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Signature_Lean Presentation

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Signature_Lean Presentation

  1. 1. Optimizing Prescription Renewal Workflow for Maintenance Drugs Signature Healthcare Himi Mathur and Hezekiah Shobiye April 27, 2015
  2. 2. Outline • Background • The problem and Rationale • Project objective • Tools and techniques • Results • Limitations and Challenges
  3. 3. Background Signature Healthcare is southeastern Massachusetts' premier local provider of personalized, quality medical services. A hospital system: • 550 affiliated physicians and other direct care providers • 150 employed physicians and a total of 2,200 associates • Operates from 7 locations • Adopts lean as a philosophy About Signature Healthcare Lean Management
  4. 4. The Problem Patient needs to refill prescription; calls either the pharmacy or the hospital The Prescription team receives the request from various sources: phone call, voicemails, e- requests and fax The review and approval process may take longer and the doctor is frustrated that he has to keep seeing hundreds of requests in his task basket Patient calls back the hospital to make a repeat request Patient is waiting to receive medication from the pharmacy
  5. 5. Rationale • Primary care practices often spend a significant amount of time and resources in the management of prescription renewals • Need to have an accurate and efficient prescription renewal system • One of Signature’s strategy to promote a QI culture using Lean
  6. 6. Project Objective 1. Understand the current prescription renewal process for maintenance drugs 2. Identify points of recognition 3. Conduct a root cause analysis of recognized points 4. Develop recommendations on improving the coordination and flow of prescription renewal
  7. 7. Tools and Techniques • Project Charter – Objectives and scope of the project • Gantt Chart – To set deadlines and priorities • Process Maps – To understand the current and future state workflows • Fish Bone Diagram and 5 whys – Root Cause analysis • Impact/Effort Matrix – Recommendations • A3 – Problem solving and tracking the progress of the project
  8. 8. Current State Process Multiple channels of request Big overlap between tasks of Prescription team and physician Redundant fax request
  9. 9. Fish Bone Diagram
  10. 10. Root Cause Analysis Fax requests •Duplication of requests •70% – 90% of fax requests are redundant •Fax request is received at a different location from where Rx team is located •Fax received is transported by mail to Rx team’s location Overlapping tasks •MD can view requests along with flagged requests in the task basket •Rx team can take as much as 48 hours to review and approve them •Rx team experiences backlog on Mondays, which takes till Tuesday afternoon to be cleared •No one is able to renew the request during the weekend Multiple stakeholders •Multiple channels of refill requests •No specific instructions from hospital to patients •There is no standardized process for making a request
  11. 11. Future State Process
  12. 12. Recommendations 1- Relocating fax machines to the prescription team’s office 2 - Reduce Rx renewal by phone calls and voicemail 3 - Standardize the number of stakeholders entering requests into allscripts 4 - Restrict the prescription-related tasks physician is able to see in task basket per time 5 – Make staff available during weekends to review and approve requests 6 - Create a standard protocol to follow-up with patients with no show for appointments 7 - Yearly and biyearly prescription renewal 8 - Contact external pharmacies to send requests via Surescripts and not fax
  13. 13. Challenges and Limitations • Defining the scope of the project • Inadequate data for process analysis • Developing recommendations that is acceptable to all stakeholders
  14. 14. Field Pictures
  15. 15. Acknowledgements • Dr. Vikash Negandhi • Dr. Bob Wienstein • OE Department, Signature Healthcare • Prescription Team, Signature Healthcare • Professor Gouri Gupte
  16. 16. Questions?

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