No Title Author Method Variable Analysis Results
1 Lead-Time Omar Al- DMAIC (Define, Ten activities Sixteen wards utilize Eliminate activities
Reduction Araidah, Measure, Analyze, performed during the satellite pharmacy 2, 3, 4, 5, and 10 and
Utilizing Lean Amer Improve, Control) and 5S the drug is of the fourth floor. The speed up activity 6
Tools Applied Momani, (Sort, Set-in-order, Shine, dispencing process wards exist on various such that the process
to Healthcare : Mohammad Standardize, Sustain) (1. Entry data; 2. wings of the floor and will take
The Inpatient Khasawneh, principles to identify and Copy of prepared have different numbers approximately 5 min
Pharmacy at a Mohammed reduce wastes that prescription sheet; of patients (sample for any ward. More-
Local Hospital Momani contribute to increasing 3. The quantity for size). For each ward, over, we increase the
the lead- time in each drug is hand the times required for time for performing
healthcare operations at written; 4. performing each activity 1 by 5 min
the pharmacy understudy. Transportation of activity in Table 2 are per ward. Table 4
Apply the proposed prescription sheet to measured and illustrates activities
model to the drug IPS; 5. Data documented. Table 3 and times for the
dispensing process from verification and re- illustrates activity modified drug
the inpatient pharmacy at entry at IPS; 6. times and the average dispensing process.
a local hospital. The Label preparation at time to complete a Note that the average
inpatient pharmacy IPS; 7. Drug medication dispensing cycle time is reduced
consists of 10 pharmacies preparation at IPS; process. The cycle from 158 to 82 min,
including the main 8. Medications are time for a ward equals which is a time
pharmacy (IPS), the received by the the summa- tion of savings of 76 min, or
chemotherapy pharmacy, satellite pharmacy times required to 448% of the original
and eight satellite pharmacist; 9. complete all activities cycle time.
pharmacies lo-cated on Transportation of for all patients in that
the third–sixth and the prescription sheets ward. It is worth
ninth–twelfth floors of to satellite noting that the time
the hospital. Initial pharmacy; 10. consumed by activities
investigation of the Medications are 1 (data entry at satellite
process shows that the received and pharmacy), 5 (data
average cycle time of the verification and re-
entry at IPS), 6 (label
process exceeds 2.5 hr. checked by the head preparation at IPS),
nurse at the level) and 7 (drug
preparation at IPS)
contribute to 460% of
the cycle time.
Moreover, redundant
data entries of the
same information are
performed at the
satellite pharmacy
(activity 1) and at IPS
(activity 5). Four
inspection activities of
drug quantities
(activities 3, 5, 8, and
10) are per-formed at
various locations and
include different
personnel. In addition
to consuming 440% of
the total cycle time, the
inspection process
takes valuable efforts
from many staff
members.
2 Improvement of João Pedro Supported by examples The order process is The results of PH2 The main results
pharmaceutical Faria dos from literature review. In represented by the indicate that the obtained in the first
services in Santos this paper the restructing fluxogram in Figure Implementation of a month, after the
hospitals of six hospital 2 where is described Continuous Review implementation of
through Kaizen Pharmacies, aiming to the sequence of Policy will enable to improvements phase
reduce the stock without operations which achieve a 25% (February/14), were
Lean compromising the service are currently reduction in the stock an annual reduction
methodology level has been presented. performed. This levels without of 11% of the stock
To better explain the fluxogram compromising the level and 0.29
sequence developed by represents the result service level. The average ruptures per
Melton, PH2 was of step one and two cumulative reduction month on each
analysed as an of Melton structure. between October 2013 hospital.
application example. The Based on this and February 2014 is
first step undertaken in analysis to the 21% in PH2. In this
the Pharmacies was to different operations hospital the average
map all the processes and, it was found stockout of medicines
based on that, different types of in 2014 is 1,45 per
improvement proposals waste such as: 1) month. The next major
were suggested and later Transactions not step is the
implemented. This initial standardized; 2) Implementation of a
phase is called data Purchase central did complementary
collection and analysis. not had view on the reduction model stock.
