The  informa,on  contained  in  this  presenta,on,  the  source  code  and  underlying  program    are  protected  by  copyright  owned  by  PlusDelta  Technologies,  LLC.  

Pharmacy Process Improvement Series:

Improving Pharmacy Process With DMAIC  

PlusDelta Technologies, LLC  

The  informa,on  contained  in  this  presenta,on,  the  source  code  and  underlying  program    are  protected  by  copyright  owned  by  PlusDelta  Technologies,  LLC.  

Six  Sigma  

•  Six  Sigma    – Data  driven  methodology  for  improving  a  process  

•  Improve  the  quality  of  process  outputs  –  Iden,fy  and  eliminate  defects  or  errors  within  a  process  –  In  most  environments,  DMAIC  is  undertaken  to  reduce  costs,  improve  profit  or  improve  customer  sa,sfac,on  

•  The  term  “six  sigma”  refers  to  a  process  that  produces  less  than  3.4  defects  per  million  opportuni,es  

The  Goal  is  99.9937%!!  

The  informa,on  contained  in  this  presenta,on,  the  source  code  and  underlying  program    are  protected  by  copyright  owned  by  PlusDelta  Technologies,  LLC.  

DMAIC  

•  One  type  of  Six  Sigma  methodology    – Used  to  ensure  quality  within  an  exis,ng  process  – A  data  driven  improvement  cycle  

•  An  easily  managed  systema,c  process  to  deliver  measurable  results  and  accelerate  change  

Reduce  Varia+on  and  Defects!  

The  informa,on  contained  in  this  presenta,on,  the  source  code  and  underlying  program    are  protected  by  copyright  owned  by  PlusDelta  Technologies,  LLC.  

Variability  &  Defects  

Process  1  

Process  2  

Process  3  

The  informa,on  contained  in  this  presenta,on,  the  source  code  and  underlying  program    are  protected  by  copyright  owned  by  PlusDelta  Technologies,  LLC.  

DMAIC  

DEFINE    

MEASURE  

ANALYZE  IMPROVE  

CONTROL  

The  informa,on  contained  in  this  presenta,on,  the  source  code  and  underlying  program    are  protected  by  copyright  owned  by  PlusDelta  Technologies,  LLC.  

DEFINE  

• Define  the  business  case  •  Iden,fy  the  problem  or  key  issue  

• Write  a  problem  statement  • What  does  the  “customer”  want  you  to  address?  • What  is  cri,cal  to  quality  (CTQ)?  • Define  scope,  objec,ve  and  goals  of  the  project  • Develop  the  ini,al  high-­‐level  process  map  

D M A   I   C  

The  informa,on  contained  in  this  presenta,on,  the  source  code  and  underlying  program    are  protected  by  copyright  owned  by  PlusDelta  Technologies,  LLC.  

DEFINE  -­‐  Example  

• Hospital  ABC’s  Inpa,ent  pharmacy  has  iden,fied  that  their  ability  to  deliver  medica,ons  on-­‐,me  or  deliver  STAT  medica,ons  within  30  minutes  is  inconsistent  • Nursing  sa,sfac,on  is  falling  as  a  result  • Pa,ents  not  receiving  medica,ons  in  ,mely  manner  in  some  cases  

• Problem:  • Failure  to  deliver  medica,ons  on  ,me  results  in  increased  nursing  workload,  increased  costs  due  to  missing  medica,ons,  and  wasted  produc,vity.    

• In  order  to  reduce  missing  medica,ons  and  improve  produc,vity,  medica,ons  need  to  be  consistently  delivered  on-­‐,me  

D M A   I   C  

The  informa,on  contained  in  this  presenta,on,  the  source  code  and  underlying  program    are  protected  by  copyright  owned  by  PlusDelta  Technologies,  LLC.  

The  Problem  

Iden,fied  failure  modes  (FMEA)  –  Incomplete  or  inaccurate  orders  

on  admission,  requiring  pharmacist  interven,on  to  correct  

–  Due  ,mes  inaccurate  or  inconsistently  entered  as  part  of  order  

–  No  tracking  of  delivery  process  –  Mul,ple  and  invalid  delivery  

loca,ons  

Medica,on  order  

received  

Pharmacist  verifies  order  

Label  prints  in  pharmacy  

Technician  fills  order  

Order  delivered  

Poten,al  root  causes  –  Due  ,mes  inaccurate  or  

inconsistently  entered    –  Lack  of  visibility  into  process,  

staff  unaware  of  priori,es  –  Invalid  delivery  loca,ons  

D M A   I   C  

The  informa,on  contained  in  this  presenta,on,  the  source  code  and  underlying  program    are  protected  by  copyright  owned  by  PlusDelta  Technologies,  LLC.  

MEASURE  

• What  are  the  core  metrics  for  the  problem?  • Define  each  metric,  as  well  as  baseline  for  each  metric  

• Map  out  the  current  state  of  the  process  • Avoid  mapping  out  the  process  as  it  should  be  or  as  it  is  assumed  to  be  

•  Include  individuals  with  a  good  working  knowledge  of  the  process  and  how  it  works  

• Addi,onal  useful  tools:  SIPOC  (see  our  webinar  on  SIPOC)  

D M A   I   C  

The  informa,on  contained  in  this  presenta,on,  the  source  code  and  underlying  program    are  protected  by  copyright  owned  by  PlusDelta  Technologies,  LLC.  

