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Creating Cost Effective Quality Care: A Toyota Lean Nurse-Driven Quality Improvement Program

Behrend, Vanessa (2013) Creating Cost Effective Quality Care: A Toyota Lean Nurse-Driven Quality Improvement Program. Master's Thesis, University of Pittsburgh. (Unpublished)

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Healthcare quality is a priority in this country. Interventions addressing this problem have been done frequently leading to entire hospital departments being dedicated to quality. Nurses comprise the largest sect in healthcare. They have direct access to patient safety. They also have firsthand knowledge of the processes that drive quality. Nurses have been underutilized as quality drivers in health care. One solution was a nurse-driven quality improvement program, called “Providing Cost Effective Quality Care,” that used Toyota Lean as its model for quality improvement. The purpose of this thesis was to determine if the program’s successes and deficits could be identified comprehensively within the context of a theoretical implementation framework.
The objectives of the program were to support ongoing quality improvement initiatives, while increasing nurses’ access to continuing education, all to improve the quality of patient care. Two cohorts of nurses attended the training and implemented quality improvement projects. Changes were made between cohorts to increase program effectiveness. Results of the program showed that nurses should be selected based on their knowledge of and dedication to the project at hand, that the training program was an effective way to introduce Lean concepts but should allow for team project time, that the use of a coach was an integral component for project effectiveness, and that a lack of administrative support stunted project uptake and implementation. The findings in this thesis demonstrate that the successes and deficits of the “Providing Cost Effective Quality Care” program could be described within the implementation framework. Additional research is needed to use the theoretical implementation framework to drive the program planning and a long-term outcomes evaluation is needed to determine effectiveness in improving patient safety.
This program has public health significance because it makes use of nurses, who are on the frontline of patient care. The nurses are in the position to support improving patient safety and quality of healthcare, thereby reducing unnecessary adverse health events. This, in turn, reduces the burden of preventable diseases.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Behrend, Vanessavab30@pitt.eduVAB30
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairNolan,
Committee CoChairKeane, Christophercrkcity@pitt.eduCRKCITY
Committee MemberCastle, Nicholascastlen@pitt.eduCASTLEN
Date: 27 June 2013
Date Type: Publication
Defense Date: 2 April 2013
Approval Date: 27 June 2013
Submission Date: 3 April 2013
Access Restriction: No restriction; Release the ETD for access worldwide immediately.
Number of Pages: 77
Institution: University of Pittsburgh
Schools and Programs: School of Public Health > Behavioral and Community Health Sciences
Degree: MPH - Master of Public Health
Thesis Type: Master's Thesis
Refereed: Yes
Uncontrolled Keywords: quality improvement, nurse-led initiatives, Toyota Lean
Date Deposited: 27 Jun 2013 18:11
Last Modified: 15 Nov 2016 14:11


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