Lean Thinking in Practice LEAN TOOLS HELP INCREASE CAPACITY, DESPITE RESOURCE CONSTRAINTS Healthcare Case Study Series Organization Profile Northern Health Authority (NHA) has over 7,000 employees and serves over 300,000 people, with multiple regional offices and commercial outlets throughout Canada. Project Goals To identify the scope for efficiency gains in pharmacy practices and develop an executable plan to realise these gains. Project Timeframe 12 months Key Deliverables A framework specifying the pharmacy processes to be eliminated, reassigned or streamlined and the human and technological resources necessary to implement these changes. Leading Edge Group applied its Lean expertise to overcome resource constraints and increase hospital pharmacy capacity As part of a program to increase capacity and achieve greater efficiency in its pharmacy practices, the NHA engaged Leading Edge Group (LEG) to develop a sustainable framework and executable plan to improve its dispensary processes through the deployment of Lean thinking and tools. The NHA was facing human resource challenges. Recruitment of staff across all disciplines presented a constant challenge and, at the time (December 2011), over 40% of available positions were vacant. The hospital pharmacies faced significant resource constraints; many of the smaller hospitals relied on pharmacy technicians to oversee the operational running of the dispensary, while pharmacists provided support remotely through the use of videoconferencing technology. To address these resource constraints, improve efficiency and increase capacity, LEG worked with NHA on a project charter and scope that aimed to: Streamline and standardise pharmacy processes. Eliminate duplicated processes and non-value added steps. Allow the technician to have greater responsibility, removing the need for a pharmacist in certain activities. Move the pharmacist to the front end of the process. Provide a roadmap for progressively improving dispensary processes. Within the allocated 12 month timeline, LEG delivered an executable framework that enabled staff to identify and implement process changes, eliminate waste and deliver measurable savings in processing time and tasks. “Using Lean, as supported by the Leading Edge Group, we have been able to engage the front line staff in identifying and implementing process changes that have resulted in measurable improvements. Staff feedback on the approach has been extremely positive. Senior Executive members have been impressed with the level of improvement and the degree of engagement by the staff.” Director of Strategic Initiatives, Northern Health Authority Lean Thinking in Practice How was the project implemented? CURRENT STATE ASSESSMENT AND METRICS KAIZEN EVENTS STANDARD PROCESS TEMPLATE The first step involved mapping and measuring the current state. A Leading Edge Group consultant assessed the largest eight pharmacies of the NHA and mapped the differences in their processes, including, order receipt, order entry, dispensing, shipping & receiving, and inventory management. The regions of the Health Authority were then divided into four separate project teams, based on geographical considerations. The consultant conducted a three-day Kaizen event in each region, which included two pharmacies per region i.e. all eight pharmacies were represented. Following this, metrics were developed to accurately measure the current situation. These included key performance indicators, such as number of errors made in the dispensing process, number of medications returned to the dispensary unused, and average turn- around time from order received to order dispensed. Each site also recorded the number missing or delayed doses. The Kaizen events revealed that the pharmacists were spending the majority of their time (82% - 88%) checking that dispensary staff had appropriately prescribed and dispensed medications. Having the pharmacist at the end of this process meant that errors were being caught at the end of a long process, thus resulting in high levels of re-work, nonvalue add and waste. MEASURE AND REPORT BENEFITS This insight allowed LEG to develop a template for centralising and standardising processes which focused on eliminating the duplication of tasks and re-work in the process. It re-distributed tasks across the pharmacist and technician roles, empowering the technician and providing the pharmacist the necessary increased capacity to do more clinically appropriate work. In addition to intangible benefits, a number of tangible benefits were measured and reported including: • 52% reduction in the number of nonvalue-added items • 39% reduction in total time spent processing non value-added items • 43% reduction in the total number of memos to pharmacy • 28% reduction in total time spent processing memos • Lean Terms and Tools Phrase Project Charter Current State Map Kaizen Non-Value-Add Activity LEI GROUP AUSTRALIA Suite V75/38 Ricketty St., Mascot, NSW 2020 Tel: +61 (2) 8004 9470 Mob: + 61 (0)401 608733 Description A project charter is a statement of the scope, objectives and participants in a project and is a critical document to ensure that everyone involved in the project is aware of its purpose and objectives. A graphic illustration of an organization’s current process, enabling one to see where value is added and lost. Essential to Value Stream Mapping, a primary Lean technique describing the flow of material and information through a system. A Japanese term meaning good (“zen”) change (“kai”). A Kaizen event is the tool used to initiate dramatic change in a short period. It is a facilitated workshop that focuses exclusively on the improvement effort and the intention is to implement rapid improvement in a targeted work area and/or process Any activity that does not add value to a product or service from the customer’s perspective. LEADING EDGE GROUP – IRELAND Charter House, 34 Harbour Row, Cobh, Co. Cork Tel: +353 21 4855863 LEADING EDGE GROUP – CANADA Suite 805, 60 St. Clair Ave East, Toronto, ON, M4T 1N5 Tel: +1 416 637 5074 FURTHER INFORMATION (AUSTRALIA) www.leigroup.com.au [email protected] LEADING EDGE GROUP – UK Oxford Centre for Innovation, New Road, Oxford, OX1 BY1 Tel: +44 (0) 1865 261438
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