Effect of Digitalization on Nursing Practices using the Lean Approach

Title: Lean Office in the public sector: Proposal for the Auction Section of a Teaching Unit. Objective of the work: The presente study aims to elaborate a proposal of the value flow of the internal phase of the auction process for the hiring of services of a continuous nature, adapted to the reality of IF Sudeste MG – Campus Barbacena, preserving legal aspects that govern the public administration. Procedures / Methods for Problem Solving: To diagnose the problem, data were collected from documental research, semi-structured interviews and participant observation. Lean Philosophy techniques were used and Case Study was taken as research strategy, wich made it possible to investigate in depth the selected product family for value stream mapping and achievement of objectives. Results: The selected product family was the internal phase of the auction process for contracting continuous services of unarmed patrimonial surveillance. The main technique used was the Current State Value Stream Mapping. The Process had a 71% Efficiency, a Lead Time of 113 days, the waste found as waiting time, transportation, movement and defect were treated with Kaizen event indications in Future State Value Stream Mapping, which reduced the lead time of the process to 73 days. Pratical Inplications: The model proposed in the Future State Value Stream Mapping was presented to managers and discussed until the consensus of the possibility of applicability of the Solution Proposal. Originality and contributions: The originality of the research can be caracterized by its construction based on a concrete case wicho sought in the literature techniques adopted to solve similar problems already addressed in the scientific community through Lean Philosophy. Technical / Technological Production: The Future State Map and the procedures for reaching the future state is the Technical / Technological product derived from this research. The future state to be achieved will bring innovation in the production of auction prcesses, strengthen teamwork and from small improvements, it will shape a culture of continuous process improvement.

This paper showcases the use of the lean manufacturing tool known as Value Stream Mapping (VSM) as a means of identifying and reducing waste in a water bottling factory. Value Stream Mapping (VSM) is a Lean Manufacturing technique for identifying where wastes occur in a manufacturing process. A Current State Value Stream Map (CVSM) was utilized in identifying the sources of waste in the current state of operations of the water bottling plant. On the other hand, a Future State Value Stream Map (FVSM) was used in proposing an improved state of the plant’s production processes. The CVSM aided in discovering that manual inspection was one of the sources of waste in the factory which led to waste in the form of over processing. The FVSM displayed a proposed state with an improvement of manufacturing lead time and cycle time of about 42.1 per cent and 22.2 per cent respectively. The proposed state of the water bottling process also required lesser workers, with a reduction of 2 quality inspectors, therefore a drop in the cost of labour was also achieved.

Performance-enhancing efforts in the manufacturing industry have centred on ‘lean’ principles and philosophies since the early 1970s. Lean principles, philosophies, tools and methods have also been significantly deployed to enhance performance in service processes within the manufacturing industry, as well as the process industry (e.g. inspection, maintenance and modification-related). It has been observed that when the main business is mostly centred on service-providing processes, significantly less effort is put into exploiting the use of lean approaches to enhance performance. Therefore, it is vital to investigate the potential of ‘lean’ concepts’ implementation in a service-providing organisation. This manuscript is based on the value stream mapping and the value stream analysis (VSA) performed in a Polish telecommunication-industry-related service-providing company. A plain old telephone services-based case study is presented. The service-providing process is analysed in order to identify the current existing drawbacks and to propose improvements to enhance performance. Based on the current state value stream map and the VSA results, a future state value stream map was developed. Then, process efficiency was calculated in order to assess the level of performance improvement.

This research has applied Lean Manufacturing Technique to improve process flow in the manufacture of noise filter products at a case study company. The research procedure started from studying the process and process times at every step in the manufacture of noise filter products. After this was written the current state value stream map to study the overall picture and indicate main problems in the process. From there was conducted brainstorming with the relevant personnel to identify areas of waste. Then methods were proposed to adjust the process, using Line Balancing technique which specified the working time of a semi-automatic soldering machine to determine the cycle time of the process. Adjustments were made to the layout design and to reduce the time used to move components and work pieces. Also, equipment was designed to speed up the work. From there was written the future state value stream map. Once the methods had been applied, it was found that the efficiency of the production line was increased from 56.9% to 85.76%, and staff reduced from 16 to 11, while maintaining production to meet customer demand. Moreover, work in process was reduced by 69.28%, waiting time reduced by 38.91%, working space reduced by 46.91%, the movement of components and work pieces reduced by 56.25%, and non-value added time reduced from 93.92% to 85.64%.

