Quantifying and eliminating failings in communication and collaboration across the pharmacy chainIn modern healthcare, achieving optimum communication and collaboration across the myriad specialised professions, organisations, technologies and processes involved in each patient’s care is an increasing challenge.

Unsurprisingly, in such a complex environment it is common for communication and collaboration to be far from optimal, with significant avoidable costs as the result. A 2010 paper by Agarwal, Sands and Schneider estimates that a typical 500 bed hospital in the US loses over $4 million annually solely as a result of communication inefficiencies. This estimate

is likely to be conservative as was based on measuring only direct resource costs such as salaries and did not account for other economic burdens, such as the impact on patient care.

Inefficiency in communication and collaboration was one of the principal themes to emerge from a workshop that continuous improvement specialist Leading Edge Group facilitated with about forty hospital pharmacists at the Hospital Pharmacist Association of Ireland conference in April last year.

Pharmacists at the workshop applied aspects of the process improvement methodology

Lean Pharmacy to analysing the flow of information and medicines between suppliers, pharmacists, prescribers and patients, to identify where bottlenecks, frustrations and waste occurred and to describe potenrial redesigned processes that could eliminate or mitigate the identified inefficiencies.

Participant pharmacists identified issues that both reached backwards to suppliers (relating to failings in communication and collaboration that contribute to stock shortages) and forward to other parts of the hospital (relating to time spent chasing down prescribers to confirm or modify prescriptions).

1. REFLECT - Before reading this module, consider the following: Will this clinical area be relevant to my practice.

2. IDENTIFY - If the answer is no, I may still be interested in the area but the article may not contribute towards my continuing professional development (CPD). If the answer is yes, I should identify any knowledge gaps in the clinical area.

3. PLAN - If I have identified a knowledge gap - will this article

satisfy those needs - or will more reading be required?

4. EVALUATE - Did this article meet my learning needs - and how has my practise changed as a result? Have I identified further learning needs?

5. WHAT NEXT - At this time you may like to record your learning for future use or assessment. Follow the 4 previous steps, log and record your findings.

CPD 3: LEANS MANAGEMENT

Continuous Professional Development Modules are sponsored by Pfizer Healthcare Ireland Pfizer Healthcare Ireland has no editorial oversight of the CPD programmes included in these modules.

Biography - Matthew Hamilton is Policy Deployment Officer at Leading Edge Group. He has worked as a policy

analyst and programme manager on health reform and e-learning projects in Ireland, Australia, Central America and the Caribbean. He is currently a Health Economics

Masters candidate at NUI Galway.

60 Second SummaryInefficiency in communication and collaboration was one of the principal themes to emerge from a workshop that continuous improvement specialist Leading Edge Group facilitated with about forty hospital pharmacists at the Hospital Pharmacist Association of Ireland conference in April last year.

Underpinning Lean Pharmacy are the principles of focusing on patients (placing patient needs at the centre of every decision in a process and seeking to eliminate any step that does not add value to patients) and involving staff (supporting, training and trusting staff to identify and solve problems).

An example of Lean Pharmacy deployment in an Irish hospital pharmacy setting that was previously featured in the Irish Pharmacy News is Galway University Hospital, where Leading Edge Group worked with pharmacy staff to help them achieve better communication with hospital colleagues and patients, a more empowered staff team and improved use of physical facilities through greater use of visual cues.

A more systematic approach to improving communication and collaboration in healthcare settings may be achievable through a combination of mapping where failings and inefficiencies currently occur, assigning explicit responsibility for the effective flow of information across healthcare organisations to named individuals, by redesigning processes and by making better use of technology.

Published by HPN, sponsored by Pfizer Healthcare Ireland. Copies can be downloaded from www.irishpharmacytraining.ie

Disclaimer: All material published is copyright, no part of this can be used in any other publication without permission of the publishers and author. Pfizer Healthcare Ireland has no editorial oversight of the CPD programmes included in these modules.

Matthew Hamilton

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Many of the concerns of these Irish pharmacists about ineffective communication and collaboration are shared by their Canadian peers. Leading Edge Group has identified a number of common themes arising from its work supporting the deployment of Lean Pharmacy in Canada, including:

• Defective (incomplete or unclear) communication. Pharmacists regularly have to contact the prescriber in order to clarify the request or to ascertain the patient allergy status. As a result there is unnecessary movement (chasing down the prescriber), the medication review is conducted with inadequate context regarding patients and

implementing the therapy is delayed.

