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Sallam M. Enhancing Hospital Pharmacy Operations Through Lean and Six Sigma Strategies: A Systematic Review. Cureus 2024; 16:e57176. [PMID: 38681323 PMCID: PMC11056219 DOI: 10.7759/cureus.57176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2024] [Indexed: 05/01/2024] Open
Abstract
Hospital pharmacies are integral to the healthcare system, and evaluating the factors influencing their efficiency and service standards is imperative. This analysis offers global insights to assist in developing strategies for future enhancements. The objective is to identify the optimal Lean Six Sigma methodologies to improve workflow and quality of hospital pharmacy services. A strategic search, aligned with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, encompassed an extensive range of academic databases, including Scopus, PubMed/Medline, Web of Science, and other sources for relevant studies published from 2009 to 2023. The focus was on management tactics and those examining outcomes, prioritizing publications reflecting pharmacy operations management's state. The quality of the selected articles was assessed, and the results were combined and analyzed. The search yielded 1,447 studies, of which 73 met the inclusion criteria. The systematic review found a low to moderate overall risk of bias. The number of publications rose during the coronavirus disease (COVID-19) outbreak. Among studies, research output in the United States of America represented 26% of the total. Other countries such as Indonesia, Spain, Canada, China, Saudi Arabia, the United Arab Emirates, and the United Kingdom also made significant contributions. Each country accounted for 12%, 8%, 7%, 5%, 5%, 5%, and 5%, respectively. The pharmacy journals led with 26 publications, and healthcare/medical with 14. The quality category came next with 12 articles, while seven journals represented engineering. Studies used empirical and observational methods, focusing on practice quality enhancement. The process control plan had 26 instances, and the define, measure, analyze, improve, and control (DMAIC) was identified 13 times. The sort, set in order, shine, standardize, and sustain (5S) ranked third, totaling seven occurrences. Failure mode and effects analysis (FMEA) and root cause analysis were moderately utilized, with six and four instances, respectively. Poka-Yoke (mistake-proofing measures) and value stream mapping were each counted three times. Quality improvement and workflow optimization dominated managerial strategies in 22 (30.14%) studies each, followed by technology integration in 15 (20.55%). Cost, patient care, and staffing each featured in three (4.11%) studies, while two (2.74%) focused on inventory management. One (1.37%) study each highlighted continuing education, collaboration, and policy changes. Analysis of the 73 studies on Lean and Six Sigma in hospital pharmacy operations showed significant impacts, with 26% of studies reporting decreased medication turnaround time, 15% showing process efficiency improvements, and 11% each for enhanced inventory management and bottleneck/failure mode reduction. Additionally, 9% of studies observed decreased medication errors, 8% noted increased satisfaction and cost savings, 6% identified enhancements in clinical activities, 3% improved prescription accuracy, 2% reduced workflow interruptions, and 1% reported increased knowledge. Also, this study has identified key strategies for service delivery improvement and the importance of quality practices and lean leadership. To the best of the author's knowledge, this research is believed to be the first in-depth analysis of Lean and Six Sigma in the hospital pharmacy domain, spanning 15 years from 2009 to 2023.
