A Self-Organized Agile Team was developed to address three interrelated nursing problems facing Prairie Lakes Healthcare System (PLHS): poor employee morale due to work intensity and lack of teamwork, high turnover and low productivity.
While developing the model, Prairie Lakes Healthcare System had the following explicit goals.
- Develop a patient-centered model of care
- Decrease work intensity and increase productivity
- Eliminate waste and unnecessary bureaucracy
- Fully integrate the newly-implemented electronic medical record
PLHS used the occasion of implementing an electronic medical record as the impetus for evaluating its care delivery model. Staff determined the electronic medical record would not reduce documentation work unless patient care processes such as admission, medication administration, and discharge were changed to eliminate waste and redundancy.
The hospital placed decision-making authority for work redesign close to the front lines so bedside nurses could make independent decisions and find ways to improve operations. In addition there was a goal to shift to a unit culture in which every nurse touches patients. As a result, jobs were restructured to eliminate nursing roles that did not provide hands-on care. The hospital eliminated the assistant nurse manager, charge nurse, and case manager positions and developed more effective systems to incorporate these clinical leadership functions into the bedside professional nursing role without adding to workload. The unit also eliminated the unit secretary position and blended the responsibilities with the traditional nursing assistant role by cross-training unlicensed staff to fill either position.
Introducing staff to principles of lean engineering helped identify and eliminate wasteful activities. Changing the organizational structure, decreasing management control, and improving access to information simplified nursing work. Participation in the Transforming Care at the Bedside initiative of the Robert Wood Johnson Foundation reinforced the role of front line staff in driving change.