• Episodic communication. In many instances, the receipt of medication orders in the pharmacy is a batch feed activity. Orders are faxed in batches from in-patient care areas or outlying facilities, or are handled in batches by the staff in the pharmacy, resulting in uneven distribution of work.

• Inconsistent communication. There are differing approaches to how information is logged and communicated within pharmacy inventory management systems and staff members may have varying levels of understanding about how to appropriately

respond to visual cues relating to declining stock levels.

• Restricted-communication. The design of existing roles and processes often force pharmacists to undertake tasks within the pharmacy that could be performed by pharmacy technicians. As a result the capacity of pharmacists to share their expertise with other clinicians in other parts of the hospital is constrained with potential knock on effects on the quality of patient care.

The suite of tools and processes that comprise Lean Pharmacy are designed to tackle these challenges. Mapping value streams, improving visual controls

and implementing rapid improvement projects are deployed in order to review the current state, to imagine and describe the ideal future state and to develop and implement a plan to achieve the ideal state and sustain continuous improvement within the hospital pharmacy.

Underpinning Lean Pharmacy are the principles of focusing on patients (placing patient needs at the centre of every decision in a process and seeking to eliminate any step that does not add value to patients) and involving staff (supporting, training and trusting staff to identify and solve problems).

Lean Pharmacy is part of a wider Lean approach to healthcare continuous improvement that has been credited with benefitting patients, improving staff morale and enhancing the financial performance of service providers, a combination that explains why Lean’s growing role in healthcare improvement initiatives has coincided with a growing imperative to improve performance whilst costs have become increasingly constrained.

Additionally, a number of findings from Leading Edge Group’s Lean Pharmacy scoping analysis of the Irish community pharmacy sector last year may have relevance to hospital pharmacists, such as achieving:

• Inventory levels that are appropriate to the level of demand, where wastage of drugs is minimized and time spent managing inventory is released for quality initiatives by pharmacists.

CPD 3: LEANS MANAGEMENT

Continuous Professional Development Modules are sponsored by Pfizer Healthcare Ireland Pfizer Healthcare Ireland has no editorial oversight of the CPD programmes included in these modules.

 How  the  project  was  implemented  

The  key  outcomes  achieved  were  empowered  staff,  improved  customer  focus,  better  stock  management,  better  workflow  and  better  space  utilisation.    

1

Prior  experience  with  implementing  Lean  thinking  had  convinced  the  hospital’s  Acting  Chief  Pharmacist  that  introducing  Lean  tools  and  concepts  to  the  pharmacy  team  would  empower  them  to  make  ongoing  improvements  despite  the  constraints  within  which  they  work.  

A  Lean  consultant  from  Leading  Edge  Group  was  appointed  to  deliver  a  tailored  programme  of  training  and  mentoring  to  10-­‐12  hospital  pharmacy  team  members,  primarily  pharmacy  technicians  and  pharmacists.  

2

The  project  was  characterised  by:  

¥ Taking  learning  out  of  the  classroom  –  Relating  Lean  concepts  to  the  everyday  work  of  pharmacy  team  members  

¥ Walking  the  process  –  Going  to  where  each  step  of  a  process  happens  and  talking  to  “customers”  about  their  experiences  and  needs  

¥ Learning  by  doing  –  developing  team  knowledge  of  Lean  techniques  by  implementing  improvement  projects  in  the  hospital  pharmacy  

¥  

Techniques  used  in  the  project  included:  

¥ Prompting  conversations  about  staff  opinions  and  anxieties  

¥ Implementing  an  ideas  board  and  establishing  daily  ten  minute  improvement  meetings  

¥ Mapping  key  team  processes  ¥ Facilitating  a  site  visit  to  another  

organisation  to  see  Lean  in  action  ¥ Mentoring  team  members  as  they  

planned  and  executed  projects  to  achieve  a  tidier,  safer  work  environment  and  better  stock  management  

 

 