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Affiliation(s)
- Mohammed Sallam
- Department of Pharmacy, Mediclinic Parkview Hospital, Mediclinic Middle East, Dubai, ARE
- Department of Management, School of Business, International American University, Los Angeles, USA
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Zhang D, Wang W, Wei F, Lu Y, Ji Y. Effects of medical and nursing group rounds combined with emotional nursing on quality of life and emotion in patients with malignant lymphoma. Medicine (Baltimore) 2023; 102:e35463. [PMID: 37800771 PMCID: PMC10553090 DOI: 10.1097/md.0000000000035463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 09/12/2023] [Indexed: 10/07/2023] Open
Abstract
To investigate the effects of medical and nursing visits in the same group combined with emotional care on the quality of life and emotions of patients with malignant lymphoma. One hundred sixty cases of malignant lymphoma patients admitted to our hospital from March 2020 to July 2022 were selected as retrospective study subjects and divided into 80 cases each in the control group and the observation group according to the different nursing methods. Among them, the control group implemented conventional emotional care, and the observation group implemented medical and nursing visits in the same group on the basis of the control group. The differences in quality of life, anxiety-related scores and sleep quality between the 2 groups of patients with malignant lymphoma before and after nursing were compared. After nursing, the mental vitality (P = .015), social interaction (P < .001), emotional restriction (P = .007), and mental status (P = .028) scores of patients in the observation group were higher than those in the control group. After nursing, the Self-Rating Anxiety Scale (P < .001) and Hamilton Anxiety Scale (P < .001) of malignant lymphoma patients in the observation group were significantly lower than those in the control group, and the sleep quality (P < .001), increased awakening (P < .001), sleep disturbance (P < .001), night terrors (P < .001) scores in the observation group were significantly lower than those in the control group. The combination of medical and nursing group checkups and emotional care can effectively improve the quality of life and sleep of patients with malignant lymphoma and reduce adverse emotions, which is beneficial to patient prognosis and clinical treatment. It has certain reference value for the care of patients with malignant lymphoma.
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Affiliation(s)
- Dan Zhang
- Department of Hematological, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Weijuan Wang
- Department of Hematological, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Feng Wei
- Department of Hematological, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yin Lu
- Department of Hematological, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Ying Ji
- Department of Hematological, The First Affiliated Hospital of Soochow University, Suzhou, China
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Quality management tools applied to drug dispensing in hospital pharmacy: A scoping review. Res Social Adm Pharm 2023; 19:582-590. [PMID: 36473787 DOI: 10.1016/j.sapharm.2022.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 10/29/2022] [Accepted: 11/22/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND The process of drug dispensing in hospital pharmacies (HPs) is one of the essential steps in health care, but presents high complexity due to the diversity of professionals and clinical conditions of patients. Therefore, the use of quality management tools may be an important strategy to improve patient safety and to achieve institutional goals, including user satisfaction and reduction of costs. OBJECTIVE This scoping review sought to describe quality management tools applied to drug dispensing in HPs; quality indicators used and results obtained. METHODS This scoping review was developed according to the Cochrane methodology and reported according to Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA), being registered at Open Science Framework (https://doi.org/10.17605/OSF.IO/KP3AJ). The searches were performed in electronic databases Medline, Cochrane Library, Embase, CINAHL and Lilacs, with no limit of date or language. Studies on quality management tools applied to drug dispensing in HPs were assessed for eligibility, extracted and compiled in a narrative form. RESULTS From the 1318 studies identified, 11 were eligible for this review. The quality management tools more frequently reported were those related to the definition of root cause (n = 4; 36%), e.g. DMAIC (Define, Measure, Analyze, Improve and Control) and the cause and effect diagram; tools for risk management, such as FMEA (Failure Mode and Effect Analysis) and its variations (n = 4; 36%); and tools related to the LSS (LEAN Six Sigma) principles (n = 3; 27%). The quality indicators used to monitor the results were, mainly, work team satisfaction, time spent performing activities and reduction of errors and costs. CONCLUSIONS The use of quality management tools showed a tendency to improve the indicators of the drug dispensing process in HPs, such as increase in work team satisfaction, reduction of time spent performing activities, errors and costs, improving the quality of services.
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Lean six-sigma (LSS) applications in hospitals: a decade (2011–2020) bibliometric analysis. INTERNATIONAL JOURNAL OF PRODUCTIVITY AND PERFORMANCE MANAGEMENT 2022. [DOI: 10.1108/ijppm-07-2021-0432] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThis study examines the research landscape of Lean Six-Sigma (LSS) applications in hospitals for the period of the last decade (2011–2020) to derive answers to the research questions RQ 1: What are the current publication trends for the application of LSS in hospitals concerning document type, Journal (Source), active authors and country-wise publications and their comparison in the two most reputed scientific databases, i.e. Scopus and Web of Science (WoS), RQ2: What are the clusters based on the authors and keywords? RQ3: What are the research trends and author's productivity in LSS applications in Hospitals? RQ4: What are the future research areas?Design/methodology/approachThis article compares these two databases (Scopus and WoS) based on publication pattern, document type, active authors and co-citation analysis. This article analyzes the core sources, author's productivity, globally cited articles, word growth analysis, thematic map and world collaboration map on the WoS and Scopus dataset. The software used are Vosviewer, Biblioshiny (R Package for Bibliometric) and M.S. Excel.FindingsThe application of LSS in hospitals is a niche theme. In the WoS database International Journal of Lean Six-Sigma and in Scopus database International Journal of Health Care Quality Assurance are the most relevant sources publishing research articles in this field. The USA has the highest scientific production in this field. Among the authors, Antony J is the most active author in this area, with the highest contribution over the years.Originality/valueThis study fills the literature gap by mapping the field of LSS in hospitals.
