Systems Thinking and Kaizen:
Tools for Hospital Pharmacy Process Improvement
With increasing operation costs, patient safety awareness, and a shortage of trained personnel, it is becoming increasingly important for hospital pharmacy management to make good operational decisions. In the case of hospital inpatient pharmacies, making decisions about staffing and work flow is difficult due to the complexity of the systems used and the variation in the orders to be filled. Pharmacy turnaround time is a crucial metric for patient safety and caregivers’ satisfaction. Pharmacy management is under constant demand to reduce turnaround time. In order to help The Methodist Hospital Pharmacy Management make decisions about work flow, a team was created to analyze the impact of an alternate work process. The team examined the impact of the process and work flow changes on the amount of time medication orders take to be processed. The goal is to help the pharmacy management team find the best process and workflow to get medications to the patients as quickly as possible. Systems Thinking and Kaizen are used as tools to achieve that goal by using pharmacy staff effectively and make the process more efficient.
The pharmacy division’s initial goals for 2006-07 were to increase patient safety by improving turnaround time (TAT) by 25% for the preparation, dispensing, and delivery process for first dose medication orders. Improved TAT means that the patient receives medication when he or she needs it without delay, thus ensuring optimal, timely, and safe administration of the medication. The goals changed after the data were analyzed by lean team using the value-stream map. Systems Thinking (thinking transformation) and Kaizen (continuous improvement) were the principle means which demonstrated marked improvement. Six pharmacists and four technicians were selected as a “Lean Team”. A systems thinking & Kaizen workshop, using a group model-building approach, was held for three days. A facilitator introduced the qualitative system dynamics approach, which would be used for finding a way to make sense of the complex relationships and work flow. Systems Thinking and Kaizen were explained and the team practiced several exercises.
Understanding Systems Thinking
To understand systems thinking as it is known today, it is necessary to go back several decades and view some of its evolution. General systems theory was introduced in the 1940's by Ludwig von Berttalanffy (Cummings, 1980), but has been vastly expanded since its inception. It developed as a response to rapid technological complexities that confronted engineering and science. It was a radical departure from traditional science which dealt with cause and effect explanations. Systems thinking viewed an organization and its respective environment as a complex whole of interrelating, interdependent parts. It stressed the relationships and the processes that make up the organizational context, rather than the separate entities or the sum of the parts (Cummings, 1980).
It is interesting to note that there are several ways to classify systems. Peter Checkland's classification system (Richardson, 1991) described the purposeful activity of human beings as human activity systems. This classification includes organizations, industrial activity, and political systems and is the one which is of most interest to managers and employees. These kinds of systems are referred to as soft systems and are usually described by language rather than mathematics. Such systems include several basic concepts. Because it is a system of purposeful activities there will be goals, objectives, or purposes. Connectivity will exist as systems imply interrelatedness. Organizational systems must also have some way to measure performance and make decisions, but these processes have control mechanisms which act within certain...
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