NOTES

TIME AND MOTION STUDY

---------------------------------------http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3037121/
A 36-Hospital Time and Motion Study: How Do Medical-Surgical Nurses Spend Their
Time? Ann Hendrich, RN, MSN, FAAN, Marilyn P Chow, DNSc, RN, FAAN, Boguslaw A
Skierczynski, PhD, and Zhenqiang Lu, PhD
---------------------------------------Patton, Michael Winston Jr., "DEVELOPING A TIME AND MOTION STUDY FOR A
LEAN HEALTHCARE ENVIRONMENT"
(2011). University of Kentucky Master's Theses. Paper 163.
http://uknowledge.uky.edu/gradschool_theses/163
The quality of available healthcare has been a pertinent issue to nearly every civilization
and culture throughout history. Some enhancements to healthcare processes, such as
Ignaz Semmelweis's research in the mid 1800's that claimed that certain diseases were
spread throughout hospitals due to physicians not washing their hands between seeing
patients, have been noted as significant events in human history (saint et al, 2010).
Quality improvements to healthcare such as these can be directly correlated to lower
mortality rates within the healthcare enterprises, and this same concern is still evident
today with deaths attributed to medical errors and estimates of millions of healthcareassociated infections acquired in teh US each year (Klevens et al, 2007). Lean
methodologies have been implemented to varying degrees of success to a variety of
industries different than traditional manufacturing environments, and some healthcare
enterprises have claimed they have obtained widespread quality improvements, better
patient safety, and millions of dollars in cost savings through their lean efforts (Kaplan,
2008)
For implementation of lean methodologies, there exists a vital need to gather relevant
and accurate information on the current state of an operation. This is a core concept of
lean manufacturing that is the basis for many specific lean tools, and in known as
"genchi genbutsu." Genchi genbutsu entails gathering first hand information on
situations by going and observing processes, rather than relying on perceived
knowledge or onfirmation (Liker, 2004).
Throughout history, there has been a distinct interest in how various medical
professionals spend their time, and measurements such as how long nurses spend at a
patient's bedside are extremely important when looking to improve a healthcare
enterprise's efficiency or layout (Hendrich et al, 2008)
----------------------------------------------------------------------A 36-Hospital Time and Motion Study: How Do Medical-Surgical Nurses Spend Their
Time?
Ann Hendrich, RN, MSN, FAAN, Marilyn P Chow, DNSc, RN, FAAN, Boguslaw A
Skierczynski, PhD, and Zhenqiang Lu, PhD

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3037121/
Nurses are the primary hospital caregivers. Increasing the efficiency and effectiveness
of nursing care is essential to hospital function and the delivery of safe patient care.
Context: Nurses are the primary hospital caregivers. Increasing the efficiency and
effectiveness of nursing care is essential to hospital function and the delivery of safe
patient care.
Objective: We undertook a time and motion study to document how nurses spend their
time. The goal was to identify drivers of inefficiency in nursing work processes and
nursing unit design.
Design: Nurses from 36 medical-surgical units were invited to participate in research
protocols designed to assess how nurses spend their time, nurse location and
movement, and nurse physiologic response.
Main Outcome Measures: Nurses' time was divided into categories of activities (nursing
practice, unit-related functions, nonclinical activities, and waste) and locations (patient
room, nurse station, on-unit, off-unit). Total distance traveled and energy expenditure
were assessed. Distance traveled was evaluated across types of unit design.
-A growing evidence base links more nursing time per patient-day with better patient
outcomes. 25 However, increased nurse workload and the growing nursing workforce
shortage6 reduce the amount of nursing time available for patient care activities. How
medical-surgical nurses spend their
time is a key driver of bold changes in the hospital work environment.79
search suggests that two interrelated elementsnurse work process and the physical
hospital environmentcontribute to the efficiency and safety of patient care.1012 An
understanding of how nurses spend their
time will target opportunities for nursing care effectiveness through improvements in
management, workforce, work processes, and organizational culture.13
Documenting the drivers of inefficiency in nursing practice will allow for targeted
changes to the work environment to positively influence patient safety
and quality of care.
The primary objectives of the study were to identify how nurses spend their time during
their shift and to pinpoint environmental variables in the acute-care nursing
workplace that can be altered to positively affect the efficiency.

Nursing activity Waste: Waiting, Looking / Retrieving / Delivering ;Unit-related

Functions: unit-rellated func / Patient care- activities / Care coordination / medication
administration / documentation / assessment or reasing cital signs
Non-Clinical: Personal Time / Patient or family care / administration or teaching
-----------------------------------------------------------------------------------------------http://online.wsj.com/articles/nurses-shift-aiming-for-more-time-with-patients1405984193
Nurses Shift, Aiming for More Time With Patients
Hospitals Hope Extra Face Time and Personal Attention Will Help Make Recovery
Easier
Updated July 21, 2014 9:58 p.m. ET
Swamped with tasks such as hunting for supplies, tracking down medications, filling out
paperwork at the nursing station and looking for missing test results, nurses may spend
less than two hours of a 12-hour shift in direct patient care, studies show. But research
has also found that the more time nurses spend at the bedside, the less likely patients
are to suffer falls, infections and medication errors, and the more likely they will be
satisfied with their care.
Now hospitals are changing traditional work practices, shifting more routine tasks to
certified nurse assistants and other less highly skilled staffers. They are eliminating
inefficient processes that make nurses walk as many as 5 miles around the hospital in a
single shift. Some hospitals are aiming to triple the amount of time nurses spend with
patients.
That means locating supplies inside patient rooms and having pharmacists deliver
medications to patient floors. As more hospitals adopt electronic medical records and
place computers in patient rooms, they are enabling nurses to access information
quickly and fill out medical charts while keeping close to patients.
The aim is to let nurses spend more time both caring for patients and educating them
and their families on follow-up care once they leave the hospital.
"We shouldn't be using expensive professional nursing time doing unnecessary and
inefficient things when that time could be reinvested in direct patient care," says Patricia
Rutherford, a nurse and vice president at the Institute for Healthcare Improvement.
Presbyterian Medical Center is one of 14 hospitals operated by Winston-Salem, N.C.based Novant Health, which found in a 2010 internal audit that nurses were involved in
direct patient care at the bedside for only 2.5 hours every 12-hour shift. "Not only was
that eye-opening, it was also completely unacceptable," says chief clinical officer Sallye
Liner, a nurse by training. "We realized we needed to change the way we delivered care
and get our nurses back to the bedside."

Nurses make rounds hourly to check on the half-dozen or more patients under their
care. Nurse assistants stop in every hour on the half-hour. During shift changes,
incoming and outgoing nurses now hand off care in patient rooms instead of the
hallway. Rather than the past practice of simply asking how patients are doing, they now
have a list of specific questions, including whether they need help getting to the
bathroom from the bed. The change helped sharply reduce the number of call bells and
cut the number of patient falls 70% across all medical-surgical units, Ms. Liner says.
http://www.laubrass.com/casestudies/?id=23264986