1. Background 5. Measures Financial Disclosure 2. Objective 4. Participants Veterans Health Administration (VHA) 8. References Unreliability in the prescription fill process utilizing UUA dispensing technology was observed to result in defective output associated with increased cycle time, reduced throughput, increased utilization of resources, higher production costs, and increased patient safety risk. The objective of this study was to reduce defects (output not meeting requirements) by 50% within 9 months for prescriptions filled by UUA. 7. Conclusion 6. Results 1. Department of Veterans Affairs, Veterans Health Administration. Systems Improvement Framework. Version 2. Washington, DC: VHA Office of Systems Redesign (10NSR); May 2011. 2. Chassin MR, Loeb JM. The ongoing quality improvement journey: next stop, high reliability. Health Affairs 2011 Apr 30(4):559-68. 3. The QI Macros SPC Software for Excel [computer program]. Version 2012. Denver (CO): KnowWare International Inc.; 2012. Quality (pre- and post-improvements) • Number of UUA “repicks” per one million UUA processed fills Cost (pre- and post-improvements) • Annualized cost of UUA “repicks” Value (post-improvements) • Return on Investment (ROI) 3 • Payback period 3 A Six Sigma DMAIC (Define, Measure, Analyze , Improve, Control ) approach incorporating Lean and Change Management principles was used as the process improvement methodology. CMOP uses the Veterans Health Administration’s (VHA) Vision - Analysis - Team - Aim Map - Measure - Change - Sustain (VA - TAMMCS) 1 model as its quality improvement framework. VA - TAMMCS supports the VHA Office of Quality, Safety, and Value’s (QSV) mission to “enhance the quality, safety, reliability, and value of VHA’s clinical and business systems by enabling innovation, enterprise - wide approaches to compliance, risk awareness, and continuous improvement.” In addition, the VA - TAMMCS model supports The Joint Commission’s requirements for “robust process improvement” which serves as one of three components necessary to achieve High Reliability as a health care organization. 2 3. Methods The Department of Veterans Affairs (VA) Consolidated Mail Outpatient Pharmacy (CMOP) provides high quality, timely, and cost-effective health care through automated prescription order processing and mail delivery of medications and supplies to patients. Since its inception in 1994, the VA has expanded the CMOP program to include seven locations strategically located across the United States. On an average workday the CMOP system processes over 470,000 prescriptions for nearly 317,000 patients. Approximately 60% of prescriptions filled by CMOP are allocated to unit-of-use automation (UUA) for processing. Improvements associated with equipment, computer software, logistics, and personnel resulted in positive outcomes for all final measures. Mean percent reduction in defective prescription fills processed by UUA was 57%. Annual cost savings were $355,404 system wide excluding a one-time initial investment cost of $39,435. Return on investment ranged from a low of $3:$1 to a high of $14:$1. Payback period averaged 41 days. A Lean Six Sigma improvement approach reduced defects in high volume unit-of-use dispensing processes across multiple facilities within a mail order pharmacy system. Benefits included cost savings to the organization and mitigation of possible harm to patients through reduction in the number of processed prescriptions not meeting requirements. CMOP can use results from the study to identify future improvement opportunities and to modify or eliminate processes not adding value for the customer. Rita L. Brueckner and Kenneth Siehr declare no conflicts of interest, real or apparent, and no financial interests in any company, product, or service mentioned in this poster, including grants, employment, gifts, stock holdings, and honoraria. Use of a Lean Six Sigma Methodology to Reduce Defects in High Volume Unit - of - Use Dispensing in a Mail Order Pharmacy System Rita L. Brueckner, Pharm.D., M.S., M.B.A. and Kenneth Siehr, R.Ph., M.P.A. Department of Veterans Affairs, Consolidated Mail Outpatient Pharmacy National Office Deliverables by VA - TAMMCS Project Phase Vision / Analysis • Project Selection • Project Charter Team / Aim • Project Charter • Voice of the Customer • SIPOC (Suppliers-Inputs-Process-Outputs-Customers) Map • Process Map • Current State Value Stream Map • Future State Value Stream Map Measure • Baseline Measures • Root Cause Analysis (RCA) • Pareto Chart of Operational Barriers and Failure Modes Change • New Current State Value Stream Map Post-improvements • Final Measures Sustain • A3 Report • Sustainability Plan • Communication Plan • Data Collection Plan • Baseline Measures CMOP Unit - of - Use Automation (UUA) Prescription Order Received at CMOP Prescription Order Allocated to UUA Prescription Order Filled with Product by UUA Product Labeled Labeled Product Sent to Packing If the prescription is filled incorrectly (defective), the order is returned to the UUA for a “repick” • CMOP (760), Leavenworth, KS • CMOP (761), Chelmsford, MA • CMOP (762), Tucson, AZ • CMOP (764), Murfreesboro, TN • CMOP (765), Hines, IL Outcomes from Improvements Implemented CMOP Location Reduction in "Repicks" Annual Cost Savings (excludes initial prevention costs) Return on Investment Payback Period 760 67% $139,332 $14:$1 18 days 761 23% $9,277 $7:$1 38 days 762 31% $17,624 $3:$1 90 days 764 50% $76,855 $7:$1 35 days 765 64% $112,316 $10:$1 24 days 6. Results Normalized Rate of Defective Prescription Fills Processed by UUA 0.33 0.77 0.69 0.50 0.36 0.00 0.20 0.40 0.60 0.80 1.00 1.20 760 761 762 764 765 Pre-improvements Post-improvements
Welcome message from author
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
1. Background
5. Measures
Financial Disclosure
2. Objective
4. Participants
Veterans Health Administration (VHA)
8. References
Unreliability in the prescription fill process utilizing UUA
dispensing technology was observed to result in defective
output associated with increased cycle time, reduced
throughput, increased utilization of resources, higher
production costs, and increased patient safety risk. The
objective of this study was to reduce defects (output not
meeting requirements) by 50% within 9 months for
prescriptions filled by UUA.
