Improving wait times to care for individuals with multimorbidities and complex conditions using value stream mapping.

Background: Recognizing the significant impact of wait times for care for individuals with complex chronic conditions, we applied a LEAN methodology, namely - an adaptation of Value Stream Mapping (VSM) to meet the needs of people with multiple chronic conditions and to improve wait times without additional resources or funding.

Methods: Over an 18-month time period, staff applied a patient-centric approach that included LEAN methodology of VSM to improve wait times to care. Our framework of evaluation was grounded in the needs and perspectives of patients and individuals waiting to receive care.

An education initiative modifies opinions of hemodialysis nurses towards home dialysis.

Background: It has been shown that in-center hemodialysis (HD) nurses prefer in-center HD for patients with certain characteristics; however it is not known if their opinions can be changed.

Objective: To determine if an education initiative modified the perceptions of in-center HD nurses towards home dialysis.

Design: Cross-sectional survey of in-center HD nurses before and after a three hour continuing nursing education (CNE) initiative.