title: Using lean methodology to improve productivity in a hospital oncology pharmacy.
abstract: OBJECTIVE
  Quality improvements achieved by a hospital pharmacy through the use of lean methodology to guide i.v. compounding workflow changes are described.
  
  
  CONCLUSIONS
  The outpatient oncology pharmacy of Yale-New Haven Hospital conducted a quality-improvement initiative to identify and implement workflow changes to support a major expansion of chemotherapy services. Applying concepts of lean methodology (i.e., elimination of non-value-added steps and waste in the production process), the pharmacy team performed a failure mode and effects analysis, workflow mapping, and impact analysis; staff pharmacists and pharmacy technicians identified 38 opportunities to decrease waste and increase efficiency. Three workflow processes (order verification, compounding, and delivery) accounted for 24 of 38 recommendations and were targeted for lean process improvements. The workflow was decreased to 14 steps, eliminating 6 non-value-added steps, and pharmacy staff resources and schedules were realigned with the streamlined workflow. The time required for pharmacist verification of patient-specific oncology orders was decreased by 33%; the time required for product verification was decreased by 52%. The average medication delivery time was decreased by 47%. The results of baseline and postimplementation time trials indicated a decrease in overall turnaround time to about 70 minutes, compared with a baseline time of about 90 minutes.
  
  
  CONCLUSIONS
  The use of lean methodology to identify non-value-added steps in oncology order processing and the implementation of staff-recommended workflow changes resulted in an overall reduction in the turnaround time per dose.
authors.affiliation: Peter Sullivan, Pharm.D., is Adult Oncology Pharmacy Resident, Memorial Sloan Kettering Cancer Center, New York, NY; at the time of writing, he was Postgraduate Year 1 Pharmacy Resident, Yale-New Haven Hospital (YNNH), New Haven, CT. Scott Soefje, Pharm.D., BCOP, M.B.A., is Director of Pharmacy, University Medical Center Brackenridge, Austin, TX; at the time of writing, he was Associate Director, Oncology Pharmacy, Smilow Cancer Hospital at Yale-New Haven, New Haven, CT. David Reinhart, CPhT, is Oncology Pharmacy Technician; Catherine McGeary, Ph.D., is Performance Improvement Coordinator; and Eric D. Cabie, B.S.Pharm., M.B.A., is Supervisor, Oncology Pharmacy Services, Department of Pharmacy, YNNH. sullivap@mskcc.org.
authors.forename: Peter
authors.initials: P
authors.lastname: Sullivan
authors.affiliation: Peter Sullivan, Pharm.D., is Adult Oncology Pharmacy Resident, Memorial Sloan Kettering Cancer Center, New York, NY; at the time of writing, he was Postgraduate Year 1 Pharmacy Resident, Yale-New Haven Hospital (YNNH), New Haven, CT. Scott Soefje, Pharm.D., BCOP, M.B.A., is Director of Pharmacy, University Medical Center Brackenridge, Austin, TX; at the time of writing, he was Associate Director, Oncology Pharmacy, Smilow Cancer Hospital at Yale-New Haven, New Haven, CT. David Reinhart, CPhT, is Oncology Pharmacy Technician; Catherine McGeary, Ph.D., is Performance Improvement Coordinator; and Eric D. Cabie, B.S.Pharm., M.B.A., is Supervisor, Oncology Pharmacy Services, Department of Pharmacy, YNNH.
authors.forename: Scott
authors.initials: S
authors.lastname: Soefje
authors.affiliation: Peter Sullivan, Pharm.D., is Adult Oncology Pharmacy Resident, Memorial Sloan Kettering Cancer Center, New York, NY; at the time of writing, he was Postgraduate Year 1 Pharmacy Resident, Yale-New Haven Hospital (YNNH), New Haven, CT. Scott Soefje, Pharm.D., BCOP, M.B.A., is Director of Pharmacy, University Medical Center Brackenridge, Austin, TX; at the time of writing, he was Associate Director, Oncology Pharmacy, Smilow Cancer Hospital at Yale-New Haven, New Haven, CT. David Reinhart, CPhT, is Oncology Pharmacy Technician; Catherine McGeary, Ph.D., is Performance Improvement Coordinator; and Eric D. Cabie, B.S.Pharm., M.B.A., is Supervisor, Oncology Pharmacy Services, Department of Pharmacy, YNNH.
authors.forename: David
authors.initials: D
authors.lastname: Reinhart
authors.affiliation: Peter Sullivan, Pharm.D., is Adult Oncology Pharmacy Resident, Memorial Sloan Kettering Cancer Center, New York, NY; at the time of writing, he was Postgraduate Year 1 Pharmacy Resident, Yale-New Haven Hospital (YNNH), New Haven, CT. Scott Soefje, Pharm.D., BCOP, M.B.A., is Director of Pharmacy, University Medical Center Brackenridge, Austin, TX; at the time of writing, he was Associate Director, Oncology Pharmacy, Smilow Cancer Hospital at Yale-New Haven, New Haven, CT. David Reinhart, CPhT, is Oncology Pharmacy Technician; Catherine McGeary, Ph.D., is Performance Improvement Coordinator; and Eric D. Cabie, B.S.Pharm., M.B.A., is Supervisor, Oncology Pharmacy Services, Department of Pharmacy, YNNH.
authors.forename: Catherine
authors.initials: C
authors.lastname: McGeary
authors.affiliation: Peter Sullivan, Pharm.D., is Adult Oncology Pharmacy Resident, Memorial Sloan Kettering Cancer Center, New York, NY; at the time of writing, he was Postgraduate Year 1 Pharmacy Resident, Yale-New Haven Hospital (YNNH), New Haven, CT. Scott Soefje, Pharm.D., BCOP, M.B.A., is Director of Pharmacy, University Medical Center Brackenridge, Austin, TX; at the time of writing, he was Associate Director, Oncology Pharmacy, Smilow Cancer Hospital at Yale-New Haven, New Haven, CT. David Reinhart, CPhT, is Oncology Pharmacy Technician; Catherine McGeary, Ph.D., is Performance Improvement Coordinator; and Eric D. Cabie, B.S.Pharm., M.B.A., is Supervisor, Oncology Pharmacy Services, Department of Pharmacy, YNNH.
authors.forename: Eric D
authors.initials: ED
authors.lastname: Cabie
mesh_terms: D004339:Drug Compounding; D017598:Efficiency, Organizational; D016522:Oncology Service, Hospital / Q000458:organization & administration*; D010607:Pharmacy Service, Hospital / Q000458:organization & administration*; D058996:Quality Improvement / Q000458:organization & administration*; D013997:Time Factors; D057188:Workflow