Being part of service industry, the meeting the expectation of patients is prime importance for any hospital. The patient centric approach to all clinical and non-clinical processes should include more value added activates for which patients are willing to pay & is done correctly in first time.
The Hospital OP pharmacy is located in main lobby at ground floor and is open round the clock on all days. The out patients department is located in ground and first floor of the building. With patient footfall increasing on monthly basis, the average prescriptions received on any working day is more than two hundred.
The challenges:
The patients were not happy with the service offered by OP pharmacy. The patient satisfaction rating of service of OP pharmacy was less than 60 % .The major feedbacks from patients were long waiting time, non-availability of drugs, poor response from pharmacy etc.
The patients had to wait for longer period to fetch the medicine. The dispensing time of medicine was inconsistent. The non-formulary medicines were prescribed by hospital clinicians.
The quantity of inventory beyond sixty days was more. The number of stock out & follow-up to procure medicine was not streamlined. The OP pharmacy team along with quality team started working on the process improvement at OP pharmacy. The quality team adopted Genchi Genbutsu, a lean tool to visit OP pharmacy to see actual situation on ground.
The Ohno circle tool was followed by quality yielded following major observations from outside the OP pharmacy counter.
• The automated Q- Management system was not functional properly as same counter was displaying two tokens leading to confusions.
• The signage of process to collecting token & waiting for patients turn was not properly displayed leading to lot of Muda i.e. waste as most patients used to disturb the staff at OP pharmacy counter.
• Counter four was not commissioned & no Q- management was put across counter.
• The smaller denomination currency was mostly not available at OP pharmacy leading to delay in dispensing medicine.
The similar exercise was done by quality team inside the OP pharmacy and it had resulted in following major observations.
• The inconsistent method of medicine dispensing at different counters.
• No quick action was initiated for any item not available at pharmacy.
• The issue counter was cluttered with unnecessary items.
• The orderliness of medicine in some area was not in logical sequence & no visual signboard was present in some places.
• The inventory of more than sixty days was held for slow & non- moving items.
The process:
The complete as it is process mapping was done by quality team. All the patient feedbacks were closely studied. The takt time was reviewed with respect to present dispensing time at various time duration to match the staff pattern. A strong need was felt by team to improve the visual control for OP pharmacy.
The 5 S workshop was initiated to staff in OP Pharmacy. The patient feedbacks, present processes, bottlenecks were brainstormed as part of the workshop. The suggestions from team members were taken .The quality team studied each stage of S on ground along with pharmacy staff to know gaps and scope of improvement.
The table below shows the steps initiated as part of 5 S measures. Around twenty five initiatives were taken up for implementation. The keshikomi chart as part of Oobeya project management was adopted for timely completion of the project.
The team encountered a lot of practical hurdles like breaking old habits of staff, delay in getting work done from other supporting departments like engineering, housekeeping. The repeated persistence of team to excel had started giving results. The senior management was very supportive in entire initiative and repeated visit from management team further motivated the pharmacy staff to quickly adopt 5 S in their office.
The results:
The visualization & accessibility of all medicines by staff increased with introduction of 5 S.The space is efficiently utilized both inside & outside the OP pharmacy. The inventory management improved including reduction of stock-out, expired medicine inside pharmacy. The patient waiting time has reduced due to realignment of space & items, standardized work flow. The patient satisfaction had increased post lean initiative at OP pharmacy as given in graph below. The environmental conditions are properly monitored and there is process in place to regularly check the stocks of desired items.
Conclusion:
The lean initiative has helped the hospital to improve the patient experience, increase working standards & reduce the unnecessary inventory.
Meaning of Japanese terms
Genchi Genbutsu: To go & see, check
Ohno circle tool: Standing inside circle
Muda: Waste
Takt time: It is the average unit production time needed to meet customer demand
Keshikomi chart: Message board containing pending activity
Oobeya: Big room for visualization, project management
Seiri: To sort
Seiton: To store/arrange
Seiso: To shine
Seiketsu: To standardize
Shitsuke : To sustain•
The Hospital OP pharmacy is located in main lobby at ground floor and is open round the clock on all days. The out patients department is located in ground and first floor of the building. With patient footfall increasing on monthly basis, the average prescriptions received on any working day is more than two hundred.
