Children's Hospital Applies Lean Thinking to Pharmacy Practice

Ms. Heinze is a freelance writer based in Vancouver, British Columbia

Reputed for its adoption of innovative technology and procedures, the Children?s Hospital of Philadelphia (CHOP) provides both inpatient and outpatient services for children and adolescents. The facility boasts a division of hematology, as well asa clinical oncology program that is recognized as one of the largest in the United States.

Like the rest of the hospital and research center, CHOP?s pharmacy practice aims for innovation through the application of a number of progressive principles, surprisingly, gleaned from automotive manufacturing. Director of Pharmacy Winson Soo-Hoo explains that over the past 2 years, the facility has incorporated the values of ?lean thinking,? a Japanese philosophy made famous by Toyota.

The basic principle behind lean thinking is that by focusing on all things that provide value to the customer, an organization can implement an effective workflow that, when streamlined, eliminates waste. ?As you are processing orders, there is a whole host of waste, such as transportation, making too much, and not having inventory at the time that you need it,? Soo-Hoo observed. ?All of these things keep the employees or the pharmacist from doing the job that they are supposed to be doing.?

This is especially challenging in CHOP?s pharmacy practice, where pharmacist training lasts up to 6 months. ?There is a lot that we have to teach the staff that they may not get from pharmacy school,? Soo-Hoo explained. ?Pediatrics, for mostpharmacy graduates, is a 1-week introduction.? CHOP?s pharmacy training program encompasses extensive testing and simulation modules, which Soo-Hoo recognizes is not the norm in many hospitals.

With their emphasis on workflow, lean principles embrace the notion of standardization, which, Soo-Hoo notes, greatly improves training. ?If you have a week?s worth of training, and you have 4 people training the same person, you are really not training them because you are not getting reinforcement,? he said. Standardization, he adds, is not only the basisof good training, but of continual improvement as well. ?If everybody is not doing things in a standardized way, there is no way to identify what the root cause is, and there is no way to develop a solution that addresses the problem, because everybody is doing something different.?

To properly incorporate lean principles in an organization, employeesmust have ownership of the workflow process. In this way, not only are they contributing to the development of the practice; they are also accountable for the changes that they make. ?When they are engaged, they hold each other accountable to those solutions, and you get better compliance to the solutions that are implemented,? Soo-Hoo said. ?Also, because we are giving them feedback on what the outcome is, we are giving them the chance to grow.?

This helps with both recruitment and retention, because as the overall workflow is improved upon, employees know both where they stand in terms of performance and why any modifications are being made in the first place. ?If you have standardized work?if everybody knows and participates in these processes?they can explain to the employees why we are doing things a certain way,? Soo-Hoo said. It is a better approach to training. He adds, ?Instead of someone saying, ?I do not really know why they are doing it this way, but this is the way that we have always done it,? employees are told, up front, ?these are the reasons why we are doing things this way.??

As CHOP continues to integrate new systems into its pharmacy, Soo-Hoo and his team are constantly evaluating how workflow and technology can complement each other for optimum performance. ?When you integrate automation, there needs to be a merging of your workflow into this technology,? he said. ?It is not about adding the technology; it is about how you rearrange your work to complement the technology or vice versa.? Has CHOP arrived at the perfect solution, then? ?No, but I think we are working towards it.?

For more information on CHOP, please visit www.chop.edu.