Background Insufficient drug reserves in hospitals pose significant challenges in management, procurement, and distribution. Rising demand often leads to shortages, while overstocking causes waste and expiration. These issues reflect inefficiencies in medical supply warehouse management and highlight the need for improvement. Therefore, enhanced resource management processes are essential to ensure a balanced and efficient medication reserve system. Lean Management is a systematic approach to eliminate waste, reduce costs, and improve efficiency. Value Stream Mapping (VSM), a core Lean tool, supports process redesign by categorizing activities as value-added (VA), necessary but non-value-added (NNVA), or non-value-added (NVA). In this study, VSM was employed to comprehensively analyze the drug disbursement process within the medical supply warehouse management system and to design and develop an enhanced drug inventory management system to improve efficiency and effectiveness. Method This research employed action research methodology with 22 participants from the drug warehouse, outpatient, and inpatient medicine rooms. A user-centered system was planned through focus group discussions. This phase emphasized conceptual framework development and planning. Potential improvements were expected to enhance satisfaction, reduce waiting time, and increase convenience, sufficiency, and availability. Result Phukhieo Chaleomphrakeit Hospital created a future state value stream map, reducing process steps from seven to six. The current system required 1,925 minutes. The redesigned system is expected to take 435 minutes, including 395 minutes for valuable activities. The proportion of value-added time increased to 20.52%, significantly reducing waste from waiting. Conclusion The study demonstrates the effectiveness of VSM in identifying inefficiencies and redesigning processes. The collaboratively developed system eliminated unnecessary steps, reduced waiting times, and enhanced operational efficiency. This provides a practical model for improving pharmaceutical supply chain management in similar hospital contexts.

Purpose: Lean manufacturing, originating from the Toyota Production System (TPS), aims to reduce waste and optimize resources. Developed countries must adopt Lean practices for performance improvements while developing countries often use just-in-case approaches. Value Stream Mapping (VSM) is a crucial tool for diagnosing, implementing, and maintaining Lean Manufacturing, helping identify improvement opportunities and eliminating waste. The research at the company aims to eliminate Lean wastes and line unbalancing issues to improve lead time and the value-added ratio (VAR), enhancing production efficiency. The research aligns with Sustainable Development Goal 12 (Responsible Production & Consumption) by focusing on waste reduction. Methodology: The research uses time study, Edaw max, and Visio software to analyze tasks, create VSMs of current and future states, and control charts to examine data variations over time. Data collection involves cycle time, batch size, packet size, and the number of workers required for each activity. Findings: The research objectives include studying the existing scenario of production units via VSM, identifying, and eliminating Lean wastes, and comparing proposed and existing scenarios for improvement opportunities. The literature review highlights the importance of Lean manufacturing in eliminating unnecessary processes, reducing lead time, and fostering positive stakeholder relationships. Unique Contribution to Theory, Practice and Policy: This study suggests the better way to reduce the lean wastages and balance the line by using VSM technique. The future state VSM is created to conceptualize potential improvements and gather feedback, focusing on reducing non-value-adding tasks, work-in-process inventory, workforce, and overall process time.

