Identification and Elimination of Non-Value Added Work to Optimize Labor During the COVID-19 Pandemic

Abstract

Background: The COVID-19 pandemic stretched respiratory therapy resources as never before. It was identified early on that respiratory therapists (RTs) were the most valuable asset in the fight against this pandemic. But continued use of RTs performing non-value added (NVA) procedures would have a direct impact on the ability to care for the increase in COVID patient volume and acuity.

Methods: Using Lean methodology (A3, root cause analysis, and team huddles) select RT procedures were evaluated for value, effectiveness, and efficiency. NVA items were described as those that had no impact to patient outcomes, those that can be transferred to other departments, or waste in procedures that were considered value added. Once identified, collaborative action planning was used to eliminate or reduce waste. Procedures and processes that were eliminated or optimized included: nebulizer to MDI conversion, incentive spirometry, continuous pulse oximetry orders, positive expiratory pressure therapy, frequency of trach rounds, nocturnal CPAP, and medical record redundancies. The time reduced or eliminated was equated to RTs saved per shift, thus Full Time Equivalents (FTEs).

Results: October–November 2020, ideas to reduce NVA work were elicited at tier 1 (clinician) and tier 2 (leadership) huddles. During this time, 32 ideas were submitted. General floor workload data was retrospectively collected and compared: November 2019–February 2020 (pre COVID) vs. November 2020–February 2021 (COVID). The COVID cohort observed a general floor volume decreased by 37.3%. NVA reduction time saved was 44.2 h per day which equated to 5.9 RTs per day (8.6 FTEs). This workload was reduced in spite of an 849% increase in acute high flow oxygen use on the general floors.

Conclusions: COVID-19 highlighted a problem that has plagued the respiratory care profession for many years. RTs delivering NVA procedures equates to poor outcomes, increased expense, and de-values respiratory therapists. The true value of an RT is not how many procedures can be completed, rather the impact they have on the patient's outcome. In the face of an unprecedented RT shortage, we hypothesize that if this philosophy is ignored by hospital leaders, we will continue to employ RTs in areas that they are not needed, thus continuous erosion of the respiratory care profession.

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