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Toronto General Hospital Patient Care Coordinators, Natalia Evitch (L) and Antonia Cole, say working with the Lean team on Leader Standard Work has led to fewer interruptions and more quality time. (Photo: UHN)

As leaders in clinical units, Patient Care Coordinators (PCC) have a lengthy list of tasks every morning – from touching base with night shift staff about their problems or concerns and checking emails, to coordinating admissions and discharges, the patient flow meeting and being the team information source.

All that while being pulled from one conversation or call to the next, often in mid-sentence.

But now, two PCCs are taking back the morning. Members of the Lean team worked with Toronto General Hospital PCCs, Natalia Evitch of 6B, and Antonia Cole of 6A, to bring order and focus to the morning chaos using Leader Standard Work.

Leader Standard Work is a tool adapted from industry and used at leading healthcare providers, such as ThedaCare in Wisconsin, to ensure leaders have a structured management system for proactively addressing the most pressing challenges facing their teams.

Before creating the standard work, Lean coaches shadowed the PCCs to understand how they spend their time. The data showed the PCCs were spending approximately 15 to 20 per cent of their time in the morning responding to the unexpected, and approximately 20 per cent of their time on activities that improve how work is done, such as problem solving and streamlining processes.

Next, Natalia and Antonia worked with their Lean coach to articulate the key goals – safety and flow – they must focus on every morning to ensure their teams have a successful day.

The structure provided by Leader Standard Work allowed them to reduce time spent responding to the unexpected and focus on their key goals.

Applying structure to chaos

"That first week using the standard work felt like having someone telling you what to do, literally every minute," says Natalia. "It was difficult because I've been doing this for years and using standard work feels like admitting that you can't organize your time.

"But by bringing this structure and focus to the morning business we created time for quality. We can spend more time coaching the night shift nurses, or do real problem solving with our team members to prevent problems from reoccurring."

After implementing Leader Standard Work, the time Natalia and Antonia spent on administrative tasks dropped by 73 minutes a day, and time spent dealing with unexpected events dropped by half an hour. Time spent improving work during the morning increased more than 10 per cent.

With less time lost to interruptions the two PCCs have more time to spend talking with patients.

"I can talk to every patient in the morning," says Antonia. "I really enjoy getting to know them, and I can talk to them about their care plan, their discharge plan and answer questions about transitioning home."

With questions and concerns addressed first thing every morning, there are fewer questions for nurses to field later in the day. That saves time for nurses who would otherwise have had to track down the appropriate person to answer the patient's question.

Creating a new 'one source of information'

Interruptions are bad for productivity. Research from Carnegie Mellon University's Human-Computer Interaction Lab found it takes an average of 25 minutes to refocus on the original task after an interruption.

The Lean coaches believed Natalia and Antonia could save time by eliminating, or at least reducing, interruptions.

The coaches spent several mornings closely observing Natalia and Antonia, tracking minute-by-minute who was interrupting them and why.

"When the Lean team shadowed us they verified what we already knew," said Antonia. "We were constantly interrupted by nurses on our unit, calls from the flow team, calls from physiotherapists and occupational therapists, and calls from other units. We never finished a task or conversation before moving on to the next one."

Natalia and Antonia worked with all these groups to determine what information they needed the most and where it should live, which turned out to be the electronic whiteboard system. Time was scheduled into the standard work for entering pertinent patient information into the system.

Now, all members of the care team can easily access whatever information they need.

"I was nervous at first about how rigid the standard would be," says Natalia. "But I can deviate if there is an emergency and we collaborated with our Lean coach to adapt it to work for us."

Leader Standard Work has had such a positive impact on unit operations that the charge nurses on both units are in the process of creating their own standard work.

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