Purpose for the Program
In response to increasing pressures, the health care industry is rapidly adopting methods and tools that have been successfully used in other industries. These tools develop health care associates to drive process changes and, thus, improve the performance of the organization. Methods that are being used in health care are the following: Six Sigma, Kaizen, and performance management.
Provide care in a high-risk obstetric triage unit and provide data to support sustained improvement toward a decrease in patient wait time that is within community and service line standards.
Implementation, Outcomes, and Evaluation
High-risk obstetric (class I/emergent) patients at Sharp Chula Vista Medical Center are required by policy to be placed on an electronic fetal monitor for immediate evaluation upon arrival. There has been an increase in the volume and acuity of patients at the Sharp Chula Vista Medical Center Obstetric Triage, however, space is limited and the workflow has not been adjusted. This resulted in baseline data of obstetric triage patient wait times that were outside Sharp HealthCare policy and community standards, and caused an increased potential for adverse outcomes. Therefore, in December 2010, an interdisciplinary, intradepartmental team used a Kaizon event to address the issues with the obstetric triage area. This event consisted of several weeks of planning, followed by an intense (3 to 5 day) burst of activity to try-storm and implement improvements. The targeted time frame for reduction is the time from when the patient arrives at the admission front desk until when the electronic fetal monitor is applied. The Kaizen team approach focused on workflows for patient assignment and assessment, resource allocations, and physical surroundings to achieve this objective. The outcomes were a change in how we provide care in a high-risk obstetric triage unit and data to support a decrease in patient wait time that is within community and service line standards.
Implications for Nursing Practice
Lean Six applications, such as lean education, waste walk, brainstorm improvements, current and future state process mapping, try-storming ideas, and document standard work were implemented. Service excellence was demonstrated and the team was empowered to facilitate immediate, action-orientated solutions to improve the triage admission process.