Application of Lean Methodology to Improve Chemotherapy Delivery in a COPS Centre

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Improvement Story session at the 2013 Saskatchewan Health Care Quality Summit. For more information about the summit, visit www.qualitysummit.ca. Follow @QualitySummit on Twitter.

In response to a significantly increasing volume of oncology treatments directed to our centre, we undertook a Lean initiative aimed at streamlining our process and eliminating waste. Significant improvements included virtual elimination of patient wait time for treatments by admixing chemotherapy the afternoon prior to treatment and a mean order processing time decrease from 60 to 30 minutes per regimen by creating electronic standardized chemotherapy order sets.
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Shannan Neubauer, Katherine Diduck, Kendra Soyka, Sunrise Health Region

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Application of Lean Methodology to Improve Chemotherapy Delivery in a COPS Centre

  1. 1. Application of Lean Methodology to ImproveChemotherapy Delivery in a COPS CentreKatherine DiduckThis Session is sponsored by:
  2. 2. Application of Lean Methodology toImprove Chemotherapy Delivery in aCOPS CentreKatherine Diduck , Presenting AuthorShannan Neubauer , Submitting Author , Presenting AuthorKendra Soyka , Presenting Author
  3. 3. 020406080100120140160180200Jan Feb Mar Apr May June July Aug Sept Oct Nov DecNumberofDosesYorkton COPSWorkload20082009201020112012
  4. 4. 020406080100120140160180200Jan Feb Mar Apr May June July Aug Sept Oct Nov DecNumberofDosesYorkton COPSWorkload20082009201020112012
  5. 5. 020406080100120140160180200Jan Feb Mar Apr May June July Aug Sept Oct Nov DecNumberofDosesYorkton COPSWorkload20082009201020112012
  6. 6. 020406080100120140160180200Jan Feb Mar Apr May June July Aug Sept Oct Nov DecNumberofDosesYorkton COPSWorkload20082009201020112012
  7. 7. 020406080100120140160180200Jan Feb Mar Apr May June July Aug Sept Oct Nov DecNumberofDosesYorkton COPSWorkload20082009201020112012
  8. 8. Current State (Feb 2012)Value Stream MapDayBEFORETreatmentDayOFTreatmentNursePharmacy tech/clerkPharmacistSCA
  9. 9. Brainstorming
  10. 10. 7Types of Waste9%18%3%6%21%28%15%MotionDefectsOverproductionInventoryProcessingWaitTransportation
  11. 11. Proportion ofValue Add vsNon-Value Add Kaizens62%38%Value AddNon-ValueAdd
  12. 12. Areas of Influence on the 7TypesofWaste Identified0 10 20 30 40 50 60 70 80 90 100MotionDefectsOverproductionInventoryProcessingWaitTransportationNursingPharmacySCAYRHC
  13. 13. JANFEBMARAPRMAYJUNEJULYAUG2012........Day beforetray prepStandardizetray prep....Admix allchemomorning oftreatment....Admix allchemo daybeforetreatment....“Single drug”electronictemplates foradmix sheetsand labels.... Save electroniccopies forpatient’s admixsheets and labels....“Regimenset”electronictemplates foradmix sheetsand labels....WinPharmgeneratedlabels....TaylorWinPharm togenerate 2labels....Scheduleappt perguidelines....Track recallappt toanticipatetreatments.... Sharedelectroniccalendar viaMicrosoftOutlook....Access toSCAdatabase(ARIA)StandardworkStandard work/Reduce wait/MotionReduce wait /Processing /
  14. 14. Prior to LEAN…
  15. 15. JANFEBMAR2012....Standard work
  16. 16. FEBMARAPR2012....Standard work
  17. 17. MARAPRMAY2012....Standard work
  18. 18. MAYJUNEJULY2012....Standard work