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Daly A, Teeling SP, Garvey S, Ward M, McNamara M. Using a Combined Lean and Person-Centred Approach to Support the Resumption of Routine Hospital Activity following the First Wave of COVID-19. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052754. [PMID: 35270447 PMCID: PMC8910100 DOI: 10.3390/ijerph19052754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 02/19/2022] [Accepted: 02/23/2022] [Indexed: 11/16/2022]
Abstract
The unexpected advent of the COVID-19 pandemic led to a sudden disruption of routine medical care, with a subsequent reorganization of hospital structures and of care. Case studies are becoming available in the literature referring to the logistical difficulties involved in a hospital resuming normal activity following the first COVID-19 lockdown period. This paper details the experience of a study site, a private hospital in Dublin, Ireland, in the redesign of service delivery in compliance with new COVID-19 prevention regulations to facilitate the resumption of routine hospital activity following the first wave of COVID-19. The aim was to resume routine activity and optimize patient activity, whilst remaining compliant with COVID-19 guidelines. We employed a pre-/post-intervention design using Lean methodology and utilised a rapid improvement event (RIE) approach underpinned by person-centred principles. This was a system-wide improvement including all hospital staff, facilitated by a specific project team including the chief operation officer, allied therapy manager (encompassing health and social care professionals), infection prevention and control team, head of surgical services, clinical nurse managers, patient services manager and the head of procurement. Following our intervention, hospital services resumed successfully, with the initial service resumption meeting the organizational target of a 75% bed occupancy rate, while the number of resumed surgeries exceeded the target by 13%. Our outpatient visits recovered to exceed the attendance numbers pre-COVID-19 in 2019 by 10%. In addition, patient satisfaction improved from 93% to 95%, and importantly, we had no in-hospital patient COVID-19 transmission in the study period of July to December 2020.
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Affiliation(s)
- Ailish Daly
- Beacon Hospital, Beacon Court, Bracken Road, Sandyford Business Park, Sandyford, Dublin 18, D18 AK68 Dublin, Ireland;
- Correspondence:
| | - Sean Paul Teeling
- UCD Centre for Interdisciplinary Research, Education & Innovation in Health Systems, Midwifery & Health Systems, UCD Health Sciences Centre, School of Nursing, D04 V1W8 Dublin, Ireland; (S.P.T.); (M.M.)
- Centre for Person-Centred Practice Research, Division of Nursing, School of Health Sciences, Queen Margaret University, Musselburgh EH21 6UU, UK
| | - Suzanne Garvey
- Beacon Hospital, Beacon Court, Bracken Road, Sandyford Business Park, Sandyford, Dublin 18, D18 AK68 Dublin, Ireland;
| | - Marie Ward
- Centre for Innovative Human Systems, School of Psychology, Trinity College, The University of Dublin, D02 PN40 Dublin, Ireland;
| | - Martin McNamara
- UCD Centre for Interdisciplinary Research, Education & Innovation in Health Systems, Midwifery & Health Systems, UCD Health Sciences Centre, School of Nursing, D04 V1W8 Dublin, Ireland; (S.P.T.); (M.M.)
