Improvement Report: Lean Thinking Applied to Pharmacy Processes

Cancer Treatment Centers of America at Midwestern Regional Medical Center (CTCA at MRMC)
Zion, Illinois, USA

 

Team

Carol Lepper, RN, MBA, Director of Lean Operations
Robert E Musick, RPh, Director of Pharmacy
Sylvia E Dinkins, CPT, BHA, Administrative Pharmacy Manager
Entire Pharmacy Staff 
Rick Feller, Manager of Manufacturing Excellence, Plymouth Tube Company, Lean Thinking Coach

 

Aim

To increase patient safety by improving turnaround time (TAT) by 20 percent for the preparation, dispensing, and delivery process for chemotherapy medication orders.

 

Measures

  • Chemotherapy turnaround time (TAT)
  • Number of process steps 
  • Distance walked per day
  • Internal medication error variances

Changes
  • Redesigned and physically renovated the pharmacy department
  • Implemented Lean Thinking methodology and tools
  • Eliminated steps in the process that were non-value-add to the customer
  • Developed new standard operating procedures (SOPs) for order entry, chemotherapy preparation, pharmacist oversight, and product delivery
  • Developed and implemented new chemotherapy safety log
  • Improved and standardized chemotherapy order entry process
  • Implemented the 5S* and visual workplace principles
  • Developed and implemented a Daily Lean Management System that includes a Production/Safety Board
  • Implemented a new Inventory Management System for IV supplies which is based on the Just-In-Time concept
  • Changed staffing patterns to meet high chemotherapy demand times
 
*5S is a Lean Thinking method for organizing work areas to maximize smooth and efficient flow of activities and reduce wasted time and effort.
 
Results
 
Graph_CancerTreatmentCenter_ChemotherapyTAT.jpg

Graph_CancerTreatmentCenter_PharmacyChemotherapyInternalErrors.jpg
Graph_CancerTreatmentCenter_ChemotherapyProcess.jpg
Graph_CancerTreatmentCenter_ChemotherapyProcessWalk.jpg

Summary of Results / Lessons Learned / Next Steps
By making these changes using Lean Thinking processes and models, we have increased patient medication safety, as measured by the internal error rate, and decreased turnaround time for chemotherapy preparation by 20 percent, while decreasing the number of steps in the process by 50 percent.
 
Lessons Learned:
  • Use a Lean Thinking Coach: Lean Thinking is a new way of thinking for health care and for MRMC. The complexity and success of Lean Thinking implementation in the pharmacy would not have been possible without the organization having a coach. Our coach provided on-site visits, phone consultation, training, assessment, evaluation, and recommendations for proposed changes. 
  • Focus on Safety: Patient safety in medication use is the most important factor of Pharmaceutical Services. We learned that, properly applied, Lean Thinking principles have enhanced patient safety by reducing errors.
  • Place value on what the customer wants: Our primary customers are oncology patients; they value getting their chemotherapy in a timely manner. Based on surveys and focus groups, we were not meeting this need. After implementation, patient comments were positive about the changes that had been made.
  • Create a visual workplace: The visual workplace allowed the pharmacy staff to examine the chemotherapy process and identify issues that could be improved. We learned to triage our orders by complexity thus reducing overall turnaround time (TAT) without compromising patient safety. The result is that TAT has been reduced by 20 percent.
  • Have fun: Lean Thinking processes are fun and motivational. As a quality improvement process, Lean Thinking is the best process we have used in our facility. It involves the entire pharmacy team, simplifies processes into bite-sized pieces, and once understood, is truly continuous.
  • Involve and communicate changes to all staff: There were many changes and new concepts with the implementation of Lean Thinking. As a result, things changed so quickly at times that not all staff were aware of the changes. Daily interaction with staff was necessary to keep everyone up-to-date. After one year, we still meet weekly and are finding new ways to enhance the process.
  • Share success and excitement: In June, the pharmacy team gave a presentation to the MRMC’s Board of Directors which was held in an Open House for all hospital staff.

 

Contact Information
Carol Lepper, Director of Lean Operations
Cancer Treatment Centers of America at Midwestern Regional
carol.lepper@mrmc-ctca.com
 
[Storyboard presentation at IHI's National Forum, December 2003]
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