JMIR Publications

ABSTRACT

Background:

Many emergency departments have used the Lean methodology to guide the restructuring of their practice environments and patient care processes. Despite research cautioning that the layout and design of treatment areas can increase patients’ vulnerability to privacy breaches, evaluations of Lean interventions have ignored the potential impact of these on patients’ informational and physical privacy. If professional regulatory organizations are going to require that nurses and physicians interact with their patients privately and confidentially, we need to examine the degrees to which their practice environment supports them to do so.

Objective:

This study explored how a Lean intervention impacted the ability of emergency medicine physicians and nurses to optimize conditions of privacy and confidentiality for patients under their care.

Methods:

During July to December 2017, semi-structured interviews were iteratively conducted with healthcare professionals practicing emergency medicine at a single teaching hospital in Ontario, Canada. The hospital has 1,000 beds and approximately 163,000 patients visit its two emergency departments annually. In response to poor wait times, in 2013, the hospital’s two emergency departments underwent a Lean redesign. As the interviews proceeded, information from their transcripts was first coded into topics and then organized into themes. Data collection continued to theoretical sufficiency.

Results:

Fifteen nurses and five physicians were interviewed. A major component of the Lean intervention was the construction of a three-zone, front cell at both sites. Each zone was outfitted with a set of chairs in an open concept configuration. While, in theory, professionals perceived value in having the chairs, in practice, these served multiple, and often, competing uses by patients, family members and visitors. In an attempt to work around e limitations and keep patients flowing, professionals often needed to move a patient out from a front chair and actively search for another location that better-protected individuals’ informational and physical privacy.

Conclusions:

To our knowledge, this is the first qualitative study of the impact of a Lean intervention on patient privacy and confidentiality. The physical configuration of the front cell often intensified the clinical work of professionals because they needed to actively search for spaces better-affording privacy and confidentiality for patient encounters. These searches increased clinical time and likely added to these patients’ length of stay. We advocate that the physical structure and configuration of the front cell should be re-examined under the lens of Lean’s principle of value-added activities. Future exploration of the perspectives of patients, family members and visitors regarding the relative importance of privacy and confidentiality during emergency care is warranted.