Integration of Lean Visual Management Tools Into Quality Improvement Practices in the Hospital Setting

BACKGROUND Lean management tools have proven effective in achieving high reliability in health care. LOCAL PROBLEM Unstructured leader rounds, decentralized prevention bundle repositories, and unfavorable patient experience outcomes prompted leaders on a thoracic and cardiovascular surgery unit to find other methods to address these issues and positively impact outcomes. METHODS Nurse sensitive indicator prevention bundles, root cause analysis tools, and best practices were used to develop Kamishibai Cards (K-Cards) for each measure targeted. INTERVENTIONS K-Cards were implemented to standardize processes, engage patients in their care, and promote staff identification of barriers and solutions. RESULTS Nurse-sensitive indicators and patient experience metrics were positively impacted by Kamishibai Rounding. K-Cards promote a state of continuous improvement, which supports sustainability of evidence-based practice and best practices that were implemented. CONCLUSIONS K-Cards use high-reliability principles to standardize nursing practice to promote quality outcomes.