Nurses’ Perspectives on Lean Redesigns to Patient Flow and Inpatient Discharge Process Efficiency

• Published in: Global qualitative nursing research Vol. 5; p. 2333393618810658
• Main Authors: Nicosia, Francesca M., Park, Linda G., Gray, Caroline P., Yakir, Maayan J., Hung, Dorothy Y.
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01-01-2018; SAGE PUBLICATIONS, INC; SAGE Publishing
• Subjects: Discharge; Efficiency; Ethnography; Lean manufacturing; Nurses; Nursing administration; Patient care planning; Patient satisfaction; Qualitative research; Quality control; Quality improvement; Single-Method; acute/critical; semistructured; qualitative; quality improvement; America; focus groups; North; nursing; ethnography; health care; research; interviews
• ISSN: 2333-3936; 2333-3936
• DOI: 10.1177/2333393618810658

As hospitals around the world increasingly face pressure to improve efficiency, “Lean” process improvement has become a popular approach to improving patient flow. In this article, we examine nurses’ perspectives on the implementation of Lean redesigns to the inpatient discharge process. We found that nurses experienced competing demands and tensions related to their time and professional roles and responsibilities as a result of Lean. Four main themes included (a) addressing the needs of individual patients, while still maintaining overall patient flow; (b) meeting discharge efficiency targets while also achieving high patient satisfaction scores; (c) “wasting time” to save time; and (d) the “real” work of providing clinical care versus the “Lean” work of process improvement. Our findings highlight the importance of soliciting hospital nurses’ perspectives when implementing Lean process improvements to improve efficiency and patient flow.