, where Mark is a board member. Mark is also the VP of Improvement & Innovation Services for the technology company KaiNexus.

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4 Comments on "The Life of a Nurse: Waste and Workarounds"

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  1. Dean Bliss says:

    Great article, Mark. The author does a good job of encapsulating what I’ve heard from our nurses here. The challenge for us in working with the nurses is to remove the frustrations, while maintaining the sense of satifaction, as we apply the Lean philosophy to their work. It’s a delicate balance.

  2. Mark Graban says:

    Yes agreed, the balance is important. I’m hoping to be able to work with a nursing unit in the 2nd half of this year… the identified themes for the project are to free up time to allow nurses to spend more time on direct patient care (which should provide more satisfaction than searching for meds or supplies).

    The idea is to support them in their “value added” work by working with them to identify and solve the root causes of waste, problems, and delays. We’ll have to identify workarounds and work with together with the other roles and processes that create the waste. The nurses can’t fix it all themselves, so we’ll have a cross-functional dedicated team (TBD).

    You should “go and see” Dean, it would be a real eye opener (and I mean that as a friendly suggestion, not a criticism).

  3. Dean Bliss says:

    Oh, I have been to the units to “go and see”, and it is without a doubt the best way to start to understand what goes on with the nurses. It’s amazing what the nurses are able to do with the resources they have, and I think it’s our responsibility to use the tools that we have to do whatever we can to help them continue this incredible work.

  4. Mark Graban says:

    OK, thanks for clarifying. I know you’re a big “go and see” guy, just figured you were doing work in other areas and functions.

    It really is a testament to healthcare employees and the mission of a hospital that people are willing to put up with so much waste in the name of providing patient care. We can make work easier and more rewarding for everybody through Lean…

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