Lean Article Archives

Tag Team TLC: Lean Nursing
(May/June 2008)

5B Internal Medicine bedside report project

NursingNurses Julie Grunawalt (left) and Deby Evans
(right) talk with a patient during the bedside report
process.

“I love it,” says Deby Evans, R.N., of the new bedside reporting method implemented on the 5B Internal Medicine unit. “We got out of the conference room and to the patient’s bedside,” adds Michigan Quality System lean coach Kate Bombach.

Previously, the 5B nurses took a traditional approach to shift-to-shift reporting by meeting in a conference room where all the outgoing shift nurses gave all the patient care updates and instructions to the incoming nurses at once. Now, nurses meet at the patient’s bedside to hand off information, introduce the new nurse to the patient and clarify any issues.

Evans, who was one of 15 nurses involved in implementing the new design, says, “You see your patients much quicker, prioritize your plan of care much more quickly, and know how to organize your day. Plus, anything that includes the patient is great.”

NursingLeft to right: Donna McClish, R.N., B.S.N., Deby
Evans, R.N., Sandra Kendziora, R.N., lean coach
Kate Bombach and Julie Grunawalt, M.S.,
A.P.R.N., B.C.

And according to Marge Calarco, Ph.D., R.N., patients like it, too. Calarco is senior associate director of Patient Care Services and chief of Nursing Services for the Health System.

“We’re already seeing the positive impact on patient satisfaction on 5B, which reflects the impact of bedside reporting and hourly rounding,” Calarco says.

5B was one of the first units to implement hourly nursing rounds.

Calarco says, “I want to thank Julie Grunawalt, M.S., A.P.R.N., B.C. (clinical nurse specialist), Donna McClish, R.N., B.S.N. (nurse manager) and Sandra Kendziora, R.N. (nurse supervisor) for their leadership and applaud the entire nursing staff for being pioneers in this wonderful work. This is a reflection of Nursing at Michigan at its best!”

“This wonderful initiative provides a forum for direct communication—and an opportunity to dialogue about patient care issues with each other,” says Christopher S. Kim, M.D., M.B.A., clinical assistant professor, Internal Medicine and Pediatrics. “The patients are the ultimate beneficiaries.”

Kim, Robert Chang, M.D., nurses McClish and Grunawalt, and lean coach Bombach are piloting several lean initiatives.

5B lean teams also are tackling the discharge process. They already have standardized the nursing shiftto- shift discharge communication process, use whiteboards to communicate patients’ anticipated discharge dates, schedule follow-up appointments with the patients—and, building on the bedside reporting project, use a bedside discharge process.

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