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.

Keywords:

Digitalization, lean approach nursing care, nursing practices,

PDF

___

Ali S, Kleib M, Paul P, Petrovskaya O, Kennedy M. Compassionate nursing care and the use of digital health technologies: A scoping review. Int J Nurs Stud. 2021;127:1-10. DOI: 10.1016/j.ijnurstu.2021.104161
De Leeuw JA, Woltjer H, Kool RB. Identification of factors influencing the adoption of health information technology by nurses who are digitally lagging: In-depth interview study. J Med Internet Res. 2020;22(8):e15630. DOI: 10.2196/15630
Davies C, Lyons C, Whyte R. Optimizing nursing time in a day care unit: Quality improvement using Lean Six Sigma methodology. Int J Qual Heal Care. 2019;31(Supplement_1):22–28. DOI: 10.1093/intqhc/mzz087
Schenk E, Schleyer R, Jones CR, Fincham S, Daratha KB, Monsen KA. Impact of adoption of a comprehensive electronic health record on nursing work and caring efficacy. CIN Comput Informatics, Nurs. 2018;36(7):331–339. DOI: 10.1097/CIN.0000000000000441
Akhu‐Zaheya L, Al‐Maaitah R, Bany Hani S. Quality of nursing documentation: Paper‐based health records versus electronic‐based health records. J Clin Nurs. 2018;27(3–4):e578–589. DOI: 10.1111/jocn.14097
Walker RM, Burmeister E, Jeffrey C, Birgan S, Garrahy E, Andrews J, Hada A, Aitken LM. The impact of an integrated electronic health record on nurse time at the bedside: a pre-post continuous time and motion study. Collegian 2020;27(1):63–74. DOI: 10.1016/j.colegn.2019.06.006
McCarthy B, Fitzgerald S, O’Shea M, Condon C, Hartnett‐Collins G, Clancy M, Sheehy A, Denieffe S, Bergin M, Savage E. Electronic nursing documentation interventions to promote or improve patient safety and quality care: A systematic review. J Nurs Manag. 2019;27(3):491–501. DOI: 10.1111/jonm.12727
Gough R, Ballardie R, Brewer P. New technology and nurses. Labour Ind a J Soc Econ relations Work. 2014;24(1):9–25. DOI: 0.1080/10301763.2013.877118 O’Neill S, Jones T, Bennett D, Lewis M. Nursing works: the application of lean thinking to nursing processes. JONA J Nurs Adm. 2011;41(12):546–552. DOI: 10.1097/NNA.0b013e3182378d37
Graban M. Yalın Hastane. 1. Baskı. İstanbul: Optimist Yayıncılık; 2011. (Turkish)
Magalhães ALP, Erdmann AL, Silva EL da, Santos JLG dos. Lean thinking in health and nursing: an integrative literature review. Rev Lat Am Enfermagem. 2016;24:e2734. DOI: 10.1590/1518-8345.0979.2734
Joubert B, Bam W. Review and classification of Lean project aims in hospitals. In: Proceedings - 2019 IEEE International Conference on Engineering, Technology and Innovation, ICE/ITMC 2019. Valbonne Sophia-Antipolis, France: IEEE; 2019. p. 1–11.
Blijleven V, Koelemeijer K, Jaspers M. Identifying and eliminating inefficiencies in information system usage: A lean perspective. Int J Med Inform. 2017;107:40–7. DOI: 10.1016/j.ijmedinf.2017.08.005
Rother M, Shook J. Learning to see: Value stream mapping to add value and eliminate muda. Cambridge:The Lean Enterprise Institute; 2003.
Ekici D, Cerit K, Gür E, Mert T, Türkmen S. Servis Yönetimi. In: Sağlık Hizmetinde Yönetsel Sorunların Analizi. 1. Basım. Ankara: Sim Matbaacılık; 2016. p. 265. (Turkish)
Franklin BD, O’Grady K, Donyai P, Jacklin A, Barber N. The impact of a closed-loop electronic prescribing and administration system on prescribing errors, administration errors and staff time: A before-and-after study. BMJ Qual Saf. 2007;16(4):279–284. DOI: 0.1136/qshc.2006.019497
