Koc Zibel, Alpar Sule Ecevit
Hisar Hospital Intercontinental, Nursing Services and Patient Services, Istanbul, Turkey.
Institute of Health Sciences, Marmara University, Istanbul, Turkey.
J Eval Clin Pract. 2025 Feb;31(1):e14278. doi: 10.1111/jep.14278.
This study investigates the effects of lean management practices on nurses' direct patient care activities and the interruptions they encounter in healthcare settings. The literature indicates that lean management enhances efficiency and improves patient care. Increased nursing time per patient correlates with better outcomes; however, rising patient loads and frequent interruptions hinder nurses' ability to deliver effective care, jeopardising patient safety. Addressing these inefficiencies is essential, given nurses' critical role in ensuring quality care.
Using a single-centre, observational, pre-post time and motion design alongside participatory action research from August 2019 to July 2022, the study included three phases: a survey assessing nurses' views on problem-solving and lean management; observations identifying nurses' activities and interruptions; and focus group discussions. The results presented here are from the observation phase, with 34 nurses from surgical, internal medicine, and mixed services participating. Quantitative variables were expressed as means, standard deviations, and significance was assessed at a 95% confidence interval (p < 0.05).
Observations in 2019 (324 h) and 2022 (314 h) revealed that nurses dedicated a significant portion of their time to direct patient care, which increased post-lean implementation (surgical: 50.67%, internal: 50.09%, mixed: 44.38%). Waste rates decreased by 35.81%, and documentation time decreased by 23.55%. Overall interruptions also decreased significantly (p < 0.05).
Lean management effectively reduces waste and improves direct patient care time, enhancing patient safety and care quality. Continuous improvement initiatives in nursing practices are essential for success.
本研究调查了精益管理实践对护士直接护理患者活动以及他们在医疗环境中所遇到的干扰的影响。文献表明，精益管理可提高效率并改善患者护理。每位患者的护理时间增加与更好的治疗结果相关；然而，患者数量的增加和频繁的干扰阻碍了护士提供有效护理的能力，危及患者安全。鉴于护士在确保优质护理方面的关键作用，解决这些效率低下的问题至关重要。
本研究采用单中心、观察性、前后时间与动作设计，并结合2019年8月至2022年7月的参与式行动研究，包括三个阶段：一项评估护士对问题解决和精益管理看法的调查；识别护士活动和干扰的观察；以及焦点小组讨论。此处呈现的结果来自观察阶段，有来自外科、内科和综合科室的34名护士参与。定量变量以均值、标准差表示，并在95%置信区间评估显著性（p < 0.05）。
2019年（324小时）和2022年（314小时）的观察结果显示，护士将大量时间用于直接护理患者，精益管理实施后这一比例有所增加（外科：50.67%，内科：50.09%，综合：44.38%）。浪费率降低了35.81%，记录时间减少了23.55%。总体干扰也显著减少（p < 0.05）。
精益管理有效减少浪费，增加直接护理患者的时间，提高患者安全和护理质量。护理实践中的持续改进举措对取得成功至关重要。