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Teeling SP, Dewing J, Baldie D. A Realist Inquiry to Identify the Contribution of Lean Six Sigma to Person-Centred Care and Cultures. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910427. [PMID: 34639727 PMCID: PMC8507723 DOI: 10.3390/ijerph181910427] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/30/2021] [Accepted: 10/01/2021] [Indexed: 11/16/2022]
Abstract
A lack of fidelity to Lean Six Sigma's (LSS) philosophical roots can create division between person-centred approaches to transforming care experiences and services, and system wide quality improvement methods focused solely on efficiency and clinical outcomes. There is little research into, and a poor understanding of, the mechanisms and processes through which LSS education influences healthcare staffs' person-centred practice. This realist inquiry asks 'whether, to what extent and in what ways, LSS in healthcare contributes to person-centred care and cultures'. Realist review identified three potential Context, Mechanism, Outcome configurations (CMOcs) explaining how LSS influenced practice, relating to staff, patients, and organisational influences. Realist evaluation was used to explore the CMOc relating to staff, showing how they interacted with a LSS education Programme (the intervention) with CMOc adjudication by the research team and study participants to determine whether, to what extent, and in what ways it influenced person-centred cultures. Three more focused CMOcs emerged from the adjudication of the CMOc relating to staff, and these were aligned to previously identified synergies and divergences between participants' LSS practice and person-centred cultures. This enabled us to understand the contribution of LSS to person-centred care and cultures that contribute to the evidence base on the study of quality improvement beyond intervention effectiveness alone.
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Affiliation(s)
- Seán Paul Teeling
- UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems, School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin D04 V1W8, Ireland
- Mater Lean Academy, Mater Misericordiae University Hospital, Eccles Street, Dublin D07 R2WY, Ireland
- Centre for Person-Centred Practice Research Division of Nursing, School of Health Sciences, Queen Margaret University Drive, Queen Margaret University, Musselburgh, East Lothian, Scotland EH21 6UU, UK; (J.D.); (D.B.)
- Correspondence:
| | - Jan Dewing
- Centre for Person-Centred Practice Research Division of Nursing, School of Health Sciences, Queen Margaret University Drive, Queen Margaret University, Musselburgh, East Lothian, Scotland EH21 6UU, UK; (J.D.); (D.B.)
| | - Deborah Baldie
- Centre for Person-Centred Practice Research Division of Nursing, School of Health Sciences, Queen Margaret University Drive, Queen Margaret University, Musselburgh, East Lothian, Scotland EH21 6UU, UK; (J.D.); (D.B.)
- Nursing and Midwifery Directorate, NHS Grampian, Scotland AB25 2ZN, UK
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McCarthy SE, Jabakhanji SB, Martin J, Flynn MA, Sørensen J. Reporting standards, outcomes and costs of quality improvement studies in Ireland: a scoping review. BMJ Open Qual 2021; 10:bmjoq-2020-001319. [PMID: 34341016 PMCID: PMC8330587 DOI: 10.1136/bmjoq-2020-001319] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 07/08/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To profile the aims and characteristics of quality improvement (QI) initiatives conducted in Ireland, to review the quality of their reporting and to assess outcomes and costs. DESIGN Scoping review. DATA SOURCES Systematic searches were conducted in PubMed, Web of Science, Embase, Google Scholar, Lenus and rian.ie. Two researchers independently screened abstracts (n=379) and separately reviewed 43 studies identified for inclusion using a 70-item critique tool. The tool was based on the Quality Improvement Minimum Quality Criteria Set (QI-MQCS), an appraisal instrument for QI intervention publications, and health economics reporting criteria. After reaching consensus, the final dataset was analysed using descriptive statistics. To support interpretations, findings were presented at a national stakeholder workshop. ELIGIBILITY CRITERIA QI studies implemented and evaluated in Ireland and published between January 2015 and April 2020. RESULTS The 43 studies represented various QI interventions. Most studies were peer-reviewed publications (n=37), conducted in hospitals (n=38). Studies mainly aimed to improve the 'effectiveness' (65%), 'efficiency' (53%), 'timeliness' (47%) and 'safety' (44%) of care. Fewer aimed to improve 'patient-centredness' (30%), 'value for money' (23%) or 'staff well-being' (9%). No study aimed to increase 'equity'. Seventy per cent of studies described 14 of 16 QI-MQCS dimensions. Least often studies reported the 'penetration/reach' of an initiative and only 35% reported health outcomes. While 53% of studies expressed awareness of costs, only eight provided at least one quantifiable figure for costs or savings. No studies assessed the cost-effectiveness of the QI. CONCLUSION Irish QI studies included in our review demonstrate varied aims and high reporting standards. Strategies are needed to support greater stimulation and dissemination of QI beyond the hospital sector and awareness of equity issues as QI work. Systematic measurement and reporting of costs and outcomes can be facilitated by integrating principles of health economics in QI education and guidelines.
