Grey Bruce Health Services (ON)

  • Melissa Thompson, Program Director, Grey Bruce Health Services, Wiarton, Ontario

Implementation of the Foundation Modules – Releasing Time to Care

The focus of Releasing Time to Care is to evaluate, streamline and improve processes to increase the time nurses spend on direct patient care. The focus of this initiative was to implement the three foundation modules – Knowing How We Are Doing, Well Organized Ward and Patient Status at a Glance. 

Releasing Time to Care is front-line nurse lead management supported. There is a team of front-line nurses (RN and RPNs) at both hospitals leading the project. The management and executive teams are providing support and guidance (i.e. budget control and keeping the project on track) to the implementation team. The project requires the whole nursing staff to participate as well as bringing in expertise to help support the team (i.e. Infection Control and Materials Management). The team requests feedback of changes that have and could make nursing processes better. 

The Knowing How we are Doing (KHWD) module is the first foundation module that was implemented.  This module provides the data or facts. To date, the nurses have performed several activity follows on each unit which identifies what the nurse is doing at the top of the minute for every minute of a 12 hour shift. The activity follows provide the data for changes in the remaining modules. The activity follows determine the amount of time nurses on the unit are spending on certain tasks, for example, nursing care, how much time they are spending at the bedside, charting as well as how many interruptions they experienced during the shift. This allows the team to make changes based on facts rather than on ‘what they think they are doing’. In addition to the activity follows completed in the KHWD module, each unit has KHWD boards where the data is hung for the staff, patients and public to know how that unit is doing. On the board there are safety crosses that the staff record on a daily basis, pressure sores, infection spread and falls, as well as other data – Activity Follows, Sick time and OT information.  Identifying incidents daily allows the team to discuss each incident and put interventions in place to prevent further incidents from occurring.

The next module to be implemented was the Well Organized Ward. This module focuses on Lean methodology to organizing the work environment. In this module the team hung diagrams of the nursing unit to request improvement ideas that would decrease the walking/motion that is needed to collect stock items, retrieve equipment and carry out nursing tasks. The teams have completed spaghetti diagrams outlining the process for nursing procedures to help staff identify ways to improve the workflow and to decrease time spent in motion. They have also involved Materials Management to implement a better stock area to ensure the items are where they are supposed to be at the right time. Each unit has outlined areas with tape on the floor to identify where equipment is to be stored so that nurses are not spending valuable time searching for equipment.   

Unfortunately due to staffing limitations as well as the need to slow the project down for greater staff engagement the Patient Status at a Glance has not been fully implemented in either unit. The staff members are excited with the implementation and changes to date and look forward to the work ahead of them implementing the remaining modules.

Staff members are reporting a calmer more satisfying work environment. Staff members are happy to be involved in a project that is aimed not only at increasing patient safety and satisfaction but also at improving the overall engagement and morale of the nursing staff. They are keen to participate and make the work environment a better place. The managers of these units believe that an enhanced work environment, a better organized ward and improved nursing processes will help retention and recruitment of front-line nurses.