Studying the efficiency of inpatient and outpatient pharmacies using lean manufacturing

Enhancing Hospital Pharmacy Operations Through Lean and Six Sigma Strategies: A Systematic Review

Hospital pharmacies are integral to the healthcare system, and evaluating the factors influencing their efficiency and service standards is imperative. This analysis offers global insights to assist in developing strategies for future enhancements. The objective is to identify the optimal Lean Six Sigma methodologies to improve workflow and quality of hospital pharmacy services. A strategic search, aligned with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, encompassed an extensive range of academic databases, including Scopus, PubMed/Medline, Web of Science, and other sources for relevant studies published from 2009 to 2023. The focus was on management tactics and those examining outcomes, prioritizing publications reflecting pharmacy operations management's state. The quality of the selected articles was assessed, and the results were combined and analyzed. The search yielded 1,447 studies, of which 73 met the inclusion criteria. The systematic review found a low to moderate overall risk of bias. The number of publications rose during the coronavirus disease (COVID-19) outbreak. Among studies, research output in the United States of America represented 26% of the total. Other countries such as Indonesia, Spain, Canada, China, Saudi Arabia, the United Arab Emirates, and the United Kingdom also made significant contributions. Each country accounted for 12%, 8%, 7%, 5%, 5%, 5%, and 5%, respectively. The pharmacy journals led with 26 publications, and healthcare/medical with 14. The quality category came next with 12 articles, while seven journals represented engineering. Studies used empirical and observational methods, focusing on practice quality enhancement. The process control plan had 26 instances, and the define, measure, analyze, improve, and control (DMAIC) was identified 13 times. The sort, set in order, shine, standardize, and sustain (5S) ranked third, totaling seven occurrences. Failure mode and effects analysis (FMEA) and root cause analysis were moderately utilized, with six and four instances, respectively. Poka-Yoke (mistake-proofing measures) and value stream mapping were each counted three times. Quality improvement and workflow optimization dominated managerial strategies in 22 (30.14%) studies each, followed by technology integration in 15 (20.55%). Cost, patient care, and staffing each featured in three (4.11%) studies, while two (2.74%) focused on inventory management. One (1.37%) study each highlighted continuing education, collaboration, and policy changes. Analysis of the 73 studies on Lean and Six Sigma in hospital pharmacy operations showed significant impacts, with 26% of studies reporting decreased medication turnaround time, 15% showing process efficiency improvements, and 11% each for enhanced inventory management and bottleneck/failure mode reduction. Additionally, 9% of studies observed decreased medication errors, 8% noted increased satisfaction and cost savings, 6% identified enhancements in clinical activities, 3% improved prescription accuracy, 2% reduced workflow interruptions, and 1% reported increased knowledge. Also, this study has identified key strategies for service delivery improvement and the importance of quality practices and lean leadership. To the best of the author's knowledge, this research is believed to be the first in-depth analysis of Lean and Six Sigma in the hospital pharmacy domain, spanning 15 years from 2009 to 2023.

Towards smart sustainable development through value stream mapping - a systematic literature review

Value Stream Mapping (VSM) is a standard Lean tool for identifying and reducing waste. It is used to create value and improve the performance of any industry. The value of the VSM has greatly expanded from conventional to smart over time; hence, researchers and practitioners in this sector are paying more emphasis. Comprehensive review research is needed to understand VSM-based smart, sustainable development from a triple-bottom-line perspective. The primary goal of this research is to look at various insights from the historical literature that can help with the adoption of smart, sustainable development through VSM. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) with a fifteen-year time range (2008-2022) is being considered to study various insights and gaps in value stream mapping. Analysis of the significant outcomes presents an eight-point study agenda: year, national context, research method, sector, wastes, VSM type, applied tools, and analysis indicators. The critical finding implies that empirical qualitative research dominates the research sector. Effective VSM implementation requires balancing the three sustainable dimensions of economic, environmental, and social through digitalization. The circular economy should also bolster research on the intersection of sustainability applications and new digital paradigms such as industry revolution 4.0.

Benchmarking outcomes on multiple contextual levels in lean healthcare: a systematic review, development of a conceptual framework, and a research agenda

Background

Reliable benchmarking in Lean healthcare requires widely relevant and applicable domains for outcome metrics and careful attention to contextual levels. These levels have been poorly defined and no framework to facilitate performance benchmarking exists.

Methods

We systematically searched the Pubmed, Scopus, and Web of Science databases to identify original articles reporting benchmarking on different contextual levels in Lean healthcare and critically appraised the articles. Scarcity and heterogeneity of articles prevented quantitative meta-analyses. We developed a new, widely applicable conceptual framework for benchmarking drawing on the principles of ten commonly used healthcare quality frameworks and four value statements, and suggest an agenda for future research on benchmarking in Lean healthcare.

Results

We identified 22 articles on benchmarking in Lean healthcare on 4 contextual levels: intra-organizational (6 articles), regional (4), national (10), and international (2). We further categorized the articles by the domains in the proposed conceptual framework: patients (6), employed and affiliated staff (2), costs (2), and service provision (16). After critical appraisal, only one fifth of the articles were categorized as high quality.

Conclusions

When making evidence-informed decisions based on current scarce literature on benchmarking in healthcare, leaders and managers should carefully consider the influence of context. The proposed conceptual framework may facilitate performance benchmarking and spreading best practices in Lean healthcare. Future research on benchmarking in Lean healthcare should include international benchmarking, defining essential factors influencing Lean initiatives on different levels of context; patient-centered benchmarking; and system-level benchmarking with a balanced set of outcomes and quality measures.

