Applications of lean management in nursing services: An example of general surgery clinic

This research is descriptive and methodological, single-group pre-and post-test interventional type. The aims of the research are to develop a lean management scale in hospitals for nurses and determine the level of be lean of nursing services in general surgery service with the scale. In addition, to evaluate whether there is a decrease in the number of steps and process times in nurses' drug supply, drug preparation-application and material access processes by interventional lean management practices. The sample of the study consisted of 657 nurses in the scale development study and 20 nurses in the interventional study. Data; Nurse Information Form, Lean Management Scale in Hospitals for Nurses, Waste Identification Form, Nurse Observation Form, Smart Wristbands were collected via Lean Hospital Knowledge Test. In the study, the scale was shaped with 5 sub-dimensions, 22 items according to the explanatory factor analysis, and the confirmatory factor analysis fit indexes concerning this structure were determined as X2/sd=2.082, GFI=0.87, CFI=0.92, RMSEA=0.06, RMR=0.08. The total Cronbach alpha value of the scale was determined as 0.878. In the interventional study, the lean management scale's pretest was 2.97±0.55 and the posttest was 3.05±0.5 in the general surgery service. In addition, in the study, wastes were determined in the drug and material supply and drug preparation application processes of nurses with value stream maps and A3 reporting. In these processes, improvements were made with 5S, Kanban and Kaizen studies. In this direction, according to the latest measurements in the sum of day and night shifts, 25.51 minutes and 188.85 steps in the drug supply process of nurses; 7.73 minutes and 277.13 steps in the process of accessing the material; 32.81 minutes and 459.15 steps in drug administration-preparation process; in total 64.48 minutes and 908.61 steps savings were achieved. As a result, "Lean Management Scale in Hospitals for Nurses" is a valid and reliable tool. In the general surgery service, which is moderately lean, wastage, nurses' working time and number of steps decreased as a result of lean management practices. These lean applications, which were determined to be effective, can be used in other services of the hospital.