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Affiliation(s)
- Siobhán Eithne McCarthy
- Graduate School of Healthcare Management, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Samira Barbara Jabakhanji
- Healthcare Outcomes Research Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Jennifer Martin
- National Quality Improvement Team, Health Service Executive, Dublin, Ireland
| | - Maureen Alice Flynn
- National Quality Improvement Team, Health Service Executive, Dublin, Ireland
| | - Jan Sørensen
- Healthcare Outcomes Research Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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Zimmermann GDS, Siqueira LD, Bohomol E. Lean Six Sigma methodology application in health care settings: an integrative review. Rev Bras Enferm 2021; 73:e20190861. [PMID: 33338158 DOI: 10.1590/0034-7167-2019-0861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 07/01/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to analyze the scientific production on the results of Lean Six Sigma methodology in health care institutions. METHODS an integrative literature review, with the following question: what are the results in health institutions using Lean Six Sigma and Six Sigma methodology? The search was carried out at MEDLINE, LILACS, BDENF, CINAHL, Web of Science, and Scopus, with no time frame. RESULTS thirty-four articles were included, published between 2005 and 2019, of which 52.9% came from the United States of America. The most commonly found improvements were in hospital institutions and from the perspective of customers and internal processes. CONCLUSION using Lean Six Sigma methodology proved to be effective in the different health care settings, evidencing a gap in its application regarding people engagement and training.
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Affiliation(s)
| | - Luciola Demery Siqueira
- Universidade Federal de São Paulo, Escola Paulista de Enfermagem. São Paulo, São Paulo, Brazil
| | - Elena Bohomol
- Universidade Federal de São Paulo, Escola Paulista de Enfermagem. São Paulo, São Paulo, Brazil
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Agarwal P, Poeran J, Meyer J, Rogers L, Reich DL, Mazumdar M. Bedside medication delivery programs: suggestions for systematic evaluation and reporting. Int J Qual Health Care 2020; 31:G53-G59. [PMID: 31053860 DOI: 10.1093/intqhc/mzz014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 12/04/2018] [Accepted: 02/12/2019] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Several factors lead to medication non-adherence after hospital discharge. Hospitals and pharmacies have implemented bedside medication delivery (BMD) programs for patients, in an attempt to reduce barriers and improve medication adherence. Here, we provide a critical review of the literature on these programs. DATA SOURCES We conducted a literature search on BMD programs in PubMed, Google Scholar, Scopus and a general Google search using these keywords: 'medication delivery bedside', 'discharge medication delivery', 'meds to bedside' and 'meds to beds'. STUDY SELECTION We identified 10 reports and include data from all reports. DATA EXTRACTION Data on study characteristics and settings were extracted along with four outcomes: medication error, patient satisfaction, 30-day hospital readmission and visits to the emergency department. RESULTS OF DATA SYNTHESIS Of the 10 reports, only 4 were peer-reviewed publications; others were reported in the lay press. Outcomes were reported in both qualitative and quantitative terms. Less than half of reports provided quantitative data on 30-day readmission and patient satisfaction. Others suggested qualitative improvement in these outcomes but did not provide data or specific details. None reported outcomes of their programs beyond 30 days. CONCLUSION We highlight the need for increased use of optimal program design and more rigorous evaluations of the impact of BMD programs. We also provide guidelines on the types of evaluations that are likely needed and encourage improved reporting.
