Workshop 2: Overview

Safer Medicine Management
amongst Older People
Living in their Own Homes
2nd workshop
13 June 2013
http://hsi.cloudapp.net/

Project - Aim
• To create Integrated pathways
for Safer medicines management
amongst Older People
Living in their Own Homes
2

Three Workshops
1. To develop the whole system understanding
 Top priority issues to be addressed
2. To develop solutions for improvement
Specific ideas to address the issues
3. To develop implementation plans
 Detailed plans for idea implementation
3

Team
• Team A: Steve Rogers
• Team B: Leigh Sayer
• Team C: Amalin Dutt
5

Top issue - Team A
• How do GPs and pharmacies make sure
that patients are in active partnerships
on medicine management?
6

7
Hospitals
General
practices
District
nurses
Community
pharmacies
Hospital
pharmacies
Social care
workers
Voluntary
services
(e.g.
AgeUK,
EPP* )
Ambulances
Drug
companies
Equipment
suppliers
Distributors
Medical
device
agency
Rehap
services
Medicine
control
agency
Backstage
communication
Frontstage
communication
Patients
Phone
PostFax
Internet
@
NHS email
Phone
emis
web
pharmacy
IT system
Hospital
patient
record
Care agency
workers
IAS
Family &
friends
Visiting
books

9
- Patient takes medicine
Patient with low on medicine
When patient/carer does it him/herself
- Patient/carer fills in the repeat prescription slip
- Patient/carer drops the repeat prescription slip at GP (visit/call?)
- Patient/carer collects repeat prescription (within 48 hrs?)
- Patient/carer drops repeat prescription to pharmacy
When pharmacy has agreed to act on behalf of patient
(prescription collection service)
- Pharmacy contacts patient (every patient?)
- Pharmacy fills in the repeat prescription slip
- Pharmacy drops the repeat prescription slip to GP
- Pharmacy collects a repeat prescription from GP
Patient at home with sufficient medicine
New (repeat) prescription at pharmacy
Patient admitted
to hospital
When patient needs hospital care
- Patient goes to hospital
- Patient takes own medicine to hospital (?)
When patient ready to go home
- Hospital discharges patient
- Hospital provides medicine for 0/2/4 weeks?
- Hospital informs GP and pharmacy?
- Pharmacy checks prescription
- Pharmacy contacts GP for enquiry (if required)
- Pharmacy dispenses medicine
Patient seen
by GP or nurse
When patient has appointment at GP
- Patient visits GP
When no change in medicine
- Patient goes home
When need for medicine change
- GP issues prescription
- GP calls pharmacy (?)
- Patient drops it to pharmacy
When pharmacy offers delivery and patient chooses to get it
- Pharmacy delivers medicine to patient's home
Otherwise
- Patient/carer collects medicine
(over 4 medicines)
Medicine dispensed (ready to be collected)

Patient admitted
to hospital
Patient seen
by GP or nurse
- Patient visits GP
- Patient goes home
(over 4 medicines)

- Patient/carer drops the repeat prescription slip at GP (visit/post)
- Patient/carer collects repeat prescription (within 48hrs?)

12
Otherwise

Top issue – Team B
• How do we make medicines
that require special consideration,
available to patients in a timely manner?
13

14
Patient admitted
to hospital
Patient seen
by GP or nurse
- Patient visits GP
- Patient goes home
Otherwise
(over 4 medicines)

Top issue – Team C
• How do we improve appropriate access
to and use of the range of Medicines
Compliance Aids?
• How can we improve the medicines
re-ordering process?
15

16
Patient admitted
to hospital
Patient seen
by GP or nurse
- Patient visits GP
- Patient goes home
Otherwise
(over 4 medicines)

Aim of Today’s workshop
• To develop specific solutions to address top
issues
17

Workshop - Purposes
• To develop ideas which you would never have
had if you are alone
• To challenge ourselves
• To learn new thinking and methods
• To have fun
18

When What Who
14.00-14.10 Summary of the last workshop Amalin Dutt
Stephen Rogers
Leigh Sayer
14.10-14.25 Lean thinking Ran Bhamra
Thomas Jun
14.25-14.40 Causes/Outcome Understanding Group discussion
14.40-14.55 Benchmarking solution showcase Priyal Shah
Mike Bereza
Sanjay Ganvir
14.55-15.15 Idea Generation and Selection Thomas Jun
Group discussion
15.15-15.20 Service prototyping Thomas Jun
15.20-16.30 Solution Development Group work
16.30-16.45 Solution presentation 5 min for each group
16.45-17.00 Summary and plans Amalin Dutt and Thomas Jun
Workshop2
19

Criteria for the winning idea
• Short-term ideas (3 months) • Long-term ideas (5 years)
20
√ Focused on Users’ Needs
√ Supporting Integrated Care
√ Cost-Effective
√ Sustainable
√ Ready-to-be–implemented √ Wide impact

Methods to be used
• Systems thinking: Looking at big pictures
• Design thinking: Users, Doing Not just Talking
• Proactive risk thinking: Structured what-if
• Lean thinking: Flow thinking
21

