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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 significant resources in any industry today. Practical usage of the employee can push the task needle a bit and 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 a long. We realized that during the shift change, nurses spent a lot of time exchanging reports. Now shift change is an essential factor for maintaining the continuity of service. Exchanging messages have equal importance as they 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 nurses' working duration 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 posts their working hours were 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 certificate, I was introduced to multiple wastes. This looked like a typical example of ‘Wait.’ The DMAIC approach learned during the LSSGB certification proved instrumental while solving this issue.  So, let us discuss it in detail.

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The nurse shift change is essential to maintain continuity of care and happens after every 12 hours. The report contains the patients' information the nurses must take care of along with their medications and medication schedule. Several other assignments are assigned to the nurses, and the lead nurse generally carries on this task. During the shift change, all five nurses from the previous shift must meet all the five 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 lead nurse recorded the time. This gave us the approximate amount of time being lost.


A complete Failure Mode and Effect Analysis was conducted to identify the problem completely, and exact factors creating the issues 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 reports' way.


Based on the observation, it was clear that the primary cause of waste was many 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 statements were passes had to be changed. The answer to the problem came in creating territories and assigning one domain 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 hospital's layout.


The plan was tested for 30 days in both 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 new training or intervention from the lead nurse.

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