Enhancing efficiency of the showering process

Showering of wheelchair and bedbound residents in nursing homes can be time-consuming and tiring for care staff. There is also a potential risk that residents may fall during showers as care staff can be pre-occupied with other showering-related activities, such as looking for toiletries or clothes.

In January 2018, Jamiyah Nursing Home (JNH) participated in a process improvement collaborative workshop with three other nursing homes. The workshop was organised and facilitated by AIC with the aim of improving safety, residents’ dignity of care, staff satisfaction and overall efficiency of the entire showering process.

JNH staff sharing about their showering process workflow during the workshop.

Some of the challenges identified by JNH residents and staff were as follows:

• Residents and staff may face misunderstandings as they do not speak the same language.
• Lack of standardised workflow and training on appropriate showering processes.
• Insufficient staff to assist residents during showering, especially during night duty.
• Falls risk for residents during showers when care staff are engaged in other showering-related tasks. There is also nobody to look after other residents or attend to the call bell immediately.
• Showering requisites not thoroughly prepared as there is no checklist to ensure that all items are on standby.

During the workshop, a visualisation of the showering process was done to track staff movements during the showering. This diagram aided the team to simplify the movements of the showering activity.

Spaghetti diagram to visualise the showering process.

A “value stream mapping exercise” was also done. Participants had to pen down a step by step process of their current workflow, identifying gaps, challenges and solutions with the use of “Lean” tools. They then created a new map with solutions incorporated into the workflow.
Value stream mapping board done by participants.

With the aid of the visualisation process and value stream mapping, staff came up with the following solutions:

• Reassigning staff workflow;
• Creating a checklist so that the shower items can be prepared in advance;
• Labelling of linen trolleys (such as uniform sizes, towels, bedsheets, pillowcases) to reduce time searching for things; and
• Organising in-house English and Malay language training for new staff.

Following the improvements made to the showering process, an audit was done with the following findings:

• Dignity of care of residents had improved by 10%, with residents being able to choose their preferred showering times. This was also enhanced by staff being to communicate with them better during the showering process as a result of the language lessons staff had gone through.
• Residents’ safety has improved, as care staff can easily find items they need during the showering process and can be more focused
• Staff satisfaction on the showering process improved by 100%.
• The home has saved approximately two hours every day for both commode and bath trolley showers. An additional 30 minutes is saved through the preparation of materials a day before.

“The showering project has benefited both the residents and staff. It has improved the safety, quality and dignity of care for JNH residents. We plan to use the time saved during the showering process to improve the welfare of residents,” shared Satyaprakash Tiwari, Consultant, JNH.

Participants at the showering project workshop.