Creating better work flow for better patient care


What takes 24 years to do and only four days to undo? Credit Valley’s Critical Care A & B are the first patient care units to implement a 5S lean project to address clutter and to find efficiencies that have a real and measurable impact on employee work flow, safety and time spent at the patient bedside.

As patient acuity has increased and new technologies have become available over the years, additional supplies have found their way into small storage areas on the units. In fact, the storage area, work area and indeed, the patient care area were so congested that it had become difficult for staff, patients and families to navigate through the unit. Since storage areas were disorganized, it was next to impossible to keep track of what was available and what was out of stock.

The struggle to find space is only partly a result of the hospital’s needs based on the increased demands of growing community – how well or poorly the space is used is, in large part, responsible for excess congestion and lost space that could be dedicated to better safety and patient care.

The 5 S project consists of: Sort; Set In Order; Shine; Standardize and Sustain.

While those most familiar with the spaces can navigate through the organized chaos to find what they need to get the job done, there were definite improvements to be had. Under the direction of Susan Kwolek, senior vice president, administration, two consultants worked alongside a team of eight employees in the critical care unit who were dedicated to the 5S project for four days.

Sort: The team identified the quantity of supplies on the unit as excessive. In fact, through the clean up, $10,000 in excess medical supplies were identified and $4,000 worth of excess and expired respiratory therapy supplies were found. Due to clutter, additional supplies were being ordered while unused and broken supplies remained in the area.

Set In Order: Supplies and equipment were identified, discarded if broken or expired, labeled, and then assigned a space that made sense according to work flow. As well, admission kits containing all the necessary supplies were created to address needs at the bedside without having to travel several times to the storage area to retrieve individual supplies. For example, when a new patient arrives in critical care, the kit contains the supplies required to admit the patient such as surgical tape, gauze, intravenous equipment etc. Once used, the kit must be replenished and put back in place for the next use.

Shine: Once the areas were cleared, they were cleaned and organized for a more organized appearance and better work flow.

Standardize: Supply carts on both units have been labeled and stocked in an identical fashion so that regardless of which unit staff are working on, access to supplies is standardized.

Sustain: Everything has a space – everything in its place. Ongoing communication and teamwork will ensure better work flow, better work space, more time at the bedside and better care for our patients.

Based on two to three new admissions a day, five to 10 minutes per patient was dedicated to gathering the standard items required for a new patient prior to the 5S pilot project. Assuming an average eight minutes spent per patient, that’s 24 minutes a day spent simply gathering supplies. Post 5S, the nurse approaches the bedside with a fully stocked admissions kit within 20 seconds – resulting in 23 found minutes that can be dedicated to patient care and increased face time with the patient and family members.

Linda Hesketh, patient care services manager, critical care says, “It was a team-building experience for the whole multi-disciplinary team. We were mostly surprised by the impact of change on staff perceptions of their personal work areas. This experience has been helpful in promoting a better understanding between disciplines.”

Susan Kwolek, senior vice president, administration is pleased with the results in the critical care unit pilot project because “the process improvement embraces the hospital’s patient and family-centred approach to care. By decreasing time and effort spent on non-value-added activities, we have more time and attention to dedicate to direct patient care,” she says.

The results of the project have been a real eye-opener for all those involved. Improved work flow, found time at the bedside, a more organized work area, improved patient safety and budget efficiencies have improved the situation in critical care dramatically – and they are not done yet.

Margaret Hernandez RN is happy with the change and looks forward to the improvements that have yet to be made in the patient rooms. “Having the opportunity to participate in the project makes us feel valued – this has improved our work environment dramatically.” Maria Kobylecky RN echoes her colleague’s perspective saying the process brought about a calmness. She likened the new atmosphere to the idea of getting into a bed made up with crisp, clean sheets versus crawling into an unmade bed at night. “It’s welcoming and it just makes more sense,” she says.

Next steps will include a review of the just-in-time stock carts and a re-design of the nursing station. New millwork will decrease space lost behind the nursing station to create a more open patient care area for patient transport purposes as well as the opportunity to store stocked carts under higher counters to maximize floor space. The team will eventually move on to a 5S approach to the patient rooms.