NICU – Application of Process Improvement


Neonatal Services was the pilot unit in Helen DeVos Children’s Hospital to initiate the Value Stream Analysis work.  The work took place over an 18 month period and included improvements in delivery room care, admission to the Neonatal Intensive Care Unit (NICU), parent communication, 6S (sustain, sort, straighten, shine, standardize, sustain, and safety), discharge processes and nutrition room planning.  There were many, many improvements made with successful outcomes for patients, families and the NICU as a whole.

It became apparent, though, that in order to maintain the level of rapid improvement along with sustaining the gains, process improvement (PI) coaches would need to be in place.

Kari Luymes, nurse technician, had shown natural ability in the process improvement work during a 6S event. Dea Schafer BSN, RNC-NIC had worked extensively with the quality and safety work in the NICU through the Vermont Oxford Collaborative for a number of years.  Nursing leadership approached Kari and Dea to determine their level of interest in becoming PI coaches.  Allotted 12 hours per week, Kari and Dea help to sustain and support the PI work within the NICU.  Sue Teman BSN, RN, nurse manager NICU, states “they have gone above and beyond our expectations.”  Accomplishments include the development of the managing for daily improvement (MDI) board and engaging unit charge nurses and staff nurses to participate.  Dea rounds on parents on very specific communication issues.  Additionally, beyond sustaining the work that was done during the value stream, they have followed up on over 200 golden ticket concerns, held rapid improvement events for standard work for babies with Neonatal Abstinence Syndrome and did 6S work at our patient bedsides, admission carts and bedside carts.


One of the most impactful areas has been the development and implementation of standard work in the newly formed nutrition room.  The nutrition room is a separate room set up for the clean and standard storage of breast milk, mixing additives to breast milk and donor breast milk, and the mixing of pediatric formulas.  The goal of this work is to decrease the incidence of necrotizing enterocolitis (NEC), an intestinal infection that is deadly in newborns.   Standard work was developed so that there is reliability in these processes.  Elements of the standard work include the steps to mixing additives to breast milk, delivery and warehousing of the milk and the mixing and management of pediatric formulas.  This standard work is now posted in the nutrition room to be able to visually manage the processes and hold peers accountable. This room is very busy with 1,144 feedings on average being prepared in a 24 hour period.  While NEC is a multifactorial disease, the rate has decreased from 7.2% in 2012 to 5.2% in 2013. In this and all of the improvement work, Kari and Dea have truly met the definition of inquiry and ownership of outcomes.


Team Members:

Kari Luymes, Nurse Technician
Dea Schafer BSN, RNC-NIC