TYPE  OF  OUTCOME    

DESCRIPTION  Empowered  staff   Pharmacy  team  members  have  made  process  improvement  an  

ongoing  part  of  their  routine  work  

 Pharmacy  team  members  have  spoken  to  their  customers  to  get  a  better  understanding  of  the  needs,  expectations  and  experiences  of  both  patients  and  hospital  staff  in  other  departments  

Better  stock  management  

 

A  Kanban  system  has  been  successfully  implemented  to  ensure  greater  visibility  of  stock  and  almost  eliminate  stock-­‐outs  of  key  stock  items  

Improved  customer  focus  

Better  workflow  

 

Work  process  have  been  mapped  and  unnecessary  movement  of  people  and  transportation  of  products  have  been  eliminated  

Taking  learning  out  of  the  classroom  

Walking  the  process  

Learning  by  doing  

LEADING  EDGE  GROUP  -­‐  UK  Centre  for  Value  Chain  Research,  Kent  Business  School,  University  of  Kent  at  Medway,    The  Medway  Building,  Chatham  Maritime,    Canterbury,  Kent  ME4  4AG.  Tel:  +44  7580  315309    

LEADING  EDGE  GROUP  -­‐  IRELAND    Charter  House,  Harbour  Row,  Cobh,  Co.Cork.  Tel:  +353  21  4855863  

FURTHER  CONTACT  www.leadingedgescm.com  info@leanscm.com    

LEADING  EDGE  GROUP  -­‐  CANADA  Suite  800,  120  Eglinton  Avenue  East,  Toronto  ON,  M4P  1E2.  Tel:  +1  416  637  5074  

Better  space  utilisation  

 

A  re-­‐organised,  tidier  and  more  visual  work  environment  has  created  space  savings  of  25%  

 

• More time for pharmacists to spend as members of the patient care teams handling complex medication-use issues and advising members of the multidisciplinary teams on current issues regarding medications and prescribing.

• Application of information Technology and automation to effectively ensure patient safety and to identify those most in need of the attention of a pharmacist.

• Print or electronic issue of all prescriptions, eliminating time spent deciphering handwriting.

• Information on patient medicines being stored and accessed when needed by the relevant persons, to ensure that the correct medications are dispensed in the correct volumes in order to deliver the most efficient and safe service to the patient.

• Pharmacy sensitive data being available to assist with workforce and resource planning.

An example of Lean Pharmacy deployment in an Irish hospital pharmacy setting that was previously featured in the Irish Pharmacy News is Galway University Hospital, where Leading Edge Group worked with pharmacy staff to help them achieve better communication with hospital colleagues and patients, a more empowered staff team and improved use of physical facilities through greater use of visual cues. These results were achieved through a combination of prompting conversations about staff opinions and anxieties, implementing an ideas board and daily ten minute improvement meetings, mapping key team processes, an off-site visit to see Lean in action and the mentoring of staff.

The pharmacy department here was under significant pressure to perform more work with less staff. The hospital asked Leading Edge to develop the capacity of the pharmacy team to solve

problems and implement solutions within their constraints by using Lean Thinking.

As a result, the pharmacy team:

Have developed the knowledge, skills and confidence to lead process improvement work on an ongoing basis;

Have a better understanding of the needs, expectations and experiences of both patients and hospital staff in other departments;

Manage stock more effectively with greater visibility of stock and less stock outs;

Utilise pharmacy space more effectively.

A Lean Consultant from Leading Edge group was appointed to deliver a tailored programme of training and mentoring to 10-12 hospital pharmacy team members, primarily pharmacy technicians and pharmacists.

The project was characterised by:

- Taking learning out of the classroom, relating Lean Concepts to the everyday work of pharmacy team members

- Walking the process – Going to where each step of a process happens and talking to customers about their experiences and needs

- Learning by doing – Developing team knowledge of Lean techniques by implementing improvement projects in the hospital pharmacy.

The key outcomes achieved were empowered staff, improved customer service, better stock management, better workflow and better work space utilisation.

