(The Children’s Hospital of Philadelphia)
University of Phoenix
May 5, 2020
(The Children’s Hospital of Philadelphia)
My Gemba walk was conducted on the process of room cleaning at The Children’s Hospital of Philadelphia (CHOP) organization. The location of this organization is in the central part of Philadelphia, which remains a charitable, nonprofit business. In the year 1855, this organization got recognized as one of the nation’s first hospitals dedicated to providing patients with specialized care (The Children’s Hospital of Philadelphia, 2020). CHOP offers both inpatient and outpatient services along with additional satellite clinics to serve the population. Consumers serviced at this organization come from all over the world (The Children’s Hospital of Philadelphia, 2020). Every organization, such as Children’s Hospital of Philadelphia, has a ‘purpose’, where ‘work’ is being done to fulfill that ‘purpose.’ From studies, processes and systems are in place to get that ‘work’ done. With all those processes, such as room cleaning; personal observation of work being done for improvement opportunities.
Within the Children’s Hospital organization are respective departments where multiple work processes are in place. The Gemba Walk selects the focus of room cleaning. An observation, along with interview questions, was conducted on the process of room cleaning that supports the care of patients. The nurse manager, nurses, senior nursing assistants, charge nurses, and environmental and linen service workers, to name a few, are some of the most important roles to keep the cycle of flow. Although it seems as if it would take up a lot of time to get through the process of a Gemba walk, it was not as long as expected. However, observations remain evident that a Gemba walk could be necessary for improvements to the unit. The selection of the N/IICU department for the Gemba walk was for reasons of current employment on one the unit, as well as most employees within the group are familiar with the representatives. Because the department is large, it is essential to include additional observers from the care team to assist in the observation, to be able to ask questions and to have an awareness of the purpose in the Gemba walk (Graham, Kothari, & McCutcheon, 2018).
The goal of the Gemba walk is Kaizen, possible improvements to the methods of room cleaning. Staff should always be knowledgeable about the process, steps, and outcomes with room cleaning. As there are efficiencies and deficiencies within the Environmental Service department, these staff members are responsible for the cleaning. The Gemba walk also remains intended to create a more solid relationship across the different entities that contribute to the patient’s safety and care. This process of room cleaning creates an environment where communication should be effective to get the job done. Therefore, clarifying the purpose of the walk to those involved in the Gemba Walk, and the reason for the observations is to seek opportunities for Kaizen of the room cleaning process, in which the staff was more receptive and willing. Studies uncover that a Gemba Walk does not deal with personnel performance duties. With staff participation of a Gemba walk it has the potential to empower workers to bring innovation to the department and collectively to the hospital as a whole by contributing to continuous improvements.
During the Gemba walk for the process of room cleaning, the observation noted that several other staff members within the unit were also observing the walkthrough. They were not very assertive in the process while it was getting conducted. As a result of some findings, there were a few things that needed changes and adjustments for reasons to improve the process. As far as the different job sector’s duties, some of the direct questions created issues for the team. Individual staff members had their interpretation of what reasons the questions created a problem to get answered. But the focus remains to uncover improvements and not with personnel performance duties. Studies have uncovered that a Gemba Walk is conducted at the operational level. With uncovered data of the process of room cleaning it can supported by systems where improvements in efficiency can be addressed.
From observing, you gather opportunities for improvements in the process. Once the observation is concluded, you gather findings, data, and move into your preliminary analysis. You address opportunities for Kaizen in effectiveness, efficiency, or both of the process selected.
An analysis of the observation showed some employees in each entity of the unit viewed the Gemba walk as a way of detecting Kaizen within the process of room cleaning which involves the patient direct care. When keeping the patient first it is good to have a mentality that does not have room for possible drawback. The walk also revealed opportunities for specific deficiencies of inpatient room cleaning within the N/IICU where shortcuts were taken, and some not completed at all. The process of cleaning rooms for inpatients should be followed as directed by the cleaning process guidelines noted in the standard work documents.
There were some opportunities observed, such as streamlining the process of room cleaning for the safety of the patient which will decrease the inefficiencies for educational learning for all staff. Therefore, educating employees with the knowledgeable of a Gemba Walk will show the opportunities available for Kaizen. Being knowledgeable of the walk would void the unexpected reactions that it is getting done for other reasons besides advancements. Also, implementing effective and efficient communication within those conducting the process will prevent the breakdown of services provided to the patients. In other words, when the outcomes of the process are not met due to staff, patient, or parent limitations, it should get communicated to the appropriate personnel for documenting (“Importance of Communication in Nursing,” 2016). Implying preventative steps are to make sure that rooms are not just going uncleaned, and all parties are getting held accountable for the process.
From observing, opportunities stood out for improvements in the process which also provided a plan of action to decrease inefficiencies within the unit to reduce waste during room cleaning. Measures to reduce waste have been taken in the N/IICU during the cleaning process of the rooms with saving products and materials that are unused and sealed. The packaging of products and materials must remain unopened and can withstand getting disinfected for reuse. This process cuts the cost of product purchasing when it comes time to do inventory for reordering. Each unit, which includes the N/IICU, has a budget for products and services that reducing waste will assist with the leverage of finances.
