Date of Graduation

Fall 12-11-2020

Document Type


Degree Name

Doctor of Nursing Practice (DNP)


School of Nursing and Health Professions




Family Nurse Practitioner

First Advisor

Dr. Jim D'Alfonso

Second Advisor

Dr. Elena Capella


This scholarly report describes a Doctorate of Nursing Practice (DNP) project that advanced the performance improvement (PI) knowledge of frontline nurses to improve timely access to acute care during a 6-month PI/Lean management nursing fellowship. Patient flow issues delay access to care and result in negative patient quality outcomes and safety failures. Patient experience, confidence, and satisfaction in healthcare organizations erode when timeliness and efficiency are deficient. The project site is a 443-bed, two-campus, not for profit community hospital in Northern California. This project included the implementation of a PI/Lean nursing fellowship program as an evidence-based intervention to address patient flow issues. During the project, the nurse fellows were expected to learn through didactic education in addition to engaging, integrating, and leading PI/Lean activities within the organization. Patient flow measurements occurred six months before and during the fellowship. PI/Lean knowledge and skills acquisition were measured using a pre- and post-knowledge assessment tool. A program effectiveness survey was administered to team members. A qualitative survey gauged the fellowship’s impact. The timeliness of access to care indicated a degradation of 5 minutes or 2% during the entire 6-month fellowship though a 3-minute improvement occurred in the final three months. The fellows’ pre- and post-assessment indicated a 60% improvement. The fellowship effectiveness survey indicated an 83% satisfaction rate. The qualitative survey revealed a positive tone. The nursing fellowship provided a methodology to advance the frontline nurses’ knowledge and skills in improvement science while assisting the organization in achieving a priority strategic initiative.