The challenges:
The patients were not happy with the service offered by OP pharmacy. The patient satisfaction rating of service of OP pharmacy was less than 60 % .The major feedbacks from patients were long waiting time, non-availability of drugs, poor response from pharmacy etc.
The patients had to wait for longer period to fetch the medicine. The dispensing time of medicine was inconsistent. The non-formulary medicines were prescribed by hospital clinicians.
The quantity of inventory beyond sixty days was more. The number of stock out & follow-up to procure medicine was not streamlined. The OP pharmacy team along with quality team started working on the process improvement at OP pharmacy. The quality team adopted Genchi Genbutsu, a lean tool to visit OP pharmacy to see actual situation on ground.
The Ohno circle tool was followed by quality yielded following major observations from outside the OP pharmacy counter.
• The automated Q- Management system was not functional properly as same counter was displaying two tokens leading to confusions.
• The signage of process to collecting token & waiting for patients turn was not properly displayed leading to lot of Muda i.e. waste as most patients used to disturb the staff at OP pharmacy counter.
• Counter four was not commissioned & no Q- management was put across counter.
• The smaller denomination currency was mostly not available at OP pharmacy leading to delay in dispensing medicine.
The similar exercise was done by quality team inside the OP pharmacy and it had resulted in following major observations.
• The inconsistent method of medicine dispensing at different counters.
• No quick action was initiated for any item not available at pharmacy.
• The issue counter was cluttered with unnecessary items.
• The orderliness of medicine in some area was not in logical sequence & no visual signboard was present in some places.
• The inventory of more than sixty days was held for slow & non- moving items.
The process:
The complete as it is process mapping was done by quality team. All the patient feedbacks were closely studied. The takt time was reviewed with respect to present dispensing time at various time duration to match the staff pattern. A strong need was felt by team to improve the visual control for OP pharmacy.
The 5 S workshop was initiated to staff in OP Pharmacy. The patient feedbacks, present processes, bottlenecks were brainstormed as part of the workshop. The suggestions from team members were taken .The quality team studied each stage of S on ground along with pharmacy staff to know gaps and scope of improvement.
The table below shows the steps initiated as part of 5 S measures. Around twenty five initiatives were taken up for implementation. The keshikomi chart as part of Oobeya project management was adopted for timely completion of the project.
The team encountered a lot of practical hurdles like breaking old habits of staff, delay in getting work done from other supporting departments like engineering, housekeeping. The repeated persistence of team to excel had started giving results. The senior management was very supportive in entire initiative and repeated visit from management team further motivated the pharmacy staff to quickly adopt 5 S in their office.
The results:
The visualization & accessibility of all medicines by staff increased with introduction of 5 S.The space is efficiently utilized both inside & outside the OP pharmacy. The inventory management improved including reduction of stock-out, expired medicine inside pharmacy. The patient waiting time has reduced due to realignment of space & items, standardized work flow. The patient satisfaction had increased post lean initiative at OP pharmacy as given in graph below. The environmental conditions are properly monitored and there is process in place to regularly check the stocks of desired items.
Conclusion:
The lean initiative has helped the hospital to improve the patient experience, increase working standards & reduce the unnecessary inventory.
Meaning of Japanese terms
Genchi Genbutsu: To go & see, check
Ohno circle tool: Standing inside circle
Muda: Waste
Takt time: It is the average unit production time needed to meet customer demand
Keshikomi chart: Message board containing pending activity
Oobeya: Big room for visualization, project management
Seiri: To sort
Seiton: To store/arrange
Seiso: To shine
Seiketsu: To standardize
Shitsuke : To sustain•
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