Niccolo Curatolo

A critical analysis of Lean approach structuring in hospitals

Purpose – As reimbursements fall and costs for services climb, organizations are forced to follow the painful motto of doing more with less. A solution could be the adaptation of industrial business process improvement (BPI) methods such as Lean to the hospital setting (HS). The purpose of this paper is to analyze if Lean approaches related in the literature provide sufficient methodological support for other practitioners to reproduce the reported results. Design/methodology/approach – The authors analyzed the published Lean literature in the HS using a methodological maturity-level framework and what the authors defined as the 11 characteristic activities of BPI. Findings – The literature analysis reveals that a Lean approach with a high-methodological maturity level that includes the 11 characteristic activities of BPI has never been reported. Considering this, the paper suggests a meta model for a high-methodological maturity-level Lean method based on the characteristic activities of BPI. Originality...

Démarches d’amélioration en milieu hospitalier : du management de la qualité totale au Lean

Hospitals have to deal strong with economic constraints and increasing requirements in terms of quality and safety of care. To address these constraints, one solution could be the adoption of approaches from the industry sector. Following the decree of April 6, 2011 on the quality management of the medication use process, some of these approaches, such as risk management, are now part of the everyday work of healthcare professionals. However, other approaches, such as business process improvement, are still poorly developed in the hospital setting. In this general review, we discuss the main approaches of business process improvements that have been used in hospitals by focusing specifically on one of the newest and most currently used: Lean.

Revue généraleDémarches d’amélioration en milieu hospitalier : du management de la qualité totale au LeanImprovement approaches in the hospital setting: From total quality management to Lean

Hospitals have to deal strong with economic constraints and increasing requirements in terms of quality and safety of care. To address these constraints, one solution could be the adoption of approaches from the industry sector. Following the decree of April 6, 2011 on the quality management of the medication use process, some of these approaches, such as risk management, are now part of the everyday work of healthcare professionals. However, other approaches, such as business process improvement, are still poorly developed in the hospital setting. In this general review, we discuss the main approaches of business process improvements that have been used in hospitals by focusing specifically on one of the newest and most currently used: Lean.

La gestion du changement

Travailler ensemble differemment : une nouvelle approche de gestion. La pharmacie hospitaliere evolue et nous faisons face a de nombreux changements. Les chefs de service doivent etre prepares au changement afin de le mener au mieux. Cet article compose de trois parties reprend les points cles d’un atelier de gestion : « Working together differently: a new approach to quality management”, organise par l’Association europeenne des pharmaciens hospitaliers a Bucarest, 30 septembre-1er octobre 2016. Afin de mener au mieux ces evolutions, nous devons mener le changement, etre familier avec le concept de gestion de la qualite en pharmacie hospitaliere et avec le concept du lean.

Gestion par la méthode lean

Travailler ensemble differemment : une nouvelle approche de gestion. La pharmacie hospitaliere evolue et nous faisons face a de nombreux changements. Les chefs de service doivent etre prepares au changement afin de le mener au mieux. Cet article compose de trois parties reprend les points cles d’un atelier de gestion : « Working together differently: a new approach to quality management”, organise par l’Association europeenne des pharmaciens hospitaliers a Bucarest, 30 septembre-1er octobre 2016. Afin de mener au mieux ces evolutions, nous devons mener le changement, etre familier avec le concept de gestion de la qualite en pharmacie hospitaliere et avec le concept du lean.

L’excellence hospitalière, ou la mise en œuvre de l'excellence opérationnelle dans le monde hospitalier

In the 80’s, the Lean Production System urged industrial companies to « think different » the operational system. Nowadays, the public hospital is facing difficulties that make revelant a global organisationnal transformation. contributions involving Lean applications in healthcare exist, but there is a lack of global and structured methodology. In this article, we propose the Healthcare Excellence framework, which transposes the Lean manufacturing principles to the specific healthcare environment. The proposed methodology for healthcare transformation is illustrated with existing projects lead in french public hospitals. MOTS-CLÉS : excellence opérationnelle, Lean, management hospitalier, excellence hospitalière.

GM-007 Clinical pharmacy services in cardiology: a Lean perspective analysis

Background With increasing economic constraints and busier hospitals, it is becoming more challenging for pharmacy services to deliver high standards of care. Lean, an improvement approach from the industry sector, has already been used to optimise manufacturing and dispensing processes in hospital pharmacies by eliminating waste and improving value for the customer. The Lean approach has not been widely published on clinical pharmacy (CP) services. Purpose To analyse CP services provided in a cardiology unit from a Lean perspective in order to identify main wastes and the main ‘value added’ activities. Materials and methods The study was performed in the cardiac CP department of a large UK teaching hospital in collaboration with a French engineering PhD student specialising in Lean thinking. A questionnaire concerning 13 main CP services provided by pharmacy was submitted to doctors and nurses to identify the high and low priority services. Direct observation over 5 days allowed realisation of a process map to identify the main activities and wastes of the CP process. A time study was conducted over 5 days to quantify the different types of wastes (as defined by Lean theory) identified from the process map. Results 21 persons responded to the questionnaire (5 doctors and 16 nurses). The three most value added CP activities were: confirming drug histories on admission (medicines reconciliation), checking prescription charts, arranging take home medicines Those 3 activities were considered high priority activities by 95.2% of the respondents. Among 8 types of waste defined by Lean we identified: Overproduction: 100% of the medicines doses written by the doctors (in abbreviation - Latin) on the discharge summary are rewritten by the pharmacist (in full) Waiting: pharmacists spend 5% of their time on the ward waiting (e.g. for a free computer or waiting for a phone answer) Non-utilised staff intellect: pharmacists spend 12% of the time on the ward verifying patients own medicines and writing ordering sheets which could be completed by a technician Transport: pharmacists spend 5% of the time transferring sheets to the pharmacy dispensary Motion: pharmacists spend 2.5% of the time on the ward looking for patients medicines charts or for their medicines This study allowed us to test the implementation of the 2 first lean principles: ‘specify the value desired by the customer’ and ‘identify the value stream for each service’. We found that from a Lean perspective, 25% of the time spent on the ward by the pharmacist was not value added; suggesting room from improvement. Conclusions To our knowledge this is one of the first attempts to apply a Lean approach to clinical pharmacy services. The Lean approach helped us gain a better understanding of our processes and highlighted opportunities to optimise our processes. The next step is to use this data to improve clinical pharmacy services. No conflict of interest.

Promoting pharmaceutical care services: a case report

To illustrate the potential benefits of ward-based clinical pharmacy, the case is reported of a patient who benefited from three successful pharmaceutical interventions. The patient visited the emergency department with an epigastric pain and a vitamin K antagonist overdose was suspected. Prothrombin complex concentrates were prescribed by the emergency physician. Analysis of the patients parameters did not show evidence of any sign of major bleeding so the order was cancelled after the intervention of the on-call pharmacy resident. Medication reconciliation performed by another resident showed two major unintended discrepancies: vigabatrin prescription had been omitted and sotalol was prescribed at the wrong dose. The physician was informed and the prescription order corrected. Eventually the pharmacy resident responsible for anticoagulant therapy education visited the patient. Careful investigation of the patients medical chart led him to suggest discontinuation of the anticoagulant therapy. This intervention resulted in the immediate discharge of the patient. This case report highlights the added value of pharmaceutical care performed on the ward and illustrates both the clinical benefit for the patient and the economic benefit for the hospital. This topic is rarely discussed in case reports. This paper demonstrates its value and argues to extend its practice.