The key takeaways during this observation uncovered that a process can be improved for effectiveness. From observing, you gather opportunities for improvements in the process. From the analysis, short- and long-term ideas were generated that support the Kaizen effort of room cleaning. Also, the weakness of following effective policies that are in place remained out of the norm of what they became accustomed to not being addressed. Results of the room cleaning outcomes uncovered the breakdown of communication that affects the productivity of the task of room cleaning and the safety of the patient and staff.
The individuals who were spoken to consist of personnel that contribute directly to the care of the patients. Namely, it would be as stated before, nurse manager, nurses, senior nursing assistants, charge nurses, and environmental services workers. These individuals’ names remain withheld for purposes of confidentiality to the public. The Children’s Hospital of Philadelphia (2020) website, provides the responsibilities of each N/IICU entity as follows:
- The nurse manager coordinates all clinical activities and makes sure quality patient care is getting delivered. A nurse manager also manages change, patient/client satisfaction, and other applicable responsibilities. Operates to improve and maintain staff satisfaction and retention (The Children’s Hospital of Philadelphia, 2020).
- Neonatal intensive care nurses are responsible for providing critical care to premature and critically ill babies, while also extending assistance to the parents. Parent support can vary from emotional inspiration to recommending parents or caregivers on different methods of taking care of a newborn once discharged home. N/IICU RN’s are also responsible for having clear and direct communication amongst staff members. (The Children’s Hospital of Philadelphia, 2020).
- Senior Nursing Assistant is to support the delivery of care to patients. Be responsible for safe care for patients in their activities of daily living, check vital signs, feed, bathe, dress, and partial room breakdown for discharge. As well as promptly and accurately communicate patient information to the appropriate team member (The Children’s Hospital of Philadelphia, 2020).
- Charge Nurses oversee and manage work assignments for staff nurses and SNAs and environmental workers in addition to helping solve patient care and other difficulties within the N/IICU. The charge nurse also coordinates the flow of patients that are admitted and discharged on the unit (The Children’s Hospital of Philadelphia, 2020).
- Environmental Service workers assist with the safety of our patients by maintaining the cleanliness and management of room turnover throughout the organization upon communication (The Children’s Hospital of Philadelphia, 2020).
Within the environment of people I remain employed, they have taught a lesson to stay consistent with methods of change for advancement. The organization or authorized staff can, at any time perform a Gemba Walk, which may acknowledge areas for improvements (Graham, Kothari, & McCutcheon, 2018). By adding a Gemba walk, it can identify recommendations for a plan of actions such as reintroduced training for room cleaning which includes communication and policy changes that acclaim strengths, growth, and encouraging practices (Gesinger, 2016). It remains vital always to have the input of direct employee concerns and viewpoints, which will provide an understanding of the deficiencies within the process selected.
Two short-term ideas/projects that can support Kaizen of the process selected are first, providing firmness by being consistent with employees’ input and communication for advancements across the board regardless of their departmental level. Secondly, make it the responsibility of all employees to make sure that cleanliness and safety is the goal to deliver quality care, consistent with an open-door policy for suggestions or concerns of progressing. A Long-term idea should consist of a check list of procedures and guidelines for being certain that goal are obtainable for advancing studies of safety of the patient. These studies will elaborate on effective and non-effective changes within the organization. Staying compliant with the company guidelines and policies that connect to this process. Implementing guided principles and education will support the expansion of reputation with services within means of modifications and regulation. With routine evaluation, it is the expectation to have positive collaboration to advance the learning practices. According to Gesinger, (2016), “Dedicating time and putting forth the effort to work side-by-side with employees also brings with it the long-lasting benefits of gained credibility and respect” (p. 35).
In response to the Gemba walk performed with my employer, it has been both aggressive and valuable to the process of room cleaning within the N/IICU. With the minor issues revealed the results exposed room for improvement that can be used for advancement. The necessary improvements that remain suggested allow innovative education as well. The conclusion and explanation of the walk provided the intention, and the interpretation from staff proved that it was not for exposure purposes nor for reprimanding, but to bring about innovation to the organization. The acknowledgment of the shortcomings and the need for change with assistance from the Gemba walk information brought about a sense of relief.
Gesinger, S. (2016). Experiential learning: Using Gemba walks to connect with employees. Professional Safety, 61(2), 33–36.
Graham, I. D., Kothari, A., & McCutcheon, C. (2018, February). Moving knowledge into action for more effective practice, programmes, and policy: protocol for a research
programme on integrated knowledge translation. Implementation Science, 13(22), DOI: https://doi.org/10.1186/s13012-017-0700-y
Importance of communication in nursing. (2016, September). The University of New Mexico. Retrieved from https://rnbsnonline.unm.edu/articles/importance-of-communication-in-nursing.aspx
The Children’s Hospital of Philadelphia. (2020). About Children’s Hospital of Philadelphia. Retrieved from https://www.chop.edu/about-us/about
The Children’s Hospital of Philadelphia. (2020). Newborn/Infant Intensive Care Unit (N/IICU). Retrieved from https://www.chop.edu/centers-programs/newborn-infant-intensive-care-unit-niicu
The Children’s Hospital of Philadelphia. (2020). Your healthcare team. Retrieved from https://www.chop.edu/patients-and-visitors/resources/your-healthcare-team
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