Truitt E, Thompson R, Blazey-Martin D, Nisai D, Salem D. Effect of the implementation of barcode technology and an electronic medication administration record on adverse drug events. Hosp Pharm. 2016;51(6):474–483. DOI: 10.1310/hpj5106-4 Nelson-Peterson DL, Leppa CJ. Creating an environment for caring using lean principles of the Virginia Mason Production System. JONA J Nurs Adm. 2007;37(6):287–294. DOI: 10.1097/01.NNA.0000277717.34134.a9
Poissant L, Pereira J, Tamblyn R, Kawasumi Y. The impact of electronic health records on time efficiency of physicians and nurses: a systematic review. J Am Med Informatics Assoc. 2005;12(5):505–516. DOI: 10.1197/jamia.M1700
Moreno‐Fergusson ME, Guerrero Rueda WJ, Ortiz Basto GA, Arevalo Sandoval IAL, Sanchez–Herrera B. Analytics and Lean Health Care to Address Nurse Care Management Challenges for Inpatients in Emerging Economies. J Nurs Scholarsh. 2021;53(6):803–814. DOI: 10.1111/jnu.12711
Tipping MD, Forth VE, O’Leary KJ, Malkenson DM, Magill DB, Englert K, Williams MV. Where did the day go? —A time‐motion study of hospitalists. J Hosp Med. 2010;5(6):323–328. DOI: 10.1002/jhm.790
Lin J-C, Lee T-T, Mills ME. Evaluation of a barcode medication administration information system. CIN Comput Informatics, Nurs. 2018;36(12):596–602. DOI: 10.1097/CIN.0000000000000459
Yui B-H, Jim W-T, Chen M, Hsu J-M, Liu C-Y, Lee T-T. Evaluation of computerized physician order entry system—a satisfaction survey in Taiwan. J Med Syst. 2012;36(6):3817–3824. DOI: 10.1007/s10916-012-9854-y
Baumann LA, Baker J, Elshaug AG. The impact of electronic health record systems on clinical documentation times: A systematic review. Health Policy (New York). 2018;122(8):827–836. DOI: 10.1016/j.healthpol.2018.05.014
Kossman SP, Scheidenhelm SL. Nurses’ perceptions of the impact of electronic health records on work and patient outcomes. CIN Comput Informatics, Nurs. 2008;26(2):69–77. DOI: 10.1097/01.NCN.0000304775.40531.67
Amato MG, Salazar A, Hickman T-TT, Quist AJL, Volk LA, Wright A, McEvoy D, Galanter WL, Koppel R, Loudin B, Adelman J, McGreevey J, Smith DH, Bates DW, Schiff GD. Computerized prescriber order entry–related patient safety reports: analysis of 2522 medication errors. J Am Med Informatics Assoc. 2017;24(2):316–322. DOI: 10.1093/jamia/ocw125
Brown CL, Mulcaster HL, Triffitt KL, Sittig DF, Ash JS, Reygate K, eHusband AK, Bates DW, Slight SP. A systematic review of the types and causes of prescribing errors generated from using computerized provider order entry systems in primary and secondary care. J Am Med Informatics Assoc. 2017;24(2):432–440. DOI: 10.1093/jamia/ocw119
The Joint Commission. Hospital National Patient Safety Goals.Published 2017. Accessed [26 Sep 2022]. https://www.jointcommission.org/assets/1/6/2017_NPSG_HAP_ER.pdf
Ayaad O, Haroun A, Yaseen R, Thiab F, Al-Rawashdeh K, Mohammad I, Aqtash M, Qadumi S, Altantawi Y, Nairat A. Improving nurses’ hand-off process on oncology setting using lean management principles. Asian Pacific J Cancer Prev APJCP. 2019;20(5):1563-1570. DOI: 10.31557/APJCP.2019.20.5.1563
Noviati BE, Yuliati BD. What can nurses do to ımplement lean hospıtals? Malaysian J Nurs. 2020;12(1):92–97. DOI: 10.31674/mjn.2020.v12i01.011
Rico F, Yalcin A, Eikman EA. Technology integration performance assessment using lean principles in health care. Am J Med Qual. 2015;30(4):374–381. DOI: 10.1177/106286061453676