Problem: Issues related to poor processflow, end-product quality and turn-around-time (TAT) created many opportunities for improvement, particularly in the layout of the intake and drop-off areas of a laboratory.
Solution: A team was assembled to resolve the lab workplace organization issues. A Lean Rapid Improvement Event was held to quickly change the central processing area and meet the project objectives.
Actions: The Layout & 5S Team quickly reached consensus and immediately implemented a revised laboratory design. Based on formal 5S training and hands-on practice, the improvements included:
As the team analyzed the information they gathered, which included process flow diagrams, spaghetti diagrams, and data analysis, they discovered that 40 percent of the specimens had to flow to one area while the remaining 60 percent went to another area. The team devised a layout that would allow the bulk of the materials to flow through the center of the department.
The team also adjusted the process to allow for some individuality within a shift in terms of positioning of work items. This permitted left-handed people to arrange items to suit them. With 18 workstations, there was no rationale to explain why anyone should need to spend 10 to 15 minutes at the beginning of their shift rearranging the workstation. That inefficiency results in a wholly unacceptable three wasted work-hours per day (18 workstations x 10 minutes = 180 minutes or three work hours). If someone found it more convenient to place something differently for his/her shift, then that person should merely return the item to its standard position at the end of their shift. Visual cards showing the standard position for major task items facilitated this practice. At shift's end, it should take the technician no more than one to two minutes to return items for the next person.
Problem: Patients using the pharmacy felt that it took too long to have prescriptions filled. Pharmacists and technicians felt that they were filling the prescriptions quickly and below the required time, that they were below standard wait times, and that the patients didn’t understand their system. They also felt that the fulfillment process had waste and inefficiencies that compromised quality. Demand was approximately 1,000 prescriptions per day for an average of about 435 patients.
· Patients spent approximately one hour with a nurse and provider before the prescription was released to the pharmacy, then would have to wait another 40 minutes, on average, for their prescription to be ready for pick-up
· Patients had limited visibility of waiting queues or of their in the queue
· Label printing equipment operated correctly only about 50 percent of the time
· Approximately one in seven prescriptions needed some level of troubleshooting attention prior to final distribution
· The automatic dispensing/filling robot was only at 60 percent utilization
Solution: A team of pharmacists, prescription [SRW3] , patient advocates, systems management, and quality improvement specialists was assembled to perform a Lean Rapid Improvement Event using Value Stream Mapping to uncover root causes and identify precise improvement actions.
The team created a current state map covering all process steps from patient check-in to the the final receipt of their prescription. Specific details were quantified, including queue times, processing times, activity accuracy, task difficulty, staff requirements and wasted resources. This exercise resulted in a clear picture of the process limitations.
The team defined an improved future process state and began to enumerate the actions items necessary to implement the improved system. This resulted in a clear action plan for the team and delineation of the resources required to complete the planning process within six months. The list included many excellent ideas that, when combined, would produce clearly measurable and sustainable improvements.
A third-party audit was conducted five months after the initial Value Stream Mapping (VSM) event. The results are highlighted below.
· Turn-around-time (TAT) for renewal of non-formulary medications was reduced by 86%, from 110 hours to 16 hours
· Pending mail orders were reduced by 59%, from a backlog of approximately 2,200 orders (10 days) to 900 (4 days)
· Patient wait times from prescription release to pick-up decreased by 35 percent to an average of 24 minutes
· Facility performance on a cost-per unique order basis improved seven positions as a benchmark against other facilities
· The drug file achieved 100 percent accuracy, was complete, current and correctly formatted
· High-speed printers were completely functional with 99% uptime
· A Q-Matic ticket system was installed to give patients visual confirmation of their queue position
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