Caring for caregivers: Designing environments for recruitment and retention Part 2

August 23, 2009
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Caregiver work environments need to be designed with sustainability in mind. In this case, creating places that sustain the energy, spirit, and productivity of the staff is the goal.
Caring for caregivers: Designing environments for recruitment and retention Part 2
In a recent survey of nurses, 67% said that their workload has increased over the past six months. Fifty-nine percent reported burnout.

Nursing is hard work, physically and emotionally. Days are long—40% of nurses today work shifts of more than 12 hours. The stress of caring for higher acuity patients, using increasingly complex technologies, also contributes to staff fatigue and burnout.

Caregiver work environments need to be designed with sustainability in mind. In this case, creating places that sustain the energy, spirit, and productivity of the staff is the goal. A safe and efficient working environment will help to reduce travel distances and streamline processes and, in so doing, reduce caregiver stress and fatigue. Staff-sustainable environments will also play a key role in attracting new talent and retaining valued caregivers.

Thinking Lean
Staff fatigue and burnout result from many factors, but helping to alleviate some of the causes can be addressed in the design of the caregivers' work environment. If the design enables caregivers to work more efficiently by reducing travel distances and the time spent “hunting and gathering,” then caregivers should have more time to spend in direct patient care activities.

The first step to creating such a place is to perform a thorough, methodical, and objective examination of all aspects of the staff work area. This assessment should cross departmental boundaries to identify dependencies, bottlenecks, and barriers to efficient patient care. Thinking Lean is a first step.

Lean thinking helps you identify waste and minimize the consumption of resources. Removing waste—in other words, getting rid of anything that does not add value—means more time and energy can be directed to patient care. Applying Lean thinking to healthcare delivery can also be profitable, since you get rid of the things that don't add value. Analyzing the thousands of interactive processes involved in patient care to identify wasted effort and resources will ultimately improve safety and reduce stress for patients and caregivers alike.

Applying Lean thinking is not a one-time exercise: it is a process of continuous improvement that requires the involvement of every staff member.

Identifying waste
To understand how Lean thinking can be applied to healthcare delivery, consider the nursing unit floor plan depicted below:

Click on the image for a larger view.

Figure 1. Traditional racetrack configurations distance staff from their patients and one another and increase time spent on non-patient activities.

This typical configuration, in which a caregiver work environment with centralized support rooms creates a racetrack design that literally keeps staff running back and forth between patients and supplies. Centralized spaces for equipment, supplies, and medications require nurses to constantly backtrack in inefficient work patterns that add miles to their days and pull them away from their patients. The result: wasted motion.

Wasted motion is a significant drain on a caregiver's time and energy. A recent study showed that 50% of nurses’ work time involves transport, motion, and delay. Locating equipment, supplies, and medications close to the patient in order to reduce travel distances and eliminate the need for hunting and gathering is a top priority.

Inventory is another form of waste if it means storing more than is needed and storing items that are rarely used. In those cases, inventory wastes space. Another form of inventory waste is hoarding. It is a behavior most of us are familiar with, and it typically happens because caregivers lack confidence that they'll have what they need when they need it. But hoarding isn't efficient. It takes up space and doesn't create a purposeful and organized approach to inventory.

Adding value
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