LEAN EXPERIENCES AT WALSALL PHARMACY - APTUK · LEAN EXPERIENCES AT WALSALL PHARMACY ... Value is...
Transcript of LEAN EXPERIENCES AT WALSALL PHARMACY - APTUK · LEAN EXPERIENCES AT WALSALL PHARMACY ... Value is...
LEAN EXPERIENCES AT WALSALL PHARMACY
Nalini V Patel APT Conference 19.6.2010.
What today’s session will be
The aim is to help individuals gain a basic and simple understanding of what LEAN is about.
The objectives : Learn some of the techniques used to help with the Lean
approach and its methods for thinking. See some examples of how lean principles have helped the
Pharmacy at Walsall. Help individuals think about benefits to their own
organisation. Group exercise to brainstorm and challenge your thinking. Discussion , feedback and questions. Finish.
Nalini V Patel APT Conference 19.6.2010.
What is Lean? Lean is a buzzword
Lean manufacturing originated from the Toyota production line from the 1990s- preserving value with less work
Lean concentrates on eliminating waste:
Waste is anything which doesn't add value to a product or service. Value is defined as the provision of customer and patient service and satisfaction. Any activity which doesn't contribute to this is classified as waste.
Waste is a symptom rather than the root cause of problem, it highlights problems within the system or organisation.
Nalini V Patel APT Conference 19.6.2010.
TIMWOODS- 8 Steps approach
Nalini V Patel APT Conference 19.6.2010.
T - Transport - Moving people, products & information I - Inventory - Storing parts, pieces, documentation ahead of requirements. M - Motion - Bending, turning, reaching, lifting W - Waiting - For parts, information, instructions, equipment O - Over production - Making more than is immediately required O - Over processing - Tighter tolerances or higher grade material than are necessary (overdoing) D - Defects - Rework, scrap, incorrect documentation S - Skills - Under utilizing capabilities, delegating tasks with inadequate training.
The 6 W’s approach
Nalini V Patel APT Conference 19.6.2010.
Planning should answer the following questions: WHAT : What will you make/do this? WHY : Why will you make/do this? WHERE : Where will you make/do this? WHO : Who will make/do this? WHEN : When will you start/stop this ? Time scheduling. WHICH : Which will you make/do this.? Process, tooling, material sources .
Root Cause Analysis- 5 Why’s
Nalini V Patel APT Conference 19.6.2010.
The 5 why's typically refers to the practice of asking, five times, • Why the failure has occurred in order to get to the root cause/causes of the problem. •There can be more than one cause to a problem as well. • In any organisation root cause analysis is carried out by a team of persons related to the problem..
Just ask yourself: WHY? WHY ?WHY? WHY? WHY?
5 C Model for the working environment
Nalini V Patel APT Conference 19.6.2010.
5 step technique to stabilise, maintain and improve the safest, best working environment to support sustainable Quality, Cost and Delivery.
Clear Out: Separate the essential from the non essential Configure: A place for everything and everything in its place. Clean and Check: Manually clean to spot abnormal conditions. Conformity: Ensures that the standard is maintained and improved. Custom and Practice: Everyone follows the rules, understands the benefits and contributes to the improvement.
5 Z Model – Get it right first time zu in japanese means don’t
Nalini V Patel APT Conference 19.6.2010.
Don’t accept defects
Don’t make defects
Don’t create variation
Don’t repeat mistakes
Don’t supply defects
5 S approach- Housekeeping
Nalini V Patel APT Conference 19.6.2010.
SORTING – Good and Bad , Useable and Non useable SYSTEMIC ARRANGEMENT – Once sorted keep systematically to have traceability SPIC AND SPAN – Keep arranged things always ready to use and in dirt free and tidy status – avoid creepiness of clutter STANDARDIZE – Make a process for the above three stages and make standards , keep on reviewing these. SELF DISCIPLINE - Individuals have to commit
Green Bag Scheme Issue with patients own medicines being lost in hospital
Introduction of a visible bag which follows the patient
Patients and GPs not happy
Patients missed doses
Patients prefer their own brands of medicines
Patients like ownership of own medicines
Needed for medication history taking
Reduced need for unnecessary supplies
Improved communication for medication history
Helped with admission and discharge planning
Helped to reduce wastage for the economy
Reduced expenditure on items -only necessary to supply
Essential for one stop dispensing
Easily identifiable and sealable bag
Recyclable and Recognised
Nalini V Patel APT Conference 19.6.2010.
