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Critical thinkingcan seem like such an abstract term that you don’t practically use. The truth is, that as nurses we can’t escape critical thinking . Let me give you a few examples from my career in which critical thinking helped me take better care of my patient. Second, since lean leaders are seen as essential in enhancing the problem-solving abilities of healthcare staff,8 we expect effective lean leadership to strengthen the relationship between lean maturity and second-order problem-solving.
What do I know that will get rid of extra fluid and make him pee? I ran over my thought process with a coworker before calling the doc. I called the doc and before I could suggest anything, he said.. The told the doctor when he rounded that morning that the meds weren’t doing anything. She kept requiring more and more meds and I’m supposed to someone wean her off? Critical thinking is something you’ll do every day as a nurse and honestly you probably do it in your regular non-nurse life as well.
OK, so he’s got extra fluid that he can’t get out of his body.. She maxed it out every time, still saying she was in horrible pain. She said to get rid of those other pain meds because they “didn’t do a damn thing,” and to “just give her that nerve pain pill because it’s the only thing that works”. She was able to work with therapy more because her pain was tolerable and was finally able to get rest.
Since then, lean has gained in popularity in the sector.1 The primary goals of lean in healthcare have been to increase the quality of care and to increase efficiency.2 To achieve these goals, most healthcare organisations have emphasised the application of lean tools to reduce direct waste, but neglected developing the problem-solving abilities of frontline employees.3 This approach may have created some process improvements, but long-term hospital-wide benefits have rarely been achieved.4 To realise more of lean’s potential, it is often suggested that structured problem-solving should be developed throughout the organisation to sustainably improve processes.3 This is inspired by Liker’s 4P model that identifies four aspects of lean: philosophy, process, people and problem-solving.3 One well-known and effective approach to this is 3 suggests that second-order problem-solving is more prevalent than first-order problem-solving in nursing teams with high levels of lean maturity.
However, evidence from a larger sample of wards is needed to confirm this.
(Mazur and Chen, p63)6 Tucker and Edmondson (p61)5 distinguish five broad actions linked to second-order problem-solving: (1) communicating to the person or department responsible for the problem; (2) bringing the problem to the manager’s attention; (3) sharing ideas about the cause of the situation and how to prevent recurrence; (4) implementing changes; and (5) verifying that changes have the desired effect.
Nurses apply both first- and second-order problem-solving approaches.
Interview data were used to assess the level of lean maturity (based on a customised validated instrument) and the level of second-order problem-solving (based on scenarios).
Within-case and cross-case analyses were employed to identify lean leadership practices.
Objectives To investigate the relationship between lean adoption and problem-solving behaviour in nursing teams, and to explore the practices of lean leaders on nursing wards to reveal how they can stimulate second-order problem-solving within their teams.
Design A mixed-methods retrospective multiple case study using semistructured interviews.