I recently saw this headline in the London Evening Standard: “Nurses struggle to ‘get the job done’ due to staff shortages and lack of time on 12 hour shifts.” The article starts with jumping to solutions (needing/wanting more staff), but the problem statement is what we should focus on – and it’s an important one:
…almost nine in 10 nurses said that at least one “necessary activity” was not done on their last shift due to lack of time – despite the average shift lasting for 12.8 hours.
This is something I’ve seen a lot of in American hospitals, as well. Let’s presume “necessary activity” means “value” to the patient. Necessary activities that don’t get done might commonly include:
- Not doing hourly rounding (which can lead to falls or patient dissatisfaction)
- Not repositioning patients every two hours if they are at risk for bed sores
- Not giving medications at the proper time
Nurses generally know what they should be doing. But, when the system is designed poorly (or was just allowed to evolve instead of being designed) and there’s too much waste, job satisfaction (of course) suffers:
Research, conducted by the National Nursing Research Unit, found that two fifths of nurses are dissatisfied with their job, with 44% saying they would leave their job if they could.
From the article again:
In wards where there were fewer patients to care for, nurses felt more satisfied with their jobs.
Nurses who had to care for fewer patients were also more likely to say that patient safety was good or excellent.
Adding more nurses isn’t likely to happen in countries that are struggling to pay for healthcare (which seems true in the UK, with the rounds of cost cutting).
If you had the money, adding nurses MIGHT be an acceptable “short-term countermeasure” as my former Toyota friends might call it. It’s not the ultimate answer and it’s not the solution to the root cause problem, but adding nurses might better serve patients (safety and quality first), but that’s probably not the most affordable way to solve this problem. That said, if you ONLY wanted to look at the financials and ROI — if the cost of increased nursing care was less than the money saved by preventing things like falls, pressure ulcers, and infections, then it might make sense to increase staffing. But, with a cost-cutting view of the world, leaders are hesitant to spend money to save money.
I’ve seen way too many nursing units where staff are stressed and patients aren’t getting the best possible care… it’s no shortage of caring… it’s a matter of too much waste.
We HAVE to fix systems and reduce the waste – that’s where Lean comes in. Virginia Mason Medical Center has systematically reduced waste to free up nurse time and more than DOUBLE the amount of time they can spend at the bedside. That’s the equivalent of hiring twice as many nurses, but it’s far less costly.
The NHS has its Lean-based program of “Releasing Time to Care” – but it’s not as universally effective as the VMMC approach? RTTC is supposed to be addressing this and the program has been going on since at least five years (it was being rolled out when I worked in England in 2008).
Back to the problem statement:
42% of nurses are suffering from emotional exhaustion, with male nurses showing more signs of a “burnout” than their female counterparts.
More than a third of nurses said that important care information is often lost during shift changes and more than half think that “things fall between the cracks when transferring patients from one unit to another”.
We need to fix this – not just England, but the U.S. as well – because the patients and the nurses are suffering.
What is your hospital doing to reduce waste and to ensure that things aren’t falling through the cracks in patient care? How are your leaders driving improvement? How are they managing the system each day to make sure the right things are being done the right way?
About LeanBlog.org: Mark Graban is a consultant, author, and speaker in the “lean healthcare” methodology. Mark is author of the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, as well as the new Executive Guide to Healthcare Kaizen. Mark is also the Chief Improvement Officer for the technology company KaiNexus.