Clinical Excellence
June 9 2008
Kaiser Permanente Co-Authors and Benefits from Groundbreaking Nursing Study
A nursing study co-authored by a Kaiser Permanente patient care executive is expected to break new ground in understanding how the hospital work environment can be improved to help medical-surgical nurses spend more time delivering patient care.
The study (pdf), published in the most recent edition of The Permanente Journal, involved studying 767 nurses in 36 hospitals nationwide. Less than half of the hospitals in the study, funded by the Robert Wood Johnson Foundation and the Gordon and Betty Moore Foundation, were Kaiser Permanente facilities. Marilyn Chow, vice president of National Patient Care Services at Kaiser Permanente, and Ann Hendrich, vice president of Clinical Excellence Operations at Ascension Health, were co-principal investigators and co-authors of the study.
Ascension Health, based in St. Louis, Mo., participated in the study along with institutions such as Duke University Health System, New York-Presbyterian (the University Hospital of Columbia and Cornell universities), Vanderbilt University, Inova Health System, Carolinas Health System, and Intermountain Healthcare.
Kaiser Permanente is committed to providing the best care to patients, and studies such as this one allow the people of Kaiser Permanente to continuously examine how they can enhance the care experience. Its participation in the Time and Motion Study is only one example of that commitment.
The study sought to examine how much time nurses spend on identified activity categories (nursing practice, non-clinical, unit-related functions, and waste), how they moved throughout the nursing unit over the course of the shift, and the physiologic impact of the work environment on nurses.
The study cited areas of nursing focus, such as care coordination/communication and medication administration that are already changing within Kaiser Permanente through successful practices developed within Kaiser Permanente facilities. Some of these practices have been acknowledged broadly by other institutions. Among these are:
- A Nurse Knowledge Exchange program that allows more efficient transferring of data during nursing shift changes. More than 20,000 Kaiser Permanente nurses use NKE, and the Institute for Healthcare Improvement already has acknowledged NKE as a Top 10 idea.
- A medical administration program targeted to improve patient safety, KP MedRite, which has reduced staff interruptions by 50 percent and increased by 50 percent the standardization of medication administration. KP MedRite is being rolled out to all Kaiser Permanente hospitals. Further, the Joint Commission is looking into acknowledging it as a best practice.
- Destination Bedside is a pilot suite of process changes that includes NKE and KP MedRite, as well as positioning supply carts at patient bedsides and using wireless, hands-free devices to let nurses spend more time with patients and less time finding supplies and people. Destination Bedside is being developed at Kaiser West Los Angeles Medical Center using unit-based teams.
It's important to note that the Nurse Knowledge Exchange and KP MedRite were developed with the expertise of the KP Innovation Consultancy with frontline staff and quality liaisons in part at the Sidney R. Garfield Health Care Innovation Center. The Garfield Center, which opened in 2006, is a Kaiser Permanente facility in which health care architecture, technology, workflow and people can be modeled and tested before being put into practice.
The full study can be read in the summer edition of The Permanente Journal, a peer-reviewed journal of medical science, social science in medicine, and medical humanities.