A Lean Nursing Example in New Zealand


Hospital's shake-up gives nurses more time

Here's a nice news article about the use of Lean in a hospital in New Zealand (hat tip to Michael for sending it to me).

Middlemore Hospital is the first in the country to implement the “Releasing Time to Care” scheme, which works with nurses to improve the efficiency of their daily duties.

That's a great title for a program. Although they clearly state they are implementing Lean concepts, the primary goal is never “implementing Lean” – the goal is better patient care and this is often done by reducing waste for the nurses and staff, allowing them to spend more time on patient care.

Middlemore gets it — they aren't using Lean to drive layoffs:

Despite the amount of time freed up for nurses, no redundancies would follow, general manager for quality improvement Allan Cumming said.

There are so many good anecdotes and examples in the article, I won't try quoting them all — check out the article. This one point jumped out at me though:

Mr Cumming said nurses generally spent about 33 per cent of their time with patients. That figure was expected to double as the scheme was introduced.

That 33% number jumps out since I also saw that number cited in an article about Virginia Mason Medical Center in Seattle – their nurses were also only spending about 30-33% of their time with patients. I've also observed and calculated that exact same number when I've worked with nurses in an inpatient unit.

The remainder of that time is spent on some activities that are “value adding” without the direct patient contact (such as charting) and a lot of activity that is clearly non-value-added, such as searching for missing medications (medications that shouldn't be missing if a better process were in place).

From Middlemore:

* A ward which used to have only two thermometers to share between nurses has switched to disposable thermometers. They cost less and can be stored at each bedside, saving a substantial amount of time each day.

* Storage areas have been cleaned out and reorganised to the nurses' specifications, meaning a search for supplies takes seconds, not minutes

This is really encouraging. I hope we start seeing more examples of Lean concepts helping nurses and helping patients.

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Mark Graban
Mark Graban is an internationally-recognized consultant, author, and professional speaker, and podcaster with experience in healthcare, manufacturing, and startups. Mark's new book is The Mistakes That Make Us: Cultivating a Culture of Learning and Innovation. He is also the author of Measures of Success: React Less, Lead Better, Improve More, the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, and the anthology Practicing Lean. Mark is also a Senior Advisor to the technology company KaiNexus.


  1. Agreed. We’ve been using the Virginia Mason example to trial in-room documentation by the nurses (among other changes) to increase their face time with the patients. So far, the results are encouraging, and the nurses seem to like it. We need to keep spreading the word as these things progress, and Mark’s blog is a great mechanism.

  2. The case study of Middlemore should be an eye opener for other healthcare providers in New Zealand.
    As more and more issues are reported in the healthcare, it is high time that more and more of the healthcare providers adopt Lean in New Zealand.
    We at Productivity Solutions Limited can assist those who are interested in implementing Lean.
    Cheers …Vishnu

  3. It is time New Zealand made it onto the Lean healthcare map,although we are first to see the sun, we are slow at adopting world class methodologies. Does anypone else have any NZ Lean stories in healthcare?

  4. […] Cali also talks about the practice of “kitting” parts, creating kits that are delivered to the electricians working on the planes. Before kitting, Cali explains, the workers would have to walk back and forth chasing their own parts down. That old condition at Boeing sounds like the current condition at many hospitals and primary care clinics — nurses and doctors and other highly skilled professionals. Lean hospitals, including VMMC and ThedaCare, place a major focus on improving the system so caregivers don’t have to walk back and forth so much. That walking, that hunting and gathering is waste! Reducing that waste (by storing supplies closer to where they are needed and having better delivery processes from the materials management department) frees up time for patient care, as Virginia Mason and other hospitals have done. […]


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