Background: Blood transfusion had a positive effect on pediatric patients' life; so nurse play an integral role to maintain pediatric patients' safety related to blood transfusion. Aim of the study: was to evaluate the effect of implementing nursing intervention program on nurses' knowledge and practice regarding children undergoing blood transfusion. Subjects and Methods: Research design: A quasi-experimental study design was adopted to carry out this study. Setting: The study was conducted at Pediatric Medicine Departments at Benha University Hospital. Subjects: A convenient sample of fifty nurses who were providing direct nursing care to children. Tools of data collection: Two tools were used in the present study. A structured interviewing questionnaire to explore nurses' personal data and their knowledge regarding blood transfusion for children and observational checklist to evaluate the actual nurses' practice towards caring for children and educational training program to train nurses related to blood transfusion. Results: The present study revealed that, the mean age of nurses was 28.52± 5.06 years and more than half of them weren't attending training courses related to blood transfusion. There were highly statistical significant differences(P<0.001) concerning nurses' knowledge and practice pre/ post implementation and follow up phases of the training program regarding blood transfusion and there was a positive correlation between total nurses' knowledge and practice regarding blood transfusion immediately after post implementation of the training program ( r = 0.539 & p < 0.001). Conclusion: Nurses' total knowledge and practice scores regarding blood transfusion for children were improved post implementation of implementing nursing intervention program than pre- program implementation. Recommendations: Based on the results of the present study, recommended the importance of continuing in- service training for nurses regarding pediatric blood transfusion.

The objective of this scoping review is to examine and map knowledge of nursing provisions for self-determination while providing care to clients with cognitive impairment in residential aged care facilities. Maintaining the ability to have choices and to make decisions about daily activities is important for older adults. In residential aged care facilities, nurses' can be challenged to preserve clients' self-determination in favor of ritualistic care routines and a perceived duty to care. Moreover, nurses may perceive that their professional responsibilities to protect clients requires them to guard against decisions that are considered unwise or pose a risk to clients' health or safety. Insight into how nurses negotiate choice with clients with cognitive impairment who are living in a residential care facility will provide an in-depth understanding of the role self-determination plays in clients' lives. The scoping review will consider research and narrative reports on nursing provisions for self-determination in clients with cognitive impairment who are living in a residential aged care facility. The concepts of interest are self-determination and nursing provisions. Self-determination is defined as client choice and nursing provisions are the intentional reactions to clients' expressed choices. This scoping review will aim to locate published and unpublished literature employing a three-step search strategy. Only papers published in English from 1995 onward will be included. Data extracted from included papers will outline details on the participants, context, strategy, activity, and outcomes. Extracted data will be reported in a tabular form and presented narratively to address the review objective.

Purpose: The aim of this paper is to show a successful improvement in operations with the implementation of lean manufacturing strategies in a Caribbean oil and gas company. Design/Methodology: Initially, a review of literature was performed on lean manufacturing (LM) tools. Then interviews and GEMBA walkthrough was carried out in the selected case organisation followed by the problems faced were analysed using value stream map (VSM) together with root cause analysis tools. At the end, future state VSM was developed and the benefits due to implementation of LM principles were quantified. Findings: The study revealed that a traditional approach is currently being used on the shop floor thus increasing the opportunity for hidden wastes between the processes as well as increased repair time due to defective equipment. The results concluded that improved shop floor utilisation, reduction in preparation time and hidden wastes were identified on the shop floor. Originality/value: The review of literature indicated that implementation of the lean principles in the Caribbean oil and gas sector has not been explored. Further, the study results provide a road map for similar organisations to achieve operational improvement but also is valuable for academic and research community for practical implementation of lean principles.

Retrofit of two way holding chuck to improve process efficiency and resource management

Packaging Factory have activities in bag production. In order to increase the productivity, the company should manage the activities to increase valued added and decrease several waste. This study was purpose for analyzed the caused problems of waste, and give recommendation for minimizing the waste. The problem solving at the study was using lean manufacturing concept approach. The waste identification began with identification of current state value stream mapping with weighting the waste in order to understand the root of problem within production process. The detail mapping selection was using Value Stream Analysis Tools (VALSAT). Root Cause Analysis was used in order to understanding the root of problem for production process followed by FMEA for understanding the improving priority which has to be done. From the data analysis result, we found that the most dominant waste order is defect, waiting, inventory, excessive transportation.The mapping detail used for analysis process as Process Activity Mapping Supply Chain Response Matrix and Quality Filter Mapping. From the result of study we found the decreasing of production time from 138.4 minute to 119.4 minute. Decreasing lead time process could reach 13,7% comparing before the recovery step.

