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.