Design thinking
Discover Define Develop Deliver
22

Lean thinking
• What is it?
1. Origins & Purpose
2. A set of tools
3. An enabler of change
4. A philosophy
5. Think Lean
23

Lean thinking
– Japanese manufacturing
– Toyoda (Toyota)
– Global since 1980s
24

Lean thinking
– Improving the flow of service or product
– Eliminating waste
– Improving quality
– Reducing cost
25

Lean thinking
2. A set of tools
– Understanding waste
» Meets an explicit customer requirement
» Cannot be shown to be performed more economically
– Fool proofing (Poke Yoke)
– Continuous improvement (Kaizen)
26

Lean thinking
27
2. A set of tools

Lean thinking
• Fool proofing (Poke Yoke) e.g.
28
Fuelling area of car has three mistake-
proofing devices:
• Filling pipe insert keeps larger, leaded-
fuel nozzle from being inserted
• Cap tether does not allow the motorist to
drive off without the cap
• Cap is fitted with ratchet to signal
tightness and prevent over-tightening.

Lean thinking
3. Enabler of change
– Improvement project process
4. Philosophy
– “The only people who do not make mistakes are those that
do nothing”
– “The most dangerous kind of waste is the waste we do not
recognize”
29

Lean thinking
5. Think Lean
– Question the status quo
– Why is something done in a particular way?
– What are the perceived problems?
– What is the root cause of an issue?
– Where do we see waste – time, quality of service,
unnecessary repetition, metrics, patients at risk?
30

• To develop specific solutions to address top
issues
– To explore a specific issue in greater depth
– To describe the best desired outcome for the problem
situation
31

http://hsi.cloudapp.net/ 32
Issue
Solution
Ideal
Final
Result
Cause
Cause

The Five WHYS
• What is it?
– A chain of WHY questions used to dig below the
outward symptoms of an issue
• How is it done?
– Answer the WHY questions using a convincing
explanation leading back from the original issue
33

The Five WHYS
• WHY can patients not get a prescription from
the doctor recommending it?
• WHY does it take so long to get a
prescription which requires hospital
approval?
• WHY is there communication breakdown
between hospitals and GPs?
34

Ideal Final Results
• What is it?
– A description of the desired outcome
• How is it done?
– Can the desired outcome achieved without any system,
only with existing resources?
• Why is it used?
– Help to overcome our psychological inertia
– Help to reach breakthrough solutions
35

Ideal Final Results
• The right amount and type of medicines are
available when needed without any system.
• The right amount and type of medicines are
administered on time without any system.
• No medicine, but still long term health care of
the elderly are well managed.
36

Medicine Management – Workshop2
1) Issue description Group No.
Page
of
2) The Five WHYS 3) Ideal Final Results
; a description of the desired outcome

Medicine Management – Workshop2
1) Issue description
How do we make medicines that require special consideration, available to
patients in a timely manner?
Group No.
2
Page
1 of 3
2) The Five WHYS 3) Ideal Final Results
; a description of the desired outcome
1. Why can patients not get a prescription
from the doctor recommending it?
2. Why does it take so long to get a
prescription which requires hospital
approval?
3. Why is there communication breakdown
between hospitals and GPs?
4. …
5. …
Medicines (right amount and type) are always
available when required?

15 Minutes
The Five Whys
Ideal Final Results
39

Service Prototyping
• What is it?
– Some form of mock-up of the service system
• “Roleplay” style conversation
• Detailed creations involving active user participation and props
• Why is it used?
– To test the service solutions being proposed
– To help iterate design solutions
41

Service Prototyping
42

43
EMIS supports
checking
GP
receptionist
gives a new
prescription
GP receptionist
collects the white
part
Pharmacy IT
system
Pharamcist
dispenses
medicine
Pharmacist receives
prescription
Physical
evidence
Service User
Actions
Frontstage
Service Provider
Actions
Backstage
Service Provider
Actions
Support
Processes
GP issues a
new
prescription
Pharmacy
reception
area
Internet,
phone, post
office
Pharmacist gives
medicine
white
part
Pharmacy
waiting area
Repeat
prescription
form
Blister pack,
dosage
dispenser,
bottle, etc
LINE OF INTERACTION
Fill in and
submit the
white part
to GP
Visit GP and
collect a
repeat
prescription
(within 48 hrs)
Visit pharmacy
and drop a
repeat
presciption
Collect
medicine
Take
medicine
LINE OF VISIBILITY
INTERNAL INTERACTION
GP
Reception
desk
Pharamcist
contacts GP for
enquiry

Workshop3
44
When What Who
14.00-14.10 Summary of the last
workshop
Stephen Rogers
Amalin Dutt
14.10-14.20 NHS change model Thomas Jun
14.20-14.50 Barriers and drivers Group discussion
14.50-15.00 Business model canvas
15.00-15.30 Business case development Group discussion
15.30-15.40 Gantt chart example
15.40-16.00 Gantt chart development Group discussion
16.00-16.30 Final presentation All
16.20-16.40 Workshop evaluation All
16.45-17.00 Award and conclusion Amalin Dutt

Workshop 2: Overview

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Editor's Notes