Furthermore, a number of issues raised by the recently released baseline report on Irish hospital pharmacy by the Pharmaceutical Society of Ireland highlight some of

CPD 3: LEANS MANAGEMENT

Continuous Professional Development Modules are sponsored by Pfizer Healthcare Ireland Pfizer Healthcare Ireland has no editorial oversight of the CPD programmes included in these modules.

the enablers and barriers to better communication and collaboration across the pharmacy chain (from manufacturers to distributors to hospital pharmacies to hospital wards and units), in particular:

• Relatively low levels of automation and communication between systems compared to other countries and inadequate technology

• Under-developed links beyond the hospital

• Limited involvement of pharmacists in patient care teams

• The need for innovative solutions relating to training and role redesign

Medicines management can mean different things to different people. The definition used in this survey is that used by the UK Audit Commission’s 2001 Spoonful of Sugar report: Medicines management in hospitals encompasses the entire way that medicines are selected, procured, delivered, prescribed, administered and reviewed to optimise the contribution that medicines make to producing informed and desired outcomes of patient care.

To explore some of these issues further, Leading Edge Group will be conducting a survey of Irish hospital pharmacists in March and April to:

• identify current strengths and weaknesses of communication and collaboration across the pharmacy chain

• identify priority areas for improvement

• assess the current and potential future application of human process, technology and data analysis strategies to enable better communication and collaboration in Irish hospital pharmacy

The purpose of this survey will be to provide an economic analysis of the impacts of communication and collaboration inefficiencies across the Irish hospital pharmacy chain. Such economic analysis may help hospital pharmacist to set priorities and to learn more about the communication and collaboration improvement strategies deployed or planned by their peers.

It is also intended that this research will make a contribution to better understanding the economic impact of communication inefficiencies in Irish healthcare and to support the development of more systematic approaches to improving communications and collaboration in Irish hospital pharmacy.

A more systematic approach to improving communication and collaboration in healthcare settings may be achievable through a combination of mapping where failings and inefficiencies currently occur, assigning explicit responsibility for the effective flow of information across healthcare organisations to named individuals, by redesigning processes and by making better use of technology. Such a more systematic approach has the potential to

improve the quality of hospital pharmacy services, use scarce resources more effectively and improve the working lives of hospital pharmacists.

More details about Lean Pharmacy and how you can participate in the survey are available at http://www.leadingedgegroup.com/consulting/zlean-pharmacy/

LEAN IN PHARMACY

Pharmacy is an area of healthcare in which major health gain, improved financial performance and greater staff satisfaction are readily achievable through implementing Lean thinking. Leading Edge Group has produced resources to aid community pharmacists, hospital pharmacists and health service planners, policymakers and regulators to achieve these gains.

•Efficient Pharmacy Inventory Practices are essential to the profitability of your pharmacy. Too much inventory is a major cause for insufficient cash flow. Don’t let profits sit on your shelves or expensive brand name drugs go out of date due to improper inventory levels. Remember inventory eats cash.

•LEAP Self Assessment Tool – This self-assessment tool was developed in order to assist community pharmacists to identify key areas where initial process improvement efforts may need to focus in order to resolve the largest problem or worst bottlenecks. If in applying the this tool, a community pharmacy scores less than 30 “yes” responses, then it is likely to benefit from

CPD 3: LEANS MANAGEMENT

Continuous Professional Development Modules are sponsored by Pfizer Healthcare Ireland Pfizer Healthcare Ireland has no editorial oversight of the CPD programmes included in these modules.

implementing Lean. Less than 20 “yes” responses would indicate that there may be an urgent case to review internal processes in order to ensure future viability.

If you are a pharmacist or are responsible for healthcare services that include pharmacy, talk to Leading Edge Group today about how we can help you achieve quality improvements and financial savings. Services we can provide include:

•Tailored training, mentoring and consulting programmes to empower pharmacy team members in both community and hospital pharmacies to achieve improvements and overcome resource constraints by implementing Lean Thinking

•Preparation of advice, analysis and reports for policymakers, regulators and service planners about tackling systemic issues to enable improved performance from the pharmacy sector

•Provision of introductory training to Lean thinking and concepts through our range of online courses and workshops

For specific queries, contact Leading Edge Group by email (info@leadingedgegroup.com) or phone on 021 4855863.

Author Information: Matthew Hamilton is Policy Deployment Officer at Leading Edge Group. He has worked as a policy analyst and programme manager on health reform and e-learning projects in Ireland, Australia, Central America and the Caribbean. He is currently a Health Economics Masters candidate at NUI Galway.