6W 5C 5Z approach
Lean simply means “LEAN is about getting the right things to the right place, at the right time, in the right quantities, while minimising waste and being flexible and open to change”.
How to improve flow to eliminate waste
How to get things right the first time
How to empower staff and motivate them to sustain results
How to make good decisions using evidence that “through learning by doing” gets results quickly.
How to make sure continuous improvements
Nalini V Patel APT Conference 19.6.2010.
In order to improve you must work out where you are now and where you want to be.
Nalini V Patel APT Conference 19.6.2010.
Prescription
received
Prescription
Clinical
Checked by
Pharmacist
Prescription
Accuracy
Checked by
Technician
or
Pharmacist
Prescription
labelled and
dispensed
Overview
Prescription
received
Prescription
labelled and
dispensed
Prescription
clinically
and
accuracy
checked by
Pharmacist
Check
PATIENT WAITING
PDSA Cycle - Plan , Do, Study, Act . Risk Assess. Process Mapping
Nalini V Patel APT Conference 19.6.2010.
Discharge Summary Process Mapping- visual sequence of events to build a product or
produce an outcome
Discharge
Summary
written
Medical Team
•Incomplete information on
discharge summary
•Pressure on doctors to
write discharge summary
on the spot
Discharge
Summary &
Treatment
sheet to
pharmacy
Porter/Nurse/Ward Clerk/
Pharmacist
Discharge
Summary
details logged
onto tracking
system
Pharmacy Receptionist
•Tracking system unaccessable
at ward level
Discharge
Summary
clinically
checked
Pharmacist
1 2
TTO medicines
labelled
Pharmacy Technician
TTO medicines
dispensed
Pharmacy Technician
Top copy Discharge
Summary
photocopied A3 and
put with dispensed
medicines
Pharmacy Technician
•Siting of photocopier
•Time
TTO
medicines
accuracy
checked
Pharmacist
3 4
5 6 7 8
Nalini V Patel APT Conference 19.6.2010.
0
5
10
15
20
25
No
. o
f c
alls
re
ce
ive
d
Time
Pharmacy Reception Telephone Audit
Is chart in Pharmacy
Is TTO ready
Ambulance prioritisation
Patient transfers
Internal call
Other
Collect Data and study it – Ask the WHY’s
Nalini V Patel APT Conference 19.6.2010.
C
C
C
C
C
Peripheral Dispensing –
Separate Review
Legend
TTO
In-Patient (Pharmacist) Out-Patient
In-Patient (Ward)
Batch
Or
de
rs
O
ut
Dispensary – Previous State Detailed Mapping TIMWOODS
Approach
Nalini V Patel APT Conference 19.6.2010.
C
C
C
C
C
Legend
TTO
In-Patient (Pharmacist) Out-Patient
In-Patient (Ward)
Batch
Or
der
s
Out
Dispensary – CURRENT Detailed Mapping
FLOW OF WORK MORE LEAN
5 C Model
Nalini V Patel APT Conference 19.6.2010.
OLD DISPENSARY AT PHARMACY WALSALL.
Nalini V Patel APT Conference 19.6.2010.
NEW DISPENSARY AND ONE STORE PHARMACY WALSALL 5 S Approach to housekeeping
Nalini V Patel APT Conference 19.6.2010.
DISPENSING ISLAND DESIGNED WITH LEAN THINKING
Nalini V Patel APT Conference 19.6.2010.
OLD PHARMACY STORE PHARMACY WALSALL
Nalini V Patel APT Conference 19.6.2010.
NEW ONE STORE PHARMACY WALSALL
Medi 365 automated system
Nalini V Patel APT Conference 19.6.2010.
•Increase safety levels by reducing errors, •Improve accountability •Provide a secure medicines management solution.
OTHER PROJECTS PHARMACY HAVE IMPROVED- Ward Based Services Old Way of working New way of working
Ward Based Services – traditionally pharmacists visited ward
Technicians were introduced into the system to help Pharmacists
Wards used drug trolleys
Traditional in patient supply and TTOs dispensed when patient was going home.
