Lean pharmacy is the implementation of lean manufacturing in pharmacy settings to reduce waste and increase efficiency. Lean manufacturing (commonly referred to as lean) is a process management philosophy derived from the Toyota Production System (TPS), which has been successfully implemented in many automobile factories for over 40 years. Moving beyond the factory wall, lean manufacturing has been applied to many area of services such as lean healthcare, lean construction, lean accounting, and lean information technology, among others.
In recent years, there has been fast growing interest in the application of lean manufacturing in the healthcare industry. With the increasing number of aging baby-boomers and rising cost of healthcare, there is a constant need for process improvement in healthcare institutions. Inpatient pharmacy benefits significantly from lean since it has to process large volume of work that requires precision and punctuality. With the application of lean methods, the inpatient pharmacy achieves a more organized work environment and a more efficient work flow. These improvements result in the reduction of lead-time, cost, and medication error.
Researchers and practitioners usually describe lean manufacturing in two layers. On the first level, lean is a philosophy. Lean defines 7 types of waste and tries to eliminate them to attain highest efficiency. The seven types of waste apply to pharmacy settings as listed:
- Transport: inefficient movement of technicians from the pharmacy to deliver medications to the wards due to hospital layout
- Inventory: expired medication and overstocking of medication
- Motion: moving of pharmacists and technicians more than necessary to perform a task due to the pharmacy layout
- Waiting: the idle time between regular order batches
- Overproduction: preparation of medications ahead of demand
- Over-processing: equipments more advanced and expensive than the tasks require
- Defects: medications that are incorrectly prepared, especially intravenous medication
On a practical level, lean includes scientific methods to identify problems based on data collection. The main methods used in lean pharmacy are:
- Value stream map identifies value-added and non-value-added steps of processes such as medication dispensing and medication preparation.
- A3 problem solving report is a visual layout of the system on A3-sized paper. The current state of the pharmacy and its problems are listed with the necessary steps to achieve the improved system.
- 5S method separates unnecessary steps from necessary ones in pharmacy processes and reorganizes them. The 5S method also emphasizes the maintenance of clean and organized work area to allow efficient work flow.
Lean manufacturing requires the use of data collection to be most effective. In healthcare settings where employees cannot set aside time to do so, institutions usually seek a separate entity to help to collect and analyze data. The project team then presents the plan for improvement, which requires all employees’ involvement until the new system is well established.
Effects of lean in pharmacy
- Value-added activities: activities that are essentials and cannot be eliminated (filling prescriptions, verifying prescriptions, verifying doses, etc.)
- Nonvalue-added activities: activities that seem necessary but are usually a waste of time (moving between departments, searching for missing medications, walking around the pharmacy to gather supplies and equipments, among many)
Application of lean tools could yield time-savings up to 48% in the drug dispensing process. The value stream map lays out the activities involved in the process such as printing records, reentering date, verifying orders, drug preparation, etc. The 5S method then guides the elimination, combination, or acceleration of certain activities to decrease the cycle time of the drug dispensing process.
The value stream map also shows that lack of task specification in the pharmacy leads to an increase in lead-time. When two pharmacists work the same shift without assigning specific tasks, they spend unnecessary time sorting out responsibilities, especially during busy hours. This problem could be eliminated by creating a system where one pharmacist focuses on entering order, while the other takes care of miscellaneous tasks.
The 5S method strongly focuses on clearing and cleaning the work area. Frequently used supplies are grouped together. Instead of the original alphabetical bin system for medication storage, basic and fast moving medications are put into easily accessible bins in the new color-coded bin system. This organization of the workplace plays an important role in decreasing the searching time and eliminating clusters.
Two main sources of medication waste are disorganized medication inventory and inefficient production.
Improvement in medication inventory
A value stream map shows that lack of systematic inventory management and rotation of products result in excessive expired medication and overstocking. The 5S method suggests the following solutions:
- Monthly checks of inventory to identify and remove expired products
- First in, first out method to rotate medication. The older drugs must be used before the newer ones.
- New color-coded bin system to enhance visual control
- Established bin par level to determine adequate restocking amount
Reduction of medication waste
“Just-in-time” (JIT) is a lean concept that suggests making products only when there is demand. Applying JIT, intravenous medication is prepared and delivered closer to the administration time. The number of batches produced a day could be increased or decreased to best suit the needs of the operation. This initiative prevents overproduction, expired products, and unused products that are wasted when the orders are changed.
Missing medication minimization
Missing medication is both a waste, due to duplicate resource and labor to remake, and a medication error. Applying lean tools, the main causes and solutions to missing medications are identified and listed in the chart.
|Delivery failure||Nurses are not aware of the delivery location and of refrigerated items||Condense delivery units and educate the nursing staff and pharmacy technicians on the procedure
Notify nurses when a refrigerated item is delivered by inserting a slip in the regular delivery bin
|Communication failure||Doctors amend or cancel new orders after the orders are printed in the pharmacy, resulting in duplicate or unprepared orders||Doctors fax the new order stating “Order changed” to notify pharmacists|
|Inevitable changes||Changes of daily doses by doctors||Adjusting production frequency to allow time for change thus avoiding preparing medications too far in advance|
- Sobek DK and Jimmerson C. 2003. “Applying the Toyota Production System to a Hospital Pharmacy”. Proceedings of the 2003 Industrial Engineering Research Conference, Portland, OR [Internet]. [cited 2010 Oct 2]
- Hintzen B, Knoer S, Van Dyke C, and Milavitz B. 2009. “Effect of lean process improvement techniques on a university hospital inpatient pharmacy”. Am J Health-Syst Pharm [Internet] (66):2042-2047. [cited 2010 Sep 29]
- Al-Araidah O et al. 2010. “Lead-Time Reduction Utilizing Lean Tools Applied to Healthcare: The Inpatient Pharmacy at a Local Hospital”. J Healthc Qual [Internet]. (32)1:59-66. [cited 2010 Sep 29].
- Craven E, Clark J, Cramer M, Corwin S, and Cooper M. 2006. “NewYork-Presbyterian Hospital Uses Six Sigma to Build a Culture of Quality and Innovation”. Journal of Organizational Excellence [Internet] (25)4:11-19. [cited 2010 Sep 29]
- Davis J. 2009. “Use of Lean Production to Reduce Waste When Compounding Sterile Pharmaceutical Products”. Hospital Pharmacy [Internet] (44)11:974-977. [cited 2010 Oct 20]