The automobile body painting production system exists in the backward management concept of focusing on production and ignoring environmental protection, focusing on traditional technology and unwilling to innovate, etc., high production cost and environmental protection standards, which have had a negative impact on the industry's long-term growth. Based on the value stream mapping (VSM) analysis technology, the current situation of the value stream of the body spraying process of TJ Automobile Manufacturing Company is analyzed, the problem of waste in the production process of automobile body painting system affected by Eliminate Combine Rearrange Simplify (ECRS)a four-step problem-solving technique was studied and analyzed, a new method for the application of value stream graph analysis technology in the digital transformation environment is proposed, and a suitable production improvement scheme for the body painting system is formulated by using the new method, which increases the value-added operation time of the painting production process by 9.5% and reduces the non-value-added operation time by 12.5%. The number of operators was reduced by 18.8%, the value-added ratio was increased accordingly, the scrap rate was reduced by 8%, and the exhaust gas purification rate was increased by 66%, which brought good economic and social benefits to the enterprise and provided a successful case for the application of lean production VSM in the digital transformation environment. The paper extends knowledge in the area of digital transformation and lean production by helping us to establish and explain the relationship between lean production management methods and the promotion of new energy vehicle body coating performance from a dual perspective of digital transformation and VSM. None of the previous studies have considered the combined application of the studied digital transformation and VSM lean management approaches.

Introduction: Nurses are the largest and one of the most important groups of health care providers. The quality of health care mostly depends on the quality of direct and indirect nursing care. Measuring the average nursing care time is an objective measure for assessing the quality of patient care.The goal of the present study was to compare the time being devoted to professional – nonprofessional activities by nurses in 8 hours and 12 hours working shift in Shahid Modarres teaching hospital in Tehran.Methods: A descriptive- comparative study was conducted on 30 nurses (27 female, and 3 male) working in medical and surgical wards of Shahid Modarres teaching hospital in Tehran. The nurses were working 8 and 12 hours shifts and in rotating schedule. Data were collected by direct observation of nurses’ activities,using a checklist with list of direct, indirect and nonprofessional nursing activities. The reliability of the checklist was assured by calculating inter observers’ agreement (The duration of time which nurses spent for each activity was recorded. Data were analyzed using SPSS and Wilcoxon test.Results: The findings of the present study revealed that, nurses working 8 hour shift duration, spent 64.99% of their time on professional and 35.3% on nonprofessional activities (41.21% on direct nursing care, 23.78% on indirect nursing care, 22.53% on personnel affairs and 12.5% on administrative activities). Nurses with 12 hour shift duration, spent 65.59% of their times on professional activities and 33.92% on nonprofessional activities (41.57% on direct healthcare, 24.02% on indirect healthcare, 20.94% on personnel affairs and 12.98% administrative activities).Conclusion: Nurses working in both 8 and 12 hours shift spend most of their times for professional activities (direct and indirect healthcare) and devote less time to nonprofessional activities (administrative and personal affairs), and these activities are independent of their shift durationKeywords: Working shift, Nurse, Direct nursing care, Indirect nursing care, Teaching hospital REFERENCES Admi H Tzischinslcy O Epstein R et al (2008). Shift work in nursing: Is it really a risk factor for Nurses health and patients safety?. Nursing Economics. 26 (4)250-256 Farquharson B (2013). How much time do nurses actually spend on patient care? An analysis of real-time data across medical and surgical wards. Avaible at: https://www.rcn.org.uk/__data/assets/pdf_ file/0019/512146/2013_RCN_research_3.1.3.pdf French L (1977). The Personal Management Process.6rd ed. Boston: Houghton Mifflin Co. Hagerty B, Spengler C.(1985). Work sampling analyzing nursing staff productivity. The Journal of Nursing Administration. 5(9) 13-20. Heslop L Power R Cranwell K (2014) Building workforce capacity for complex care coordination: A function analysis of workflow activity. Heslopet al. Human Resources for Health2014,12:52. Avaiable at:http://www. human-resources-health.com/content/12/1/52 Josten DC (2003).The effects of extended work days on fatigue, health, performance and satisfaction in Nursing. Journal of Advanced Nursing.44(6) 643-652. Kabiri F (1992) [ How nurses relate themselves to patients in the internal and cardiology wards of Tehran university]. M.S Thesis. Faculty of Nursing and Midwifery Shahid Beheshti University of Medical Sciences. (Persian). Liang Y, Chen W, Lee J & Huang L (2012). Nurse staffing, direct nursing care hours and patient mortality in Taiwan: the longitudinal analysis of hospital nurse staffing and patient outcome study BMC Health Services Research 2012, 12:44 Medical Dictionnary (2014). Avaible At: http://medical-dictionary.thefreedictionary.com/indirect+care. Accessed time: 9/24/2014. Puente LM, Rabbino H (2003). Creating value with strategic resources. Avaiable At:http://www.iseesystems. com/community/connector/Zine/SeptOct03/luz.html. Accessed time: 9/24/2014. Rogers AE, Hwang WY, Scott LS, Aiken LH, Dinges DF(2004). The Working Hours of Hospital Staff Nurses And Patient Safety. Avaiable at:http://content.healthaffairs.org/content/23/4/202.full. Accessed time 9/24/2014. Rostamipoor A(1986).[ Assessment of nurses non professional activities in Tehran hospitals ] M.S Thesis. Tarbiat Modarress university.(Persian). Shams Azad M (1995).[ Comparison of nurses’ productive hours in various wards of educational hospital in Tehran. M.S thesis. 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Background and Objectives: Work sampling is a useful technique to characterize how employees allocate their work time to various activities. Given the value of nurses’ time for quality health care delivery, characterization of nursing time distribution may provide useful information for optimal use of nursing staff. The purpose of the present study was to explore time allocation by nurses using work sampling method. Method: The study was conducted in a 150-bed private hospital. Data was collected using a researcher-designed work-sampling tool addressing 259 tasks grouped into four high-level activities, including direct care, indirect care, and unit-related, and personal activities. By conducting a pilot study, a sample size of 669 was determined for observation. In practice, however, a total of 228 nurses were observed in 540 shifts, which provided a robust sample for data analysis. Data were collected at 20–30 minute intervals over a nine-week period. The nurses’ activities were randomly observed and recorded by 12 trained observers. Findings: A total of 17517 nursing activities were observed for the day shifts and 12902 for the night shifts. The nurses were found to spend 44–46% of their work time on direct care, 20–22% on indirect care, 10–14% on unit-related duties, and 20–24 % on the personal activities, depending on shift time. The proportion of nursing time specified to direct patient care was the highest in the Emergency Department (55%, day shift, 57%, nigh shift) and the lowest in Maternity Ward (35%, day shift, 32%, night shift). Administration of medication (28.7%, day shift, 28.4%, day shift) and monitoring patients’ vital signs (25.6%, day shift, 26.7, night shift) were identified as the most time-intensive patient care tasks. The nursing time distribution was virtually the same in the day and night shifts. The proportion of time spent on personal issued (22%, day shift, 25%, night shift) was found to be higher than that required by the hospital. Conclusions: While the nursing staff spends the majority of work time on direct patient care, the time spent on personal activities is relatively high, requiring specific inspection. Our results identify the most time-intensive nursing tasks and provide potentially useful data for optimal design of nursing schedule.

Medicines are the cornerstone of healthcare. Lean methodology approach such as Value Stream Mapping (VSM) is being used in healthcare to manage resources wisely to ensure sustainability of medicines and resources. The aim of this quality improvement study was to evaluate and improve the medication management and hospital imprest supply processes in Australia's first dedicated cardiology hospital using VSM. We conducted a review of our medicine supply processes at a 180-bed cardiology hospital in Australia. We followed a lean methodology approach over a 4-month period from February to May 2023 and evaluated the outcome of our improvements for another 4months from July to October 2023. We used VSM to identify non-value adding activities. Cost of medicines holding was calculated, as well as time taken to complete supply processes, pre and post. Pharmacy department stockholdings reduced by 51%; p=0.000121 (from $539,662 to $275,406). Time taken to manage the inventory system also reduced by 42%; p=0.025762 (from 148h/month to 62h/month). Lean methodology such as VSM can facilitate cost-effective and sustainable system improvements for pharmacy procurement systems.