Continuous Improvement

The UCSF Health Department of Nursing is invested in continuous improvement work to maintain and enhance our great patient, family, and Nursing outcomes. This includes a culture of inquiry that continuously asks “How are we doing?” and “Can we do better?”. Our continuous improvement work is focused around leveraging our thoughts and ideas to improve processes and add value. We utilize a model aligned with the UCSF Continuous Improvement department that empowers teams to review, assess, and improve processes. Within this model, we use Lean processes to provide structure and support for improvement work.  


LinkedIn Learning Resources for Lean Thinking

  • Lean principles (4m 37s)
  • The Lean Mindset (3m 59s)
  • What is A3 Problem-Solving? (3m 34s)
  • A3 Problem Solving for Continuous Improvement (41m)

Lean Templates


Adult ICU HAPI Prevention

Recognizing that there were opportunities for improvement with hospital acquired pressure injuries (HAPI) within several of the Adult ICUs, a taskforce was assembled to help problem solve and design experiments. Unit leaders, direct care skin/wound champions, CNSs, WOCN team, and leaders from the Center for Nursing Excellence and Innovation utilized an A3 approach, designed several experiments, and are currently evaluating their impact.

Adult Acute Care Falls Prevention

One of the priorities for this fiscal year was to decrease fall rates among the Adult Acute Care units. To accomplish this, several of the units with the highest fall rates met and started to problem solve. Using an A3 and evidence-based practice (EBP) approach, several experiments were conducted. One of them, use of the Fall TIPS (Tailoring Interventions for Patient Safety), was piloted on one unit with successful outcomes. As such, the practice is spreading to all Adult Acute Care units as one approach to decrease our overall fall rates.


Evidence based care bundles, when performed collectively and reliably, have been proven to improve patient outcomes. One method that has been shown effective in evaluating and supporting standard work is the use of K-Cards (stands for Kamishibai Cards, a type of Lean Management tool). The goal of using a K-Card is to provide an easy-to-use tool that supports the team in identifying deviations from the standard work and best practices. The use of K-Cards has been implemented to support our practices around central line-associated bloodstream infections (CLABSI) and catheter-associated urinary and is being explored to use among other nurse-sensitive indicator practices.