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Medisch SpectrumTwente,Enschede,TheNetherlands
Schermafbeelding 2015-04-06om11.15.31
TheHighRiskMedicationprocedure,partofthecurrentSafetyManagementSystemimplementation.
WithinnursingdepartmentsexecutingtheHighRiskMedicationprocedurerequiresagreatworkeffortcausingproblemsindailycareandtimespentonpatients.Theexecutionofthisproceduretakesonaverage15minutesperpatientperprocedure,whichisexecuted4timesadayperpatient.Theaveragenumberofpatientsinaward isabout30patients.Therewere15wardsinvolvedinthisproject.
Analysis
Ø ValueStreammappingofthecurrentsituation.Ø Measurementsleadtimeofthecurrentsituation
Proposalistoredesigntheprocedurebasedonexecutingexperimentsinpractice.
LessonslearnedWehavelearnedthatit isimpossibletodesignproceduresinan ivorytower.Anewprocedureshouldalwaysbeexperimentedbeforeimplementingit.Hospitalsdonotusetheexpertiseofthewardsenoughtodesignadequateandacceptableprocedures.
JanWijnandHoekLeanImprovementOfficer
Project/Kaizen>Improvingthehighriskmedicationprocedure
EffectsofthechangesØ Theaveragetimespentexecutingtheprocedureisreducedbymore
than5minutesperpatientperprocedure.Ø Procedure adaptedfrom30stepsto27stepsØ NewProcedure isunderstood andapplied atthewardØ Thetimegainedbytheprojectisspentonpatientcareand
attention.
#Medication
1st
experiment2nd
experiment3rd
experiment
1st
medication4:02 2:20 2:44
2nd
medication5:47 3:48 3:47
3rd
medication5:50 5:04 4:20
4th
medication6:54 5:22 4:54
P D
SA
21
experimentingwithinonewardinpractice
cycles
Progressoftheexperiments
nurse& nurse&nurse&nurse&nurse&nurse& nurse&nurse&nurse&
nurse&1&
nurse&2&
Reducing&handling,&interup4ons&searching,&enforing&efficient&work&
nurse&
nurse&
nurse&nurse&
nurse&
nurse&
nurse&
nurse&
nurse&
=&Old&approach:&
New&approch:&
VideoinstructionadaptedprocedureProcessredesign
P D
SA
56
experimentingwithina laboratorysetting
cycles
StrategyforchangeusingToyotaKata
Bottomline:makeimprovementsinsmallstepsbyexperimentingaprocesswiththeexpertsoftheshopfloorinpractice.