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Affiliation(s)
- Parul Agarwal
- Department of Population Health Science and Policy, Institute for Health Care Delivery Science, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1077, New York NY 10029, USA
| | - Jashvant Poeran
- Department of Population Health Science and Policy, Institute for Health Care Delivery Science, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1077, New York NY 10029, USA
| | - Joanne Meyer
- Department of Pharmacy, The Mount Sinai Hospital, Annenberg B2-12, One Gustave L. Levy Place, Box 1211, New York NY 10029, USA
| | - Linda Rogers
- Mount Sinai-National Jewish Respiratory Institute, The Mount Sinai Hospital, 10 East 102nd Street, 5th Floor, New York NY 10029, USA
| | - David L Reich
- Anesthesiology and Perioperative Pain Medicine, The Mount Sinai Hospital, 10 East 102nd Street, 5th Floor, New York NY 10029, USA
| | - Madhu Mazumdar
- Department of Population Health Science and Policy, Institute for Health Care Delivery Science, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1077, New York NY 10029, USA
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Reducing medication errors using lean six sigma methodology in a Thai hospital: an action research study. INTERNATIONAL JOURNAL OF QUALITY & RELIABILITY MANAGEMENT 2020. [DOI: 10.1108/ijqrm-10-2019-0334] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PurposeThe purpose of this paper is to illustrate the use of Lean Six Sigma (LSS) and its associated tools to reduce dispensing errors in an inpatient pharmacy of a teaching hospital in Thailand.Design/methodology/approachThe action research methodology was used to illustrate the implementation of Lean Six Sigma through the collaboration between the researcher and participants. The project team followed the Lean Six Sigma Define, Measure, Analyze, Improve, Control (DMAIC) methodology and applied its tools in various phases of the methodology.FindingsThe number of dispensing errors decreased from 6 to 2 incidents per 20,000 inpatient days per month between April 2018 and August 2019 representing a 66.66% reduction. The project has improved the dispensing process performance resulting in dispensing error reduction and improved patient safety. The communication channels between the hospital pharmacy and the pharmacy technicians have also been improved.Research limitations/implicationsThis study was conducted in an inpatient pharmacy of a teaching hospital in Thailand. Therefore, the findings from this study cannot be generalized beyond the specific setting. However, the findings are applicable in the case of similar contexts and/or situations.Originality/valueThis is the first study that employs a continuous improvement methodology for the purpose of improving the dispensing process and the quality of care in a hospital. This study contributes to an understanding of how the application of action research can save patients' lives, improve patient safety and increase work satisfaction in the pharmacy service.
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McNamara M, Teeling SP. Developing a university-accredited Lean Six Sigma curriculum to overcome system blindness. Int J Qual Health Care 2019; 31:3-5. [PMID: 31867665 PMCID: PMC6926382 DOI: 10.1093/intqhc/mzz074] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 05/31/2019] [Accepted: 07/01/2019] [Indexed: 12/28/2022] Open
Abstract
This paper discusses the development of a Lean Six Sigma (LSS) postgraduate education programme that has enabled the delivery of over 90 quality improvement projects led by its graduates across 50 healthcare organizations in Ireland. A key success factor in embedding and sustaining LSS in these organizations was the accreditation by a major, national, research-intensive university of the LSS education programme from which the students graduated. To ensure the programme's approval by the university it was necessary to contextualize LSS within established conceptual frameworks. This helped counter misconceptions that what was proposed was technical training in tools and techniques to provide quick fixes for routine healthcare process issues. Two related conceptual frameworks were selected to frame the curriculum: Senge's Fifth Discipline and Deming's System of Profound Knowledge. This paper focuses on how a central element of both frameworks, systems thinking or appreciation for a system, was enacted in the curriculum using Oshry's work on system blindness. Showing how systems thinking was conceptualized in the curriculum established the legitimacy and credibility of the programme within academia. This led to the approval of the first university-accredited graduate programme in LSS for healthcare in Ireland.
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Affiliation(s)
- Martin McNamara
- UCD School of Nursing, Midwifery and Health Systems, College of Health and Agricultural Sciences, Dublin 4, Ireland
| | - SeÁn Paul Teeling
- UCD School of Nursing, Midwifery and Health Systems, College of Health and Agricultural Sciences, Dublin 4, Ireland
- Mater Lean Academy, Mater Misericordiae University Hospital, Eccles St., Dublin 7, Ireland
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