Many caregivers know all too well the frustration of searching for a wheelchair to transport a patient. Wheelchairs are used by multiple clinical departments, outpatients, volunteers, families and even visitors. Often like a grocery cart, wheelchairs are picked up in one location and dropped off somewhere totally different. Until recent increased awareness to prevent the spread of infections, wheelchairs and grocery carts were often not cleaned between uses. 
The issue of waste in searching for a clean wheelchair, raised by the front line staff, was the focus of a recent hospital Kaizen event. The facility had already done a great job at 5S and most patient care units had a designated location and par level for wheelchairs. Still only 1% of staff felt wheelchairs were always available when they were needed. Audits found that only 69% of the designated locations had the available par levels of wheelchairs. More importantly to the patient and despite intense emphasis on infection prevention practices, observations of wheelchair use found that only 7% were actually cleaned between use. The event team took cultures from a sample of wheelchairs and found 4 out of 10 positive for bacterial growth. 
Lean is about becoming a learning organization through relentless reflection and continuous improvement. Reflection is an attitude and philosophy known as “hansei” in Japan. Reflection is key to moving forward, building on your past rather than starting over with each new improvement.  Lean organizations integrate reflection at an individual level, in day to day problem-solving, and before; during and after kaizen events.
In reflecting and building on past work, the wheelchair team modified previous visual markings for wheelchairs by placing pictures at eye level showing staff members cleaning wheelchairs and the number of wheelchairs to be placed in each location. They also ensured cleaning wipes were stocked in each wheelchair location with cards for replenishment. Standard work was implemented for volunteers to round and ensure wheelchairs were up to PAR. 
Observation 60 days following the event found cleaning of wheelchairs was carried out 75% of the time.  Time spent by staff searching for wheelchairs was decreased by 50%. The time saved gives back almost two 8 hour shifts per month for staff to spend in value-added direct patient care. Clinical staff at this facility are no longer wishing for a clean wheelchair, they know exactly where to find one and have the supplies immediately available to provide patients with clean and safe transportation. 
This week’s blog was written by Maureen Sullivan, a senior associate at HPP. Maureen has over 28 years of healthcare experience in clinical nursing, management and quality leadership to Healthcare Performance Partners. Previously Maureen was the director of lean and quality improvement for Exempla Lutheran Medical Center and successfully led the implementation of Lutheran’s Lean production system from 2004 to 2008 demonstrating improvements in clinical quality, employee engagement, and financial stewardship. As a registered nurse, Maureen’s clinical experience is in medical surgical nursing with progressive responsibilities in nursing management at the front line, middle management, and administrative levels. Maureen began her quality management career in 1996, coordinating, facilitating and managing improvement and accreditation programs at a departmental, site and system level within Exempla Healthcare. Maureen has an associate degree in Nursing from Joliet Junior College in Joliet, Illinois and a bachelor of science in nursing with an emphasis in healthcare management from Metropolitan State College in Denver, Colorado. Maureen achieved certification from National Association for Healthcare Quality, certified professional in healthcare quality (CPHQ), Colorado State University in process mapping, and University of Michigan in lean healthcare.

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