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3 steps to standardize a good workaround

Publish Date: 6/19/2013
Supplies out of stock? Required equipment broken? The show must go on. Nurses know this better than anyone.

Nurses work in broken systems everyday and have first-hand knowledge of the workarounds that are good for their patients, according to Jennifer Blaha, MBA, a Lean Six Sigma Master Black Belt at Cedars-Sinai Health System in Los Angeles, Calif., who oversees housewide improvement projects focused on operations and clinical quality.

“Good workarounds can save time, make a process safer, and lead to overall better patient care,” Blaha says. She has been working with trauma nurses at Cedars-Sinai to pull good workarounds into a more standardized workflow.

The key is asking the right questions to separate the good workaround from the bad, Blaha notes. To do this, ask:

  • Does this workaround improve patient care?
  • Does it increase efficiency?
  • Does it reduce waste (and potentially cost)?
Once a nurse identifies a good workaround, here are Blaha’s recommended steps to move it into standardized practice:

1. Collect data to gain buy-in for your idea
Collect some simple observational data to help people understand the problem. For example, if you have noticed that you are often going to another OR to get the correct size gloves, observe and record how many times you see others go to another OR for gloves over a one-week period. Take the data to your manager to start the dialogue. If you can also bring a potential solution to your manager, you are well on your way.

2. Identify useful interventions to standardize the practice
Simplification, coordination, information integration—these should be your watchwords as you think through the benefits of a change in practice. These interventions resonate well with users and managers striving toward increased efficiency/reduced waste.

For example, by standardizing correct glove sizes in each OR, you are simplifying traffic flow and supporting greater situational awareness of the OR environment.

3. Implement standardization using good communication, measurement
Successful implementation MUST include feedback/buy-in and clear communication as changes are made, as well as impact measurement to show how the change improved care delivery.

For example, once correct glove sizes are standardized in each OR, measure the reduced steps and time nurses are taking due to this change. Compare that to pre-implementation to show the positive impact of the change.

Hint: Communication is critical for establishing any change process. Too often, a small group of folks come up with a great improvement, but it does not become standard practice because it was not adequately communicated to everyone affected.

Workarounds are easy to identify and do not require extensive data collection to build a case for introducing them, Blaha stresses. “Identifying workarounds, whether those workarounds are useful or not, will improve your OR process.”

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