1. Medisch Spectrum Twente,
Enschede, The Netherlands
Schermafbeelding 2015-04-06 om
11.15.31
The High Risk Medication procedure, part of the current Safety Management System implementation.
Within nursing departments executing the High Risk Medication procedure requires a great work effort causing problems in daily care
and time spent on patients. The execution of this procedure takes on average 15 minutes per patient per procedure, which is executed
4 times a day per patient. The average number of patients in a ward is about 30 patients. There were 15 wards involved in this project.
Analysis
Ø Value Stream mapping of the current situation.
Ø Measurements lead time of the current situation
Proposal is to redesign the procedure based on executing experiments in practice.
Lessons learned
We have learned that it is impossible to design procedures
in an ivory tower. A new procedure should always be
experimented before implementing it. Hospitals do not use
the expertise of the wards enough to design adequate and
acceptable procedures.
Jan WijnandHoek
Lean Improvement Officer
Project / Kaizen > Improving the high risk medication procedure
Effects of the changes
Ø The average time spent executing the procedure is reduced by more
than 5 minutes per patient per procedure.
Ø Procedure adapted from 30 steps to 27 steps
Ø New Procedure is understood and applied at the ward
Ø The time gained by the project is spent on patient care and
attention.
#
Medication
1st
experiment
2nd
experiment
3rd
experiment
1st
medication
4:02 2:20 2:44
2nd
medication
5:47 3:48 3:47
3rd
medication
5:50 5:04 4:20
4th
medication
6:54 5:22 4:54
P D
SA
21
experimenting within
one ward in practice
cycles
Progress of the experiments
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nurse&1&
nurse&2&
Reducing&handling,&interup4ons&searching,&enforing&efficient&work&
nurse&
nurse&
nurse&
nurse&
nurse&
nurse&
nurse&
nurse&
nurse&
=&Old&approach:&
New&approch:&
Video instruction adapted procedureProcess redesign
P D
SA
56
experimenting within
a laboratory setting
cycles
Strategy for change using Toyota Kata
Bottom line: make improvements in small steps by experimenting
a process with the experts of the shop floor in practice.