"Shaping up" Unit-to-Unit Handoffs with a Lean Six Sigma Work-Out

Purpose for the program: It is well-documented that ineffective communication through handoffs can lead to gaps in patient safety. Sharp Mary Birch Hospital for Women & Newborns has approximately 8,500 annual deliveries. As a result of the rapid turnover of patients, number of daily admissions, and daily bed capacity limitations, unit-to-unit handoffs are frequent, fast-paced, and problem prone. Employee Opinion Survey and Culture of Safety data indicated that there was room for improvement in unit-to-unit handoffs and teamwork across departments.

Proposed change: The proposed change included conducting a Lean Six Sigma Work-Out, focusing on unit-to-unit handoffs.  A Work-Out is a process designed to bring together the right stakeholders to develop solutions and actions. The Work-Out group reviewed current practices, determined information that should be included in reports between units, and developed a standardized report checklist. The Work-Out group also planned the next steps for implementing face-to-face report.

Implementation, outcomes and evaluation:

After a trial of the standardized report checklist, input from staff was utilized to revise the checklist, which is now to be used for all unit-to-unit handoffs.  When comparing the 2012 to 2011 Culture of Safety Survey for the hospital, there was a significant improvement in “Patient Safety Perception” and “Teamwork Within Units”.  There was no change in the overall score for “Teamwork Across Units”, although this score was already at the 75^thpercentile and there were notable improvements in individual departments.  The hospital plans to implement face-to-face report in all hospital units starting with Labor & Delivery and Maternal Infant Services (MIS).  To minimize training costs to implement the new process and to improve retention of information, creative tools such as animated video of good and bad handoffs will be utilized.

Implications for nursing practice:  Lean Six Sigma tools provide an effective methodology for process improvement in hospitals. The Lean Six Sigma Work-Out process can be utilized to standardize report between units and as a result, lead to improvements in patient safety.

Keywords:  Handoffs, Six Sigma, patient safety, Culture of Safety, communication