Studying the Efficiency of Waiting Time in Outpatient Pharmacy

In general, the pharmacy is the last department to be visited for outpatient in the hospitals, and therefore its efficiency is directly linked to patients’ satisfactions and more important the reputation of the entire hospital. The study here is based on Medical City that is located in Riyadh, Saudi Arabia. It serves patients from all over Saudi Arabia. The aim of the study is to improve the efficiency of waiting time of outpatient pharmacy based on the problems that have been observed using management quality tools and techniques. After analyzing the data for the current situation, then trying to propose changes for improvement in system efficiency. Results showed that by proposing automated waiting system with automated prescriptions, patient categorization, reduce the unclaimed prescriptions, and modify the pharmacy's layout. All of that will help in reducing the waiting time as well as increasing the patients' satisfaction which will lead to improve the pharmacy's efficiency. From reviewing the literature, it concludes that applying management quality tools and techniques will tremendously improve the quality of services in healthcare systems. The statistical analysis presented shows some outliers points when serving patients which were studied and recommendations were proposed. This is new approach to enhance the quality of healthcare management and leads to increase in the efficiency of the outpatient pharmacies.

A systematic review of Lean in healthcare: a global prospective

Purpose

Fostered by a rapid spread beyond the manufacturing sector, Lean philosophy for continuous improvement has been widely used in service organizations, primarily in the healthcare sector. However, there is a limited research on the motivating factors, challenges and benefits of implementing Lean in healthcare. Taking this as a valuable opportunity, the purpose of this paper is to present the key motivating factors, limitations or challenges of Lean deployment, benefits of Lean in healthcare and key gaps in the literature as an agenda for future research.

Design/methodology/approach

The authors used the secondary data from the literature (peer-reviewed journal articles) published between 2000 and 2016 to understand the state of the art. The systematic review identified 101 articles across 88 journals recognized by the Association of Business Schools ranking guide 2015.

Findings

The systematic review helped the authors to identify the evolution, current trends, research gaps and an agenda for future research for Lean in healthcare. A bouquet of motivating factors, challenges/limitations and benefits of Lean in healthcare are presented.

Practical implications

The implications of this work include directions for managers and healthcare professionals in healthcare organizations to embark on a focused Lean journey aligned with the strategic objectives. This work could serve as a valuable resource to both practitioners and researchers for learning, investigating and rightly adapting the Lean in the healthcare sector.

Originality/value

This study is perhaps one of the comprehensive systematic literature reviews covering an important agenda of Lean in Healthcare. All the text, figures and tables featured here are original work carried by five authors in collaboration (from three countries, namely, India, the USA and the UK).

Implementation of Lean Six Sigma in Saudi Arabian organisations

Purpose

Although the popularity of the Lean Six Sigma (LSS) methodology has illustrated many benefits over the years for those organisations who have implemented it, this strategy has received less attention in developing countries. The purpose of this paper is to critically assess the current status of LSS implementation in Saudi Arabian organisations.

Design/methodology/approach

This research is based on a descriptive survey questionnaire which has been derived from two systematic literature reviews. The survey was distributed to 400 organisations in Saudi Arabia using Qualtrics online software. In total, 146 responses were received where 102 responses were completed and analysed.

Findings

The findings of the survey highlighted that the implementation of LSS is still in the early stages in organisations within Saudi Arabia. This was clearly shown by many factors such as years of deploying LSS, LSS infrastructure, level of awareness of LSS, impact of LSS on business functions and so on.

Research limitations/implications

The primary limitation of this study is that data has been collected from an online survey and therefore no deeper insights could have been captured from the survey. This calls for future research to be undertaken by executing semi-structured interviews in selective organisations within Saudi Arabia.

Originality/value

This paper contributes to the current status of LSS in Saudi Arabian organisations. It also gives recommendations to guide the future of LSS in Saudi organisations by comparing LSS literature with best practice.

Lean Thinking in Global Health Care

This chapter explains the overview of Lean production; the overview of value stream mapping (VSM); the applications of Lean production in global health care; the implementation of Lean production in global health care; and the challenges and implications of Lean production in global health care. Lean production can be used to identify and eliminate the wastes in any health care activity performed within a health care facility. Lean production can be applied to hospitals and health care organizations to redesign health care processes toward improving the quality of care and reducing costs and wastes. Successful Lean health care efforts result in the measurable improvements in patient outcomes, such as improved quality, less harm due to preventable errors, better access, shorter waiting times, and better service. Implementing Lean production has the potential to enhance health care performance and gain sustainable competitive advantage in global health care.

Investigating emergency room service quality using lean manufacturing

PURPOSE

The purpose of this paper is to investigate a lean manufacturing metric called Takt time as a benchmark evaluation measure to evaluate a public hospital's service quality. Lean manufacturing is an established managerial philosophy with a proven track record in industry. A lean metric called Takt time is applied as a measure to compare the relative efficiency between two emergency departments (EDs) belonging to the same public hospital. Outcomes guide managers to improve patient services and increase hospital performances.

DESIGN/METHODOLOGY/APPROACH

The patient treatment lead time within the hospital's two EDs (one department serves male and the other female patients) are the study's focus. A lean metric called Takt time is used to find the service's relative efficiency.

FINDINGS

Findings show that the lean manufacturing metric called Takt time can be used as an effective way to measure service efficiency by analyzing relative efficiency and identifies bottlenecks in different departments providing the same services.

ORIGINALITY/VALUE

The paper presents a new procedure to compare relative efficiency between two EDs. It can be applied to any healthcare facility.