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Optimizing Nurse Shift Change Using DMAIC Approach from Lean Six Sigma ( Case Study)

Published on Tue 3, 2020
Optimizing Nurse Shift Change Using DMAIC Approach from Lean Six Sigma ( Case Study)

The employee has become one of the major resources in any industry today. Effective usage of the employee can not only push the task needle a bit but can also result in better customer satisfaction, especially for client-facing roles. I am John and I am working as an Operations Manager in a health care facility.



During one of the routine audits, we came across a problem that has escaped our vision for long. We realized that during the shift change, nurses spent a lot of time exchanging reports. Now shift change is an important factor for maintaining the continuity of service. Exchanging reports have equal importance as it kept the nurses updated with the condition of the patients.  Although the problem looks minuscule, it had some effect:

  • Nurses had to stay past their working duration to transfer reports to the nurses taking their place.
  • Almost 30 to 35 minutes of the working duration of the nurses coming in the next shift was getting used in this task. That is 30 – 35 minutes that could have been to look after the patients.
  • The extra duration spent by nurses post there working hours was not utilized as well.
  • Too many nurses trying to collect reports from too many nurses often lead to confusion.


Realizing the value of Lean Six Sigma Green Belt certification

What came to my rescue was the Lean Six Sigma Green belt certification that I had taken up sometimes back. During the certification, I was introduced to multiple wastes and this looked like a typical example of ‘Wait’. The DMAIC approach learned during the LSSGB certification proved to be very instrumental while solving this issue.  So, let us discuss it in detail.

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The nurse shift change is important to maintain continuity of care and happens after every 12 hours. The report contains the information of the patients the nurses must take care of along with their medications and medication schedule. Several other assignments are assigned to the nurses and this task is generally carried on by the lead nurse. So, during the shift change, all the 5 nurses from the previous shift must meet all the 5 nurses from the next shift. The time lapse is shown in the SIPOC figure below.

If the nurses spent less time interacting among themselves, they could direct this time to patients. This would also minimize the extra time spent by nurses post their working hours.



The timestamp was decided based on the time noted on 30 days and both the transitions. The time was recorded by the lead nurse. This gave us the approximate amount of time being lost.



In order to completely identify the problem, complete Failure Mode and Effect Analysis was conducted and exact factors creating the problems were identified. A few of those problems identified were:

  • There were too many nurses to give reports to.
  • When there are so many nurses, the wait time increased.
  • There was no control mechanism to solve these problems.

Based on the analysis, one way to solve the problem was to change the way of passing the reports.



Based on the observation it was clear that the major cause of waste was a huge number of nurses and the order in which the reports were passed. Reducing the number of nurses would have increased the workload. So, the method in which reports were passes had to be changed. The answer to the problem came in the form of creating territories and assigning one territory to one nurse. This meant that one nurse had to interact with only one nurse. The application of the idea did require a couple of extra tasks like restructuring the layout of the hospital.



The plan was tested for a period of 30 days in both the shifts. This gave in-details exposure to the time stamp during the transfer of the report. The time spent had been reduced to 10 to 15 minutes.


The DMAIC approached reduced the time wasted, without increasing the number of nurses or initiating any form of new training or intervention from the lead nurse.

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