The pharmacy staff (150 FTE) work in a dynamic department with which almost everyone in the hospital has regular contact. The introduction of Operational Excellence in 2012 was seen as a breath of fresh air: finally, a suitable method had been implemented to enable continual improvement. 'When you're enthusiastic about it from day one, it catches on very quickly. It really makes you want to use it!'
Upon completing her Green Belt training in 2012, Afke van de Plas implemented Hoshin Kanri into the Pharmacy department. This powerful strategy matrix consists of a vision that gradually takes a more detailed shape within the organization on a step-by-step basis. The schedule includes the strategy as determined on 'policy days', the objectives for the year in question, the projects set up to achieve these objectives and the employees working on these projects. The mutual cohesion between all parties paints a much clearer picture of the overall situation than old-fashioned policy plans. The matrix is discussed during the biweekly staff meetings to ensure it is kept up to date and keeps us on our toes.
It's a 'living' document, which makes a real difference. A large-scale version of the latest matrix is always displayed in the corridor, which is a great way to inform all employees about the most important change projects and keep them involved.
“We don't always follow the strategies to the letter, but what we did adopt has become part of our DNA. We couldn't work without it.'”Ellen Frankfort, Head of the Clinical Pharmacy and Toxicology Department
Another tool that the Pharmacy department is enthusiastic about is the Gemba Walk, which is effectively a management activity focusing on continual improvement. Loosely translated, the Japanese word 'Gemba' means 'shop floor': the main area where value is added for clients. During the Gemba Walk, managers view the department through the eyes of others, make observations, and ask questions. Where can waste be found and where is it expected? Why do we work in this way? How does the client/patient benefit from this? In general, the responses from the staff have been positive, they feel they are being listened to and they can indicate the changes they would make.
Improvement of Operational Excellence
Improvement is already ingrained in the standard quality process, and as a result not all projects are being conducted in strict compliance with the Operational Excellence methodology. So much is happening, a multitude of different processes are involved, and there is always room for improvement. It takes a considerable amount of time to carry out an entire project in accordance with the method, which is not always necessary: sometimes a pragmatic approach is all you need. However, many other elements have become part of our standard process and culture, such as use of the A3, measurement, the lean method, and SMART objectives.
Don't jump straight to the solution: go back to the start and question everything in order to find the best solution. Naturally, you have to maintain your focus on the patients and involve them wherever possible, as they are the people you are ultimately trying to help. You will also encounter resistance along the way, but thanks to the positive experiences and the Yellow Belt training, people realize that this approach really has something to offer.
The years to come
The Pharmacy department will face many different challenges in the years to come, and we are preparing ourselves to meet them. Our role in the hospital is changing and the services we provide to patients are evolving. We're going to be doing completely different things from what we currently do, such as home IV therapy. We have also noticed that for a number of reasons, the cross-departmental projects can be trickier than projects within our own department. Who is the problem owner? What other interests are at play besides our own department's? Projects like these allow us to break new ground within the hospital.
Reducing the risk of injury when administering parenteralsPassengers Nurses within B5 and D5Directions August 2015 > april 2016Journey
Measurements were conducted to gauge the effects of improvement measures concerning medical mistakes and the risk of injury when administering parenterals. These measurements showed that the measures reduced the risk of injury. Lean Six Sigma was found to be a highly suitable method for selecting the right tailor-made improvement measures. See Pubmed for a summary of this study and a link to the article in BMJ Quality Improvement Reports.
Reduction of throughput time between the prescription and delivery of medicationPassengers Project team consisting of 8 employees, including one nurseDirections From 5.6% within four hours to 13.4% within four hours.|Average from 41 hours to 28 hours.|Medial from 22 hours to 13 hours.|Duration of project: approx. 1.5 yearsJourney
The objective of this project is to reduce the throughput time between the prescription of medication by the doctor and the supply of the medication to the patient. This focuses on medication that is not part of the department in question's regular stock and therefore must be supplied by the pharmacy. The pharmacy information system provided a great deal of data for the purposes of our analysis, and the exact times were recorded for every step in the process.
Reduction of waiting time at the outpatients' pharmacyPassengers Project team consisting of 7 pharmacy staffDirections Duration of project: approx. 1.5 yearsJourney
The goal of this project was to increase the proportion of clients to be called to the desk in less than ten minutes after collecting a ticket from 73% to 95%.
The desired result was not achieved, and furthermore the percentage remained the same. However, this project did provide greater insight into the processes involved, resulting in a number of follow-up projects such as the Central Scheduling project, which focuses on coordinating personnel levels to match client volume. In addition, the identification of different methods employed by the staff members resulted in the set-up of a new training programme.