  19. 19. AUGJULY2012....?Standard work
  20. 20. JANFEBMARAPRMAYJUNEJULYAUG2012........Day beforetray prepStandardizetray prep....Admix allchemomorning oftreatment....Admix allchemo daybeforetreatment....“Single drug”electronictemplates foradmix sheetsand labels.... Save electroniccopies forpatient’s admixsheets and labels....“Regimenset”electronictemplates foradmix sheetsand labels....WinPharmgeneratedlabels....TaylorWinPharm togenerate 2labels....Scheduleappt perguidelines....Track recallappt toanticipatetreatments.... Sharedelectroniccalendar viaMicrosoftOutlook....Access toSCAdatabase(ARIA)StandardworkStandard work/Reduce wait/MotionReduce wait /Processing /
  21. 21. Prior to LEAN…
  22. 22. MARFEB2012....Standard work
  23. 23. MARAPRMAY2012....Standard work
  24. 24. MAYJUNEJULY2012....Motion / WaitMar.13Mar.13
  25. 25. AUGJULY2012....Motion / WaitMar.12Mar.12Mar.13
  26. 26. JANFEBMARAPRMAYJUNEJULYAUG2012........Day beforetray prepStandardizetray prep....Admix allchemomorning oftreatment....Admix allchemo daybeforetreatment....“Single drug”electronictemplates foradmix sheetsand labels.... Save electroniccopies forpatient’s admixsheets and labels....“Regimenset”electronictemplates foradmix sheetsand labels....WinPharmgeneratedlabels....TaylorWinPharm togenerate 2labels....Scheduleappt perguidelines....Track recallappt toanticipatetreatments.... Sharedelectroniccalendar viaMicrosoftOutlook....Access toSCAdatabase(ARIA)StandardworkStandard work/Reduce wait/MotionReduce wait /Processing /
  27. 27. Prior to LEAN…
  28. 28. JULY2012....WaitTreatment MinutesFluorouracil - 5FU 15Fluorouracil - 5FU/Leucovorin 15Doxorubicin(Adriamycin)/Bleomycin/Vinblastine/Dacarbazine 15Adriamycin/Cyclophasphamide 15Adriamycin(Doxorubicin) 15Aldesleukin (Interleukin) 30Premetrexed 45Bacillus Calmette-Guerin (Intravesical) 45Velcade 45Cyclophosphamide/Methotrexate/Flourouracil(5FU) 60Carboplatin 60Carboplatin/Cyclophosphamide 60Carboplatin/Gemcitabine 60Cisplatin 90Cisplatin/Irinotecan 90Cisplatin/Vinblastine 90Cisplatin/Vinorelbine 90Cyclophosphamide 150Doxorubicin(Adriamycin) 150Epirubicin 150Flourouracil(5FU)/Epirubicin/Cyclophosphamide 150Flourouracil(5FU)/Leucovorin/Irinotecan 150Gemcitabine 150Irinotecan 150Methotrexate 150Octreotide 180Pamidronate 180Topotecan 240Trastuzumab(Herceptin) 240Vinblastine 360Vinorelbine 360Zoledronic acid 360Goserelin 360
  29. 29. JULYJUNE2012....Processing
  30. 30. AUGJULY2012....Processing / Rework
  31. 31. AUG2012..Implementationdate:Feb. 27, 2013.Processing /Standard work
  32. 32. Future Kaizens
  33. 33. 1) Kanban inventory system
  34. 34. 1) Kanban inventory system
  35. 35. 1) Kanban inventory system
  36. 36. 1) Kanban inventory system
  37. 37. 2) Future State Mapping withARIA
  38. 38. 3)Value Stream Mapping internaldrug delivery processes
  39. 39. Activity+ =-
  40. 40. Kotters 8-Step Change Modelhttp://www.acgme.org/acgmeweb/Portals/0/PDFs/2013AEC-Presentations/ses046.pdf/Communicatethe ChangeVisionCreating theChangeVisionEmpowerTeamMembersBuild on theChangeCreateShort-termWins
  41. 41. Kotters 8-Step Change Modelhttp://www.acgme.org/acgmeweb/Portals/0/PDFs/2013AEC-Presentations/ses046.pdf/Communicatethe ChangeVisionCreating theChangeVisionEmpowerTeamMembersBuild on theChangeCreateShort-termWins
  42. 42. The Global Production System“LEAN House”
  43. 43. LEAN Team

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