Publication Date

Spring 2020

Degree Type

Doctoral Project

Degree Name

Doctor of Nursing Practice (DNP)



First Advisor

Nisha Nair

Second Advisor

Susan McNiesh

Third Advisor

Ryan Darke


Lean, Performance Improvement, Nurse Physician Collaboration


This project sought to see if training frontline nurses and physicians together in Lean methodology improved collaboration between the two disciplines while giving them the tools they need to lead change at the bedside and in their practice. A quasi-experimental pre- and post-intervention methodology was used. The intervention was six, four-hour in-person modules on performance improvement (PI). Respondents completed two surveys, the performance improvement instrument and the Professional Practice Environment Assessment Scale (PPEAS). Surveys were paired for analysis. There was a statistically significant median increase in participants confidence for all questions on the PI instrument post-intervention. Results for the PPEAS showed lower scores post-intervention, however, the results were not statistically significant. This project emphasizes that, with time, training, and support from leadership, frontline nurses and physicians can become confident in applying Lean and performance improvement tools to lead change at the bedside. Improving the professional practice environment will likely need to take place on a larger, organization wide scale to be impactful.


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