Waste and Value Added

2. Waste and Value Added • Waste – defined as any activity that does not add value to the service or product provided • Adds to the cost of operations • Impairs ability to meet core performance metrics • Decreases ‘customer’ satisfaction Successful adaption of continuous improvement principles can reduce waste and non-value added activities

3. Sources of Waste Overproduction Producing too much or producing too soon Intellect Failure to fully utilize the time and talents of people Transportation Any nonessential transport Inventory Maintaining more inventory than minimum to get the job done Motion Any motion that does not add value Rework Correcting any errors or doing completion steps not done before Waiting Waiting for the next step in the process without added value Processing Over-processing, unnecessary steps

4. 8 Sources of WasteWaiting • Waiting – Any idle time in the process that would be considered non-value time. • Examples • Nursing waiting for medications • Pharmacist waiting for medications to be prepared before checking product • Patients waiting for discharge paperwork to be completed. • 90% • Waiting may constitute up to • of the cycle time of a process

5. 8 Sources of WasteOverproduction • Overproduction – Preparing products ahead of time or preparing more than is required • Examples: • Requesting additional labs before receiving initial laboratory results • Infrequent large batches, farther in advance of use (utilizing more time and with increased risk of wasted doses)

6. 8 Sources of WasteRework • Rework – Correcting mistakes/errors, remaking products • Examples • Medications not transferred with patient • Re-preparing any medication (IV, oral, etc) • Reordering labs

7. 8 Sources of WasteMotion • Motion – Any movement of peoplethat does not add value • Examples: • Staff searching for medications or supplies • Staff looking for information • Movement between locations to fulfill orders (example: ADC fills)

8. 8 Sources of WasteOver-Processing • Over-Processing- Excessive processing or doing more than is minimally required • Examples: • Excessive paperwork to meet regulatory compliance • Duplicate documentation • Multiple forms completed with same information

9. 8 Sources of WasteInventory • Inventory- Maintaining inventory that is more than the minimum • Examples: • Overstocked medications on units or in pharmacy • Maintaining full automated dispensing cabinets • Expired medications Check internal and regulatory policies requiring minimum required inventory

10. 8 Sources of WasteIntellect • Intellect - Failing to use the talent and knowledge of the organization • Examples: • Pharmacists performing technician related tasks • Performing process improvement without consulting front line staff members in the process

11. 8 Sources of WasteTransportation • Transportation – Transporting patients or materials around an organization that does not add value to the product or service • Examples: • Moving patients between rooms with no added value • Travel to storage room to retrieve medications repeatedly (Medications not located near point of work)

12. Reducing Waste in Pharmacies • Waste can be reduced through incorporating continuous improvement principles and Lean methods • Standardize work and simplify workflow • See Future Webinar on ‘5S’ • Utilize visual management • For quick and easy prioritization of work • Prevent errors or process failures • Identify and resolve root causes of problems • Avoid work-arounds

13. Reducing Waste in Pharmacies • Ensure point-of-care access to information • Reconsider role of batching medications, considering just-in-time preparation • To minimize likelihood of rework or wasted doses • Simplify processes when possible • Synchronize steps within workflow • Implement downstream triggers to signal need for next step

14. Reducing Waste – Root Causes To achieve improved results: Determine Problem Identify Root Cause Change the Conditions • Do not address the symptom • Continue to investigate all sources of waste by asking “Why?” • See Webinar on the 5 Why’s

15. Operational Pearls • Examine physical workflow to identify opportunities to limit motion and transportation related waste • Limit manual documentation when possible • Process map various pharmacy process and identify sources of waste • Identify technology that can reduce rework, motion, over-processing, or other sources of waste

16. Three Immediate Steps • Collect Data regarding frequency of phone calls from Nursing for missing medications • Waiting, Rework, Motion, Intellect, Transportation • Examine Batch processing times • Waiting, Overproduction, Rework, Motion, Inventory, Transportation • Examine one hour of pharmacy workflow and document sources of waste • Waiting, motion, rework, inventory, transportation

17. Thank You Thank you for joining us for this Pharmacy Process Improvement Webinar. Please view our other webinars on pharmacy operational process improvement, available at www.plusdeltatech.com