ANALYZE  

• Analyze  all  relevant  data  and  process  maps  •  Summarize  inves,ga,ons  •  Summarize  root  cause  analysis  • Validate  root  cause  if  appropriate  • Determine  what  can  be  explained  vs  what  is  s,ll  not  fully  understood  

• Numerous  tools  may  be  useful:  5  Whys,  run  charts,  cause  and  effect  diagram  

D M A   I   C  

The  informa,on  contained  in  this  presenta,on,  the  source  code  and  underlying  program    are  protected  by  copyright  owned  by  PlusDelta  Technologies,  LLC.  

MEASURE  AND  ANALYZE  

•  Data  was  collected  randomly  across  3  months  which  were  representa,ve  of  typical  volume,  staffing  

• While  the  majority  of  medica,ons  are  delivered  prior  to  the  due  ,me,  42%  of  medica,ons  were  not  delivered  on  ,me  

•  Further  analysis  demonstrated  that  medica,ons  prepared  in  the  IV  room  represented  ~60%  of  the  medica,ons  that  were  delivered  aoer  the  due  ,me  

•  The  range  for  late  deliveries  was  between  1  min  and  75  minutes  past  due  ,me  

•  Staff  were  completely  unaware  of  where  medica,ons  were  in  the  process  and  thus  were  unable  to  move  medica,ons  to  the  next  step  in  the  process  

D M A   I   C  

The  informa,on  contained  in  this  presenta,on,  the  source  code  and  underlying  program    are  protected  by  copyright  owned  by  PlusDelta  Technologies,  LLC.  

IMPROVE  

• Brainstorm  poten,al  solu,ons  • Evaluate  cost,  complexity,  benefit,  risk  • Priori,ze  solu,ons  (long  term  vs  interim  solu,ons)  

• Communicate  an  implementa,on  plan  •  Implement  solu,on  • Assess  solu,on  effec,veness  

D M A   I   C  

The  informa,on  contained  in  this  presenta,on,  the  source  code  and  underlying  program    are  protected  by  copyright  owned  by  PlusDelta  Technologies,  LLC.  

IMPROVE  

• A  good  solu,on…  • Is  well  understood  and  supported  by  the  organiza,on  • Addresses  the  issues  of  problem  containment  and  focuses  on  preven,on  and  elimina,on  of  non-­‐value-­‐added  ac,vi,es  

• Maximizes  the  effec,veness  of  the  solu,on  while  minimizing  complexity  and  cost  

• Is  durable,  thus  remains  effec,ve  for  an  extended  period  of  ,me  

D M A   I   C  

The  informa,on  contained  in  this  presenta,on,  the  source  code  and  underlying  program    are  protected  by  copyright  owned  by  PlusDelta  Technologies,  LLC.  

IMPROVE  

• Standardize  process  with  technology  support  • Con,nuous  monitoring  of  process  • Just-­‐in-­‐,me  medica,on  prepara,on  and  delivery  

• Accurate  due  ,mes  entered  into  pharmacy  informa,on  system  

D M A   I   C  

The  informa,on  contained  in  this  presenta,on,  the  source  code  and  underlying  program    are  protected  by  copyright  owned  by  PlusDelta  Technologies,  LLC.  

CONTROL  

• Iden,fy  opportuni,es  for  standardiza,on  • Determine  stability  of  the  solu,on  • Determine  controls  • Realize  the  benefits  of  the  solu,on  • Debrief/reflect  on  the  improvement  process  

D M A   I   C  

The  informa,on  contained  in  this  presenta,on,  the  source  code  and  underlying  program    are  protected  by  copyright  owned  by  PlusDelta  Technologies,  LLC.  

CONTROL  

• Standardiza,on  ooen  provides  the  greatest  benefit  to  the  organiza,on  

• Numerous  types  of  controls  • Measurement  based  (scorecard)  • Documenta,on  (process  flow,  writen  procedures)  • Design  (error-­‐proofing)  • Periodic  Checks  (scheduled  maintenance)  •  Incen,ves  

D M A   I   C  

The  informa,on  contained  in  this  presenta,on,  the  source  code  and  underlying  program    are  protected  by  copyright  owned  by  PlusDelta  Technologies,  LLC.  

CONTROL  

•  Implemented  technology  solu,on  that  incorporated:  • Real-­‐,me  scorecard/dashboard  • Ensures  visibility  into  the  process  and  drives  standardized  process  

•  Incorporated  educa,on  of  staff  on  delivery  process  

D M A   I   C  

The  informa,on  contained  in  this  presenta,on,  the  source  code  and  underlying  program    are  protected  by  copyright  owned  by  PlusDelta  Technologies,  LLC.  

SUMMARY  

•  DMAIC  is  an  effec,ve  method  to  improve  exis,ng  processes  within  an  organiza,on  – Systema,c  approach  – A  data  driven  improvement  cycle  

•  More  detailed  informa,on  regarding  the  use  of  Six  Sigma  and  LEAN  in  pharmacy  opera,ons  will  be  provided  in  future  webinars  

 

The  informa,on  contained  in  this  presenta,on,  the  source  code  and  underlying  program    are  protected  by  copyright  owned  by  PlusDelta  Technologies,  LLC.  

Thank  You  

 Thank  you  for  joining  us  for  this  Pharmacy  

Process  Improvement  Webinar.      

Please  view  our  other  webinars  on  pharmacy  process  improvement,  available  at  

www.plusdeltatech.com