7. Conclusion
6. Results
1. Department of Veterans Affairs, Veterans Health Administration. Systems Improvement Framework. Version 2. Washington, DC: VHA Office of Systems Redesign (10NSR); May 2011.
2. Chassin MR, Loeb JM. The ongoing quality improvement journey: next stop, high reliability. Health Affairs 2011 Apr 30(4):559-68.
3. The QI Macros SPC Software for Excel [computer program]. Version 2012. Denver (CO): KnowWare International Inc.; 2012.
Quality (pre- and post-improvements)
• Number of UUA “repicks” per one million UUA
processed fills
Cost (pre- and post-improvements)
• Annualized cost of UUA “repicks”
Value (post-improvements)
• Return on Investment (ROI)3
• Payback period3
A Six Sigma DMAIC (Define, Measure, Analyze, Improve,
Control) approach incorporating Lean and Change
Management principles was used as the process
improvement methodology. CMOP uses the Veterans
Health Administration’s (VHA) Vision-Analysis-Team-Aim
Map-Measure-Change-Sustain (VA-TAMMCS)1 model as its
quality improvement framework. VA-TAMMCS supports the
VHA Office of Quality, Safety, and Value’s (QSV) mission to
“enhance the quality, safety, reliability, and value of VHA’s
clinical and business systems by enabling innovation,
enterprise-wide approaches to compliance, risk awareness,
and continuous improvement.” In addition, the VA-TAMMCS
model supports The Joint Commission’s requirements for
“robust process improvement” which serves as one of three
components necessary to achieve High Reliability as a
health care organization.2
3. Methods
The Department of Veterans Affairs (VA) Consolidated Mail
Outpatient Pharmacy (CMOP) provides high quality, timely,
and cost-effective health care through automated
prescription order processing and mail delivery of
medications and supplies to patients. Since its inception in
1994, the VA has expanded the CMOP program to include
seven locations strategically located across the United
States. On an average workday the CMOP system
processes over 470,000 prescriptions for nearly 317,000
patients. Approximately 60% of prescriptions filled by
CMOP are allocated to unit-of-use automation (UUA) for
processing.
Improvements associated with equipment, computer
software, logistics, and personnel resulted in positive
outcomes for all final measures. Mean percent reduction in
defective prescription fills processed by UUA was 57%.
Annual cost savings were $355,404 system wide excluding
a one-time initial investment cost of $39,435. Return on
investment ranged from a low of $3:$1 to a high of $14:$1.
Payback period averaged 41 days.
A Lean Six Sigma improvement approach reduced defects
in high volume unit-of-use dispensing processes across
multiple facilities within a mail order pharmacy system.
Benefits included cost savings to the organization and
mitigation of possible harm to patients through reduction in
the number of processed prescriptions not meeting
requirements. CMOP can use results from the study to
identify future improvement opportunities and to modify or
eliminate processes not adding value for the customer.
Rita L. Brueckner and Kenneth Siehr declare no conflicts of
interest, real or apparent, and no financial interests in any
company, product, or service mentioned in this poster,
including grants, employment, gifts, stock holdings, and
honoraria.
Use of a Lean Six Sigma Methodology to Reduce Defects in High Volume Unit-of-Use Dispensing in a Mail Order Pharmacy SystemRita L. Brueckner, Pharm.D., M.S., M.B.A. and Kenneth Siehr, R.Ph., M.P.A.
Department of Veterans Affairs, Consolidated Mail Outpatient Pharmacy National Office
Deliverables by VA-TAMMCS Project Phase
Vision / Analysis
• Project Selection
• Project Charter
Team / Aim
• Project Charter
• Voice of the Customer
• SIPOC (Suppliers-Inputs-Process-Outputs-Customers)
Map
• Process Map
• Current State Value Stream Map
• Future State Value Stream Map
Measure
• Baseline Measures
• Root Cause Analysis (RCA)
• Pareto Chart of Operational Barriers and Failure Modes
Change
• New Current State Value Stream Map Post-improvements
• Final Measures
Sustain
• A3 Report
• Sustainability Plan
• Communication Plan
• Data Collection Plan
• Baseline Measures
CMOP Unit-of-Use Automation (UUA)
Prescription Order
Received at CMOP
Prescription Order
Allocated to UUA
Prescription Order Filled with Product
by UUA
Product Labeled
Labeled Product Sent
to Packing
If the prescription is filled
incorrectly (defective),
the order is returned to the
UUA for a “repick”
• CMOP (760), Leavenworth, KS
• CMOP (761), Chelmsford, MA
• CMOP (762), Tucson, AZ
• CMOP (764), Murfreesboro, TN
• CMOP (765), Hines, IL
Outcomes from Improvements Implemented
CMOP
Location
Reduction
in "Repicks"
Annual
Cost Savings (excludes initial
prevention costs)
Return on
Investment
Payback
Period
760 67% $139,332 $14:$1 18 days
761 23% $9,277 $7:$1 38 days
762 31% $17,624 $3:$1 90 days
764 50% $76,855 $7:$1 35 days
765 64% $112,316 $10:$1 24 days
6. Results
Normalized Rate of Defective
Prescription Fills Processed by UUA
0.33
0.77
0.69
0.50
0.36
0.00
0.20
0.40
0.60
0.80
1.00
1.20
760 761 762 764 765
Pre-improvements
Post-improvements
Related Documents