Clear extended role for Technicians to help Pharmacists.
Services carried out at ward level- Medicine reconciliation,
Services prioritised at admissions to facilitate care
Dispensing at ward level using drug carts including discharges
Patient counselling directly at bedside.
Patients given bedside lockers
Nalini V Patel APT Conference 19.6.2010.
INFO IN for INFO OUT- Trade off GPs not happy about poor information on discharge letters
Pharmacists and Doctors not happy about poor information in for new admissions regarding drug histories
Nalini V Patel APT Conference 19.6.2010.
Automated email alert to GP on patient admission requesting to send list of
medicines patient currently taking back via email, accessible by Pharmacists . Printed copy placed in patient
records.
Re-design of discharge prescription to include discharge summary and
prescribed medicines 1 page to 2 page with better quality paper.
Progressed to Electronic Discharge
Summaries with log in for GPs.
Networking with Multi-disciplinary groups
Aim to deliver the highest quality care with the best resource utilisation Patient Safety
Patient Experience
Quality
Costs
Delivery
Network with your Customers/Stakeholders – ask them what they want not what you think they want
GOOD CUSTOMER SERVICE – ALWAYS GIVE IT
Nalini V Patel APT Conference 19.6.2010.
Pharmacy’s tips for success
Nalini V Patel APT Conference 19.6.2010.
•Good relationships with customers •Engage staff of all grades •Staff have a voice – new ideas •Regular team meetings •Leaders who support projects and help staff to drive them forward •Staff Training for developing skills is important for future plans •New pharmacy department – new ways of working
Nalini V Patel APT Conference 19.6.2010.
The Chief busy at work
Group Exercise On your tables is a group exercise scenario.
Work in your groups to come up with a way of helping
Mrs Cornfield and her problem.
There is a list of the lean approach techniques to help you if necessary.
You have 10 minutes for your discussions.
Review and feedback.
Any questions ?
Nalini V Patel APT Conference 19.6.2010.
Tips for the team TIMWOODS
The 6 W’s – What, Why, When , Where, How and Who ( Colombo effect)
5 Why’s – Root Cause Analysis
5 C Model – Quality, Cost, Delivery
5 Z Model – Get it right first time
5 S approach – Housekeeping , Keep it in order
THINK OUTSIDE THE BOX – Challenge what you do
Nalini V Patel APT Conference 19.6.2010.
Nalini V Patel APT Conference 19.6.2010.
•What are the issues: Mrs Cornfield has a bad memory
•What is the risk: She won’t take her medication and her condition won’t improve
•How can you help: Ask her why she is forgetting, Magic Maize is one idea, what about other ideas- alarm clock, medi dose unit, colour coding on the container, Whatever you decide think what the bigger picture will be after she leaves the pharmacy
•Lean techniques: 6Ws, 5 Why’s, 5C model, 5 Z model, Timwoods, Think outside the box. •How much have you spent?
This patient needs some help, she is relying on your support, you must consider her needs and what will happen afterwards once you implement your idea. She must be satisfied that you have helped her.
Feedback to Group exercise
Sources of Information NHS Institute for innovation and improvement
Lean Thinking – James P Womack & Daniel T Jones
Six Sigma
Lean Enterprise Institute
Wikipedia
The Goal by Eliyahu M Goldratt and Jeff Cox
-A Gower novel to read.
Nalini V Patel APT Conference 19.6.2010.
Self Reflections for you DO YOU UNDERSTAND WHAT LEAN IS?
HAVE YOU LEARNT ANY OF THE TECHNIQUES?
WILL YOU USE THE TECHNIQUES ?
WHAT PART OF IT INSPIRED YOU THE MOST?
WHAT WILL YOU TAKE BACK TO YOUR COLLEAGUES AND WORKPLACE?
WILL YOU TALK ABOUT IT?
Nalini V Patel APT Conference 19.6.2010.
The End
Nalini V Patel APT Conference 19.6.2010.
Thank you for attending this session. I hope you have enjoyed it and learnt something. If you would like a copy of this presentation please leave your details and I will send them onto you
I am available to answer any specific questions. My contact details are Nalini V Patel [email protected]
Tel 01922 657869 or 01922 656748