After this, the needs of This model consists of
Implementation program Pharmacies; 3) The revising the formulas
was defined based on needs of purchases for calculating the RP
opportunities from a followed a Push and QO to include the
fluxogram with value model; 4) Existence cost of inventory
analysis. of several manual management and
operations; 5) control the service
Reprocessing of level. Tests performed
files and lists of on PH1 enabled a
needs; 6) Printing reduction of about 6%
incomplete in the stock level (after
purchasing lists. a 25% of reduction)
with a service level of
91%. This service
level was defined from
a sensitive analysis
with the Pharmacies
Director. Another step
that should be
implemented in the
future is the creation of
a system where the
purchase central can
view orders made by
Pharmacies to reduce
the variability in the
orders to the suppliers.
3 Using lean Peter Applying concepts of This workflow The workflow was The results of
methodology to Sullivan, lean methodology (i.e., included 20 steps decreased to 14 steps, baseline and post
improve Scott Soefje, elimination of non-value- (14 involving eliminating 6 non- implementation time
productivity in David added steps and waste in pharmacists and 6 value-added steps, and trials indicated a
a hospital Reinhart, the production process), for pharmacy pharmacy staff decrease in overall
oncology Catherine through observation and technicians). To resources and turnaround time to
pharmacy McGeary, one-on-one interaction further understand schedules were about 70 minutes,
and Eric D. with pharmacists and the baseline flow of realigned with the compared with a
Cabie technicians, a detailed the pharmacy streamlined workflow. baseline time of
workflow map was medication process, The time required for about 90 minutes.
created, accounting for each step was timed pharmacist
the time an order was from beginning to verification of patient-
released from nursing to completion. To specific oncology
medication delivery. The more effectively orders was decreased
pharmacy team organize the time by 33%; the time
performed a failure mode trials, the steps were required for product
and effects analysis, categorized into 6 verification was
workflow mapping, and workflow decreased by 52%. The
impact analysis; staff processes: order average medication
pharmacists and verification, drug delivery time was
pharmacy technicians setup, decreased by 47%.
identifed 38 opportunities compounding,
to decrease waste and product
increase efficiency. Three verification, nal
workflow processes labeling (sorting),
(order verification, and medication
compounding, and delivery.
delivery) accounted for
24 of 38
recommendations and
were targeted for lean
process improvements.
4 Efficiency Abigail J. Systematically review Efficiency A total of 39 studies Most studies used
improvement in Fong, were identified that time or money as
the operating Meghan Intervention met inclusion criteria. their metric for
room Smith and These divided efficiency, though
Alexander naturally into small others were used as
Langerman (single operative well. Interventions
team), medium (multi- were naturally
operative team), and partitioned into three
large (institutional) categories based on
interventions. Of the scale: small (those
39 intervention that could be
articles, 29 (74%) used implemented in a
time as their metric for single operating
efficiency, 9 (23%) room potentially by a
used financial single surgeon or
measures, and 12 team); medium
(31%) studies used (those that require a
other metrics such as surgical group or
tool reduction, case floor cooperation);
number, delays, and and large (those that
steps. Some studies require major
used more than one institutional buy-in,
metric and some support and change).
included quality Common themes
metrics as well. The across these
most common factors interventions were
studied were parallel standardization,
processing, lean collecting and using
management, value actionable data, and
stream/process maintaining effective
mapping, checklists, communication.
OR redesign and
environment, six
sigma, and total
quality management.
Most articles focused
on the OR space or the
surgical team and did
not examine efficiency
of the operative
procedure itself.
5 Improving Edward P. The entire perioperative Turn over time Six-hundred-twelve These results
Operating Room Tagge, John process was mapped, cases were included in demonstrate that a
Efficiency in Lenart, Arul using fishbone diagrams, Turn around time the seven Children’s coordinated
Academic S. Pareto analysis, and other Hospital operating multidisciplinary
Children’s Thirumoorthi, process improvement rooms over a 6-month process improvement
Hospital Using Carlos tools. Results for period. Turnover time redesign can
Lean Six Sigma Garberoglio, Children’s Hospital (interval between significantly improve
Methodology Kenneth W. scheduled main operating patient OR departure efficiency in an
Mitchell room (OR) cases were and arrival of the academic Children’s
analyzed, where the subsequent patient) Hospital without
surgical attending decreased from a preselecting specific
followed median 41 minutes in services, removing
the baseline period to surgical residents or
32 minutes in the incorporating new
intervention period personnel.
(p<0.0001).
Turnaround time
(interval between
surgical dressing
application and
subsequent surgical
incision) decreased
from a median 81.5
minutes in the baseline
period to 71 minutes in
the intervention period
(p<0.0001).
