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.


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.


TIMWOODS- 8 Steps approach


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


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


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


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


Don’t accept defects

Don’t make defects

Don’t create variation

Don’t repeat mistakes

Don’t supply defects

5 S approach- Housekeeping


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


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


In order to improve you must work out where you are now and where you want to be.


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


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


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


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


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


OLD DISPENSARY AT PHARMACY WALSALL.


NEW DISPENSARY AND ONE STORE PHARMACY WALSALL 5 S Approach to housekeeping


DISPENSING ISLAND DESIGNED WITH LEAN THINKING


OLD PHARMACY STORE PHARMACY WALSALL


NEW ONE STORE PHARMACY WALSALL

Medi 365 automated system


•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


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


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


Pharmacy’s tips for success


•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


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 ?


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



•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.


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?


The End


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

lean experiences at walsall pharmacy - aptuk · lean experiences at walsall pharmacy ... value is...

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