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"What is Lean? The chicken, or your practice model?"

After meeting hours, over ASHP Policy Week in Bethesda, a group of seasoned, new and aspiring health-system pharmacy administrators (HSPA's) gathered for dinner in downtown DC. As one of the aspiring HSPA's, I valued the opportunity to sit amongst the authors of the leadership and management articles I had been reading, and witness the unscripted discussion of innovative solutions carried out in their respective institutions to overcome operational problems and barriers to practice model change.  When the meal arrived, the volume level at the table hit a maximum, but one soundbite in particular remained audible and commonplace: "Lean, lean...think lean!". 

"Lean thinking, is an approach to redesigning a practice model to assist with streamlining pharmacy operations" 

Sitting across from me at the dinner table was Dr. Phil Brummond. Prior to accepting a Director of Pharmacy position at Froedtert Hospital in Wisconsin, Dr. Brummond worked with the team at the University of Michigan to redesign the pharmacy practice model; notably, integrating decentralized pharmacists and clinical faculty to support the expansion of pharmacy services. 

Recently, the Department of Pharmacy at Froedtert Hospital started using a lean-thinking approach to practice model change. The team streamlined the medication dispensing process, and successfully reduced the first dose medication turnaround time from 46 minutes to 26 minutes. Over the last several months, through the use of continuous quality improvement methodology and problem solving techniques, the team at Froedert has begun to see sustainable benefits. This upcoming year, there will be a continued focus on implementing "a lean approach to everyday thinking" amongst all employees within the Department. His team is attempting to move towards developing sound processes that drive sustainable outcomes. Dr. Brummond will be hiring a process improvement engineer in the next several months to assist with driving this change. 

"Pharmacy Practice Model Change: Lean Thinking Provides A Place to Start"

That evening in my hotel room I read an article from the Management Consultation column of AJHP, written by Jennifer Hlubocky, Phil Brummond, and John S. Clark, titled "Pharmacy Practice Model Change: Lean Thinking Provides a Place to Start". In this article, the authors discuss the concept of “lean thinking”: an approach to redesigning a practice model, to assist with streamlining pharmacy operations. The goal is to eliminate “waste” from the system and achieve quickened and improved quality service with reduced errors and improved employee participation. The three lean-thinking principles include: identifying waste, creating permanent solutions for identified problems, and ensuring continuous improvement. Waste is identified by classifying process activities as value added, non-value added, or supportive. The next step is to find ways to eliminate the non-value added steps from the process and shift the resources to enhance value-added activities. Three common sources of waste one might find in pharmacy include medication-related errors (which result in wasted time and resources), processing, and unused employee potential.

The authors present the four tools used to create permanent solutions, including: the five whys, future-state diagrams, the 5 S’s, and plan-do-check-act (PDCA) cycles. The five whys is a lean-thinking tool that provokes a discussion of whether or not a process is needed. Future-state diagrams make up what the ideal process would look like if the steps could be redesigned to allow for redistribution of the resources. The 5 S’s – sort, straighten, shine, standardize, and sustain – involve the staff sorting what they need and do not need in order to do their work; straightening the items they do need; shining the newly organized work area; standardizing the implemented changes amongst staff members; and sustaining the steps to prevent backtracking by reviewing items regularly. PDCA cycles provide the outline on problem solving beginning with (1) a “plan” to investigate the problems or new services to be implemented within the current model; (2) to “do”, by implementing the action plan and testing; (3) “check” by evaluating the results of the test; and (4), to “act” by implementing the change throughout the practice model, particularly when the change is found to be a successful and sustainable solution. Finally, one must ensure continuous improvement by educating and involving all the employees in the change initiative; so that they can continuously identifying problems and brainstorm solutions on a daily basis. Overall, this will help the manager identify and develop leaders who can intricately foster the lean-thinking approach in all members of the department.