Slowdown's Side Effect: More Nurses – WSJ.com:
Not a Lean article, but a major issue for hospitals is a shortage of nurses. With the economy in its current condition, more nurses are returning to work. There's still a need for the reduction of wasted motion and wasted time in a nurse's workday… that's the Lean concept.
“Hospitals have also taken steps to keep older nurses in the work force by making their jobs easier, including replacing hand cranks used to lift beds with automated lift devices, bringing in lift teams so nurses don't strain themselves picking up patients, or putting supplies closer to patients' rooms to cut down on walking.”
These are good practices, regardless of age. Lift assists are better ergonomically for nurses (preventing injury) and they can also help prevent patient falls. Reducing walking is good since that wasted time can be used in more productive ways (such as patient care).
Keeping supplies closer to rooms — that goes against a previous trend toward centralized inventory cabinets (often automated) in a floor or unit. The advantages were all for materials management — it was easier to restock and kept better control of inventory. But, optimizing materials management shouldn't be the primary goal. The nurses are providing “value added” care — the job of the rest of the organization should be to support them in “making their jobs easier.” There's a pretty direct parallel to a factory using material handlers to allow assembly operators to be more efficient.
You don't want assembly workers to stop, looking for parts. You don't want surgeons digging and searching for tools during a procedure (nurses or techs hand the instruments to the surgeon, an old idea that originally came from Frank Gilbreth). You also don't want nurses to be roaming around, searching for medications or supplies either. Systems and processes (and technology) need to support them in the way they do their jobs.
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True those efforts need to continue. I can’t believe the nursing shortage is anywhere close to easing in an macro way. The long term numbers just point the other way every time I look (which granted isn’t that often). But the projected demand always grows (fed by the aging population) and the supply chain is poor. And the working conditions are often not desirable for a significant portion of the population… Hospitals adopting lean management could put a significant dent in the macro situation over 10-15 years but I would be really surprised if that has happened.
The article seems to basically be saying their is a relationship between the economy and nursing shortages in that when times are bad more nurses work longer hours or stay employed as nurses. And when times get better then pull back and the nursing shortage becomes more significant.
Apparently the shortage is easing but it’s due to nurses taking back hours in the face of a recession (as spouses are laid off). it’s not a person-power issue but a pay issue. pay more and they’ll come back. re: walking around — good luck cutting that down in any significant way. I’ve seen posts from other lean sites about keeping equipment on the ward but I find it hard to believe a significant (practical not statistical) amount of walking will be reduced.
Dr. Furst — regardless if whether you find it “hard to believe” there are many documented cases of hospitals that have used Lean to DOUBLE the amount of direct patient care time that nurses have. They do this by eliminating wasted time spent searching for equipment and information. There’s so much waste in existing processes (this is true in one primary care clinic I’ve worked with also).
See this case in New Zealand and this article about Virginia Mason.