Patient care, by definition and commonly accepted logic, is a set of people-engaging processes. Many of those processes have severe impacts if taken too long to complete, or if included with errors. Yet, healthcare is a bit of a final frontier compared to other industries for fully embracing the methods, techniques, and tools of Lean and Six Sigma.
Once Lean and Six Sigma are understood, applied, and adopted, the improvement opportunities are endless! So, let’s help move that along by citing a case study in healthcare and looking at the benefits.
During conversion of several systems at a 300-bed hospital, the pharmacy dispensing area and Medication Administration Record System (MARs) was noted as having several errors. Errors in ordering and dispensing medications had several unknown source errors and were a source of risk, patient dissatisfaction, strained relationships in hospital personnel, and low employee morale. IT system “fixes” had been previously installed, but little change was noted in reduction of errors. It was decided to apply Lean and Six Sigma to resolve errors as part of the conversion.
- A process improvement team was assembled, analyzed available information, conducted interviews, and determined that the most urgent problem was unknown MARs errors
- The focus was on the pharmacists and the order process
- The Lean Six Sigma team used Cause/Effect, Failure Modes Effect Analysis (FMEA), and Pareto Diagrams to subjectively capture types of errors and errors by employee (see Figures 1 and 2 below)
The blue bars in Figure 1 denote the errors in the month previous to the start of the Lean and Six Sigma initiative. Note that Not Received, Duplicate Order, and Incorrect Frequency account for over 50% of the errors. Figure 2 captures the number of errors by pharmacist. Note that 56% of the errors are accountable to only three of the pharmacists.
Developing Solutions Using Lean and Six Sigma
The team developed and implemented better practices, documented procedures, and provided training and oversight supervision by shift managers.
System changes were made to Computerized Physician Order Entry (CPOE) specific to medications orders, and re-training of physicians, nurses, pharmacists, and shift supervisors was completed.
Lead pharmacists were assigned by hospital units and co-located with nurse shift stations.
Lead pharmacists were included in the weekly nurse meetings with co-facilitation of the standing agenda by the Chief Nursing Officer and the Chief Pharmacist, with focus on quality, collaboration, and timely resolution of trending issues.
Figure 3 shows most of the errors have been dramatically reduced, with a total number dropping from 323 the month prior to the start of the Lean and Six Sigma project to 73 the third month following implementation of the improvements. Figure 4 shows a significant reduction in errors for pharmacists due to the standardization of process and procedure, education and training, nurse/pharmacist collaboration, and tighter supervision.
Additional benefits realized from introducing Lean and Six Sigma methodology were:
- Reversal of errors from an increasing to a downward trend for most types of errors
- A decrease in total error rate from 0.33% to 0.04% in six months
- Annualized Pharmacist, Nurse, and Physician cost avoidance of $1.65 million for time resolving errors
- Improved patient satisfaction
- Improved employee morale and better relationships between nurses and pharmacists