The Effect of Lean Hospital Practices on Nurses' Direct Care Activities: Time and Motion Study

IF 2.1 4区医学 Q3 HEALTH CARE SCIENCES & SERVICES Journal of evaluation in clinical practice Pub Date : 2024-12-19 DOI:10.1111/jep.14278

Zibel Koc, Sule Ecevit Alpar

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Abstract

Background

This study investigates the effects of lean management practices on nurses' direct patient care activities and the interruptions they encounter in healthcare settings. The literature indicates that lean management enhances efficiency and improves patient care. Increased nursing time per patient correlates with better outcomes; however, rising patient loads and frequent interruptions hinder nurses' ability to deliver effective care, jeopardising patient safety. Addressing these inefficiencies is essential, given nurses' critical role in ensuring quality care.

Method

Using a single-centre, observational, pre-post time and motion design alongside participatory action research from August 2019 to July 2022, the study included three phases: a survey assessing nurses' views on problem-solving and lean management; observations identifying nurses' activities and interruptions; and focus group discussions. The results presented here are from the observation phase, with 34 nurses from surgical, internal medicine, and mixed services participating. Quantitative variables were expressed as means, standard deviations, and significance was assessed at a 95% confidence interval (p < 0.05).

Results

Observations in 2019 (324 h) and 2022 (314 h) revealed that nurses dedicated a significant portion of their time to direct patient care, which increased post-lean implementation (surgical: 50.67%, internal: 50.09%, mixed: 44.38%). Waste rates decreased by 35.81%, and documentation time decreased by 23.55%. Overall interruptions also decreased significantly (p < 0.05).

Conclusion

Lean management effectively reduces waste and improves direct patient care time, enhancing patient safety and care quality. Continuous improvement initiatives in nursing practices are essential for success.

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精益医院实践对护士直接护理活动的影响：时间与动作研究。

背景：本研究调查了精益管理实践对护士直接病人护理活动的影响，以及他们在医疗保健环境中遇到的中断。文献表明，精益管理提高了效率，改善了病人的护理。每位患者护理时间的增加与更好的结果相关；然而，不断增加的患者负荷和频繁的中断阻碍了护士提供有效护理的能力，危及患者安全。鉴于护士在确保高质量护理方面的关键作用，解决这些低效率问题至关重要。方法：2019年8月至2022年7月，采用单中心、观察性、岗前时间和运动设计以及参与式行动研究，研究包括三个阶段：调查评估护士对问题解决和精益管理的看法；观察护士的活动和中断；焦点小组讨论。本文介绍的结果来自观察阶段，共有34名来自外科、内科和混合服务部门的护士参与。结果：2019年（324 h）和2022年（314 h）的观察显示，护士将很大一部分时间用于指导患者护理，这增加了精益后的实施（手术：50.67%，内部：50.09%，混合：44.38%）。浪费率降低了35.81%，记录时间减少了23.55%。结论：精益管理有效地减少了浪费，提高了患者的直接护理时间，提高了患者的安全和护理质量。护理实践的持续改进是成功的关键。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of evaluation in clinical practice 医学-卫生保健

CiteScore

4.80

自引率

4.20%

发文量

143

审稿时长

3-8 weeks

期刊介绍： The Journal of Evaluation in Clinical Practice aims to promote the evaluation and development of clinical practice across medicine, nursing and the allied health professions. All aspects of health services research and public health policy analysis and debate are of interest to the Journal whether studied from a population-based or individual patient-centred perspective. Of particular interest to the Journal are submissions on all aspects of clinical effectiveness and efficiency including evidence-based medicine, clinical practice guidelines, clinical decision making, clinical services organisation, implementation and delivery, health economic evaluation, health process and outcome measurement and new or improved methods (conceptual and statistical) for systematic inquiry into clinical practice. Papers may take a classical quantitative or qualitative approach to investigation (or may utilise both techniques) or may take the form of learned essays, structured/systematic reviews and critiques.