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Process Improvement to Enhance Quality in a Large Volume Labor and Birth Unit



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The registration fee for this test is $24.95.




General Purpose:


To present the results of a study done to evaluate the use of the LEAN process to plan and implement changes that would improve the patients' experience during labor and birth.


Learning Objectives/Outcomes:


After reading this article and taking this test, you will be able to


1. Identify the methods and goals of this process improvement project.


2. Outline the authors' findings and any implications for practice.



1. The LEAN process is based on the premise that which of the following could achieve rapid improvement in multiple care processes?


a. leadership


b. experience


c. teamwork


2. Value in health care is based on the perspective of the


a. managers.


b. customers.


c. nurses.


3. In a LEAN leadership environment, the experts are those who


a. perform the work.


b. direct the work.


c. evaluate the work.


4. The quality improvement team set a goal for labor induction to start within how many minutes of the patient's arrival?


a. 30


b. 60


c. 90


5. One of the barriers to on-time scheduled cesarean cases was identified as


a. missing required laboratory data and results.


b. waiting for physicians to return pages.


c. lacking a standard process for the admission in the electronic medical record (EMR).


6. For the purposes of this study, start time for the induction was defined as the time


a. the woman arrived in the OR.


b. the induction agent was started.


c. the physician arrived in the OR.


7. Medical aliases are used in this facility


a. for women unable to communicate.


b. to prevent identity theft from the EMR.


c. to safeguard victims of domestic violence.


8. To help minimize the time spent waiting for food trays to be delivered and patients eating, the team proposed


a. stocking food on the OB triage unit.


b. having patient' families provide or obtain food.


c. discouraging patients from eating until after disposition.


9. The solution implemented to solve the problem of time spent looking for wheelchairs for patients was


a. labeling wheelchairs brightly with "property of triage" signage.


b. initiating a budget increase for procuring additional wheelchairs.


c. having nurses from the labor and birth unit bring wheelchairs when picking up patients.


10. Which of the following changes saved the most LOS time per patient?


a. not offering patients a meal from the hospital menu


b. making appointments for patients in the perinatal testing center


c. not looking for wheelchairs to transfer patients to the labor and birth units


11. The authors found that the main reason scheduled cesareans did not start on time was


a. physician's unavailability.


b. patients' late arrivals.


c. inadequate epidural blocks.


12. After full implementation of the changes, OR cases started on time what percentage of the time?


a. 52%


b. 63%


c. 74%


13. The newly created "Add On Team" was made up of


a. nurses that were already staffed to help in the OR.


b. nurse managers who took turns relieving labor unit nurses.


c. patient care assistants to transport patients from triage to the labor and birth units.


14. The hardest part of a project like cleaning and organizing the entire labor and birth unit is


a. sorting.


b. standardization.


c. sustainment.


15. The group work for the process implemented in this study requires


a. collaboration.


b. complex data analysis.


c. sophisticated research methodology.


16. Key aspects of the role of the facilitator include


a. owning the entire process.


b. defining the non-negotiables of the project.


c. supporting all team members during the stages of the process.