Background With increasing economic constraints and busier hospitals, it is becoming more challenging for pharmacy services to deliver high standards of care. Lean, an improvement approach from the industry sector, has already been used to optimise manufacturing and dispensing processes in hospital pharmacies by eliminating waste and improving value for the customer. The Lean approach has not been widely published on clinical pharmacy (CP) services.
Purpose To analyse CP services provided in a cardiology unit from a Lean perspective in order to identify main wastes and the main ‘value added’ activities.
Materials and methods The study was performed in the cardiac CP department of a large UK teaching hospital in collaboration with a French engineering PhD student specialising in Lean thinking. A questionnaire concerning 13 main CP services provided by pharmacy was submitted to doctors and nurses to identify the high and low priority services. Direct observation over 5 days allowed realisation of a process map to identify the main activities and wastes of the CP process. A time study was conducted over 5 days to quantify the different types of wastes (as defined by Lean theory) identified from the process map.
Results 21 persons responded to the questionnaire (5 doctors and 16 nurses). The three most value added CP activities were:
confirming drug histories on admission (medicines reconciliation),
checking prescription charts,
arranging take home medicines
Those 3 activities were considered high priority activities by 95.2% of the respondents.
Among 8 types of waste defined by Lean we identified:
Overproduction: 100% of the medicines doses written by the doctors (in abbreviation - Latin) on the discharge summary are rewritten by the pharmacist (in full)
Waiting: pharmacists spend 5% of their time on the ward waiting (e.g. for a free computer or waiting for a phone answer)
Non-utilised staff intellect: pharmacists spend 12% of the time on the ward verifying patients own medicines and writing ordering sheets which could be completed by a technician
Transport: pharmacists spend 5% of the time transferring sheets to the pharmacy dispensary
Motion: pharmacists spend 2.5% of the time on the ward looking for patients medicines charts or for their medicines
This study allowed us to test the implementation of the 2 first lean principles: ‘specify the value desired by the customer’ and ‘identify the value stream for each service’. We found that from a Lean perspective, 25% of the time spent on the ward by the pharmacist was not value added; suggesting room from improvement.
Conclusions To our knowledge this is one of the first attempts to apply a Lean approach to clinical pharmacy services. The Lean approach helped us gain a better understanding of our processes and highlighted opportunities to optimise our processes. The next step is to use this data to improve clinical pharmacy services.
No conflict of interest.
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