Effect of Digitalization on Nursing Practices using the Lean Approach

Objective: This study aimed to examine the effect of digitalization on nursing practices using the lean approach. Method: This is a descriptive observational study. The data were collected using an activity chart to record nurses’ direct and indirect care practices and personal work and the Value Stream Map to compare and analyze work processes and determine both waste and value areas in the clinics. The study included a total of 15 nurses from two different internal medicine units of a hospital, including one digital clinic that uses digital applications for nurse work processes, and one partial digital clinic that has limited digital applications. The data were analyzed using current state value stream mapping, lean seven waste areas, and future state value stream mapping. Results: In the digital clinic, 748.5 minutes were allocated for direct care, 129.1 minutes for indirect care, and 562.1 minutes for personal work. Total value-added time and non-value-added time was calculated as 1137.1 and 302.9 minutes, respectively. In the partial digital clinic, 623.9 minutes were allocated for direct care, 404.4 minutes for indirect care, and 411.1 minutes for personal work. Total value-added time and non-value-added time was calculated as 1006 and 433.4 minutes, respectively. According to the future state value stream map prepared in line with the improvement suggestions to eliminate unnecessary production, process, movement, transportation, waiting, and error waste in the current state of both clinics, it is predicted that 1354.3 minutes of value-added time will be obtained and non-value-added time will decrease to 85.7 minutes, by spending 910.9 minutes less on direct care, 190.2 minutes less on indirect care, and 259.2 minutes less on personal work. Conclusion: The lean approach creates a repeated opportunity to review and improve processes. Analyzing nursing processes using the lean approach before and after digitalization and reviewing sources of both waste and value will contribute to implementing higher quality nursing care practices more effectively and safely and to using time and staff more efficiently.