1 Blackbelt, 2 Greenbelts, and 69 trained Lean Leaders on site ... Lean Thinking:
Banish Waste and Create Wealth in Your Corporation. New York, NY: Simon ...
Reduction of IV Room Waste A Case Report Utilizing Lean Principles Nancy L. Rampe, Pharm.D. Pharmacy Supervisor St. Rita’s Medical Center, Lima, Ohio
Disclosure • The content of this presentation has been created by the presenter and does not necessarily reflect the views of Baxter Healthcare Corporation
• Baxter has provided an honorarium for this presentation to St. Rita’s Medical Center in support of pharmacy education.
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Learning Objectives • Review key concepts of Lean methodology • Review the IV room waste project at St. Rita’s Medical Center and discuss how Lean concepts were applied
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St. Rita’s Medical Center
Image used with permission - St. Rita’s Medical Center; Courtesy Nancy Rampe 111474B
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St. Rita’s Medical Center 450 bed, level II trauma center Non-profit community hospital – part of CHP
health-system Pharmacy practice environment includes
decentralized model, clinical dosing and monitoring services, robotic distribution, and affiliations with Ohio Northern University and University of Findlay Colleges of Pharmacy. 111474B
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Operational Excellence Lean/Six Sigma program at SRMC in existence since
6/2007 1 Blackbelt, 2 Greenbelts, and 69 trained Lean Leaders
on site Currently, 75% of management team is trained in
Change Acceleration Process (CAP) and Work Out (WO) Goal of 100% of management team to be trained in
Lean Awareness
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What is Lean? Lean…the relentless pursuit of the perfect
process through waste elimination… Increases customer value by eliminating waste
throughout the value stream1
1. Womack JP, Jones DT. Lean Thinking: Banish Waste and Create Wealth in Your Corporation. New York, NY: Simon and Schuster; 1996. 111474B
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Lean Thinking Providing a way to do more and more with less and less – less human effort, less equipment, less time, and less space – while coming closer and closer to providing customers with exactly what they want1
1. Womack JP, Jones DT. Lean Thinking: Banish Waste and Create Wealth in Your Corporation. New York, NY: Simon and Schuster; 1996. 111474B
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Steps in Lean2 Define actual performance Define desired performance
Gather and analyze data Identify root causes Remove root causes Change procedures to sustain gains Standardize 2. http://www.creative-healthcare.com/pdf/PerformanceImprovementInPharma.pdf. Accessed March 10, 2011. 111474B
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The Basic Concept As you facilitate, you will follow the basic divergent and convergent processes. Both steps are needed for effective solutions. Opening and Set-up
Diverge
Converge
Diverge
Converge
Think Freely
Selecting
Think Freely
Selecting
Issues and Barriers
Solutions Report out / Wrap up
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Issue to Address On average, the pharmacy at SRMC wasted
around $10,000 to $12,000 monthly due to inefficiencies in the IV room. Yearly impact of over $140,000 in avoidable
cost to the organization. It was decided that the department would hold
a 4-hour Lean event to combat the problem.
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The Lean Team!
Image used with permission - St. Rita’s Medical Center; Courtesy Nancy Rampe 111474B
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The Lean Team! Nurses Pharmacist Pharmacy Technician IT Pharmacy Student
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Goals and Objectives of the Event Reduce waste from our IV room by 60% within
the first 3 months Stretch goal to reduce waste by 90% by the end
of 2010 Objective: positively impact the financial
status of the organization as well as maintain proper inventory of medications for our patients 111474B
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Voice of the Customer VOC is the sum total of the needs expressed by
all customer groups. VOC data collection tools include: • • • •
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Focus groups Interviews Surveys Complaints and suggestions
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Why is VOC Important? Customer behavior is a key input to strategy
and process design. VOC is a tool used to discover what customers
care most about; it’s a way of collecting data about your customers’ needs and desires.
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Voice of the Customer Customer
Comment
Physician
Wasting medications leaves the potential for reduced supply when needed. May not have available for the next patient when needed
Physician
If medication not available will waste physician time trying to decide on an alternative regimen
Patient
Wasting medications will reduce SRMC supply which may in turn affect whether or not the next patient is eligible to receive the medication
Technician
Missing doses having to be re-made which takes away time; wasted doses take time to credit to patient and then waste
Pharmacist
Missing doses having to be re-made which takes away time
SRMC
Wasted medications in turn means wasted dollars which negatively impacts the financial status of the Medical Center
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SIPOC
Suppliers
Inputs Process
Outputs Customers
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SIPOC SIPOC Supplier
Input
Process
Output
Customer
A
Drugs
IV label prints
IV Admixture
Patient
B
IV Solutions
Obtain drug
Nurse
C
Admixture
Obtain supplies
Pharmacist
Supplies
Tech compounds
Technician
RPh checks Sent to floor or delivery by tech or sent via tube RN receives IV admixture
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Current State Process Map
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Brainstorming Problems! Various tools available to use through
Lean training Develop a parking lot Narrow your focus
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Brainstorming Problems! Medications made too far in advance –
may be discontinued or changed Lost medications Patient’s discharged report High dollar medications
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Brainstorming Resolutions! Change to 4-hour IV batches Secure tube high dollar medications
Label for discontinued patients Report for discharged patients
Staff education – both nursing and pharmacy
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Future State Process Map
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2010 IV Room Waste IV Waste $25,000 $22,439 $20,000 $17,123 $15,000 $12,310 $10,000
$9,990 $8,834
$13,441
$11,965 $9,334 $7,339 $5,429
$6,654
$5,000
$14,779
$9,506 $8,329
$9,567
$13,655
$15,176
$15,175 $14,940 $11,046
$8,864
$8,224 $5,958
$6,353
$0 January
February
March
April
May
June
2009
July
2010
August
September October November December
Data on file, St. Rita’s Medical Center 111474B
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2010 IV Room Improvement % Improvement 80.0% 60.0% 60.5% 58.1% 56.4% 45.9% 44.4% 40.0% 28.8% 26.0% 22.0% 20.0% 12.4% 11.6% 0.0% -1.6% -20.0% January February March April May June July August September October November December -40.0% -55.0% -60.0% -80.0% Data on file, St. Rita’s Medical Center
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2010 Savings
Net projected savings for SRMC in 2010 is over $65,366!!!!
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Conclusions Lean philosophy can be applied to multiple scenarios in
healthcare to improve processes and reduce waste. The pharmacy department at SRMC has participated in
multiple Lean events in 2010 including: reducing missed cath lab charges, many LOS projects, pharmacy late charges/credits, pain improvement project.
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References 1.
Womack JP, Jones DT. Lean Thinking: Banish Waste and Create Wealth in Your Corporation. New York, NY: Simon and Schuster; 1996.
2.
Creative Healthcare. Lean & Six Sigma: The New Face of Performance Improvement in Pharma. Available at: http://www.creative-healthcare.com/pdf/ PerformanceImprovementInPharma.pdf Accessed March 10, 2011.
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