Tuesday, May 12, 2009

Returning to Gemba




You may recall that I discussed the Lean training program being taken by our senior management group. A second session was held this week, and we returned as a group to Gemba, the place where work happens, where value is created for consumers. Today's visit was to the pharmacy. SVP Jayne Sheehan, seen above in her "bunny suit", and I observed how things are done in the clean room.

We watched Rena Lithotomes (left), a trainee, and Rosmara Harvey (right), a pharmacist, as they carried out the incredibly precise and important work of preparing dosages of a wide variety of drugs used in clinical settings.

Later in the classroom setting, we compared notes to refine our observational skills and ability to see opportunities for reductions of muda, mura, and muri in our work areas. These concepts have often been used in other industries, but not so much yet in the health care industry. Probably the best example is Virginia Mason Medical Center in Seattle, where CEO Gary Kaplan has made this the hallmark of his administration for several years. We are earlier on the path to adoption of this philosophy in our hospital, merging it into our BIDMC SPIRIT program in a more systematic way over the coming months.

4 comments:

nasov said...

Just curious -- why no gloves?

Bob Yokl said...

Paul, I just had a client (they have a separate initiative than my value analysis supply savings) that was able to eliminate the clean room altogether buy using a clean chamber. Now they actually mix the drugs by using a set of rubber gloves that are external to the chamber thus they don't have to put on the gowns, masks, gloves, etc. (savings$$$). Picture the boy in the plastic bubble type of thing but a bigger chamber geared towards mixing drugs.

My reason for monitoring it is that I was working with them on supply costs and we quickly realized a 95% elimination of gowns, supplies, gloves, etc.

AND it guaranteed a sterile environment which most clean rooms cannot do...e.g., Nasov's question above with no gloves on in the Clean Room.

Hope this is helpful.


P.S. BENCHMARK....This hospital uses the Space Suit type of gowns for their clean room but I noticed that is not the case in BIDMC's clean room.

Paul Levy said...

A note from Frank Mitrano, our head of pharmacy:

The sterile products compounding area is comprised of three separate and distinct areas:
Gowning and Scrubbing
Anteroom or assembly/storage area
Cleanroom or compounding area (referred to as buffer area in the USP standards)
We require that operators wear sterile gloves when they are in the cleanroom area only. They are not required in the anteroom or assembly area. This is consistent with USP standards and assures that those involved in the "less clean areas" don’t get as false sense of security that they are wearing sterile gloves and then pass from that area to the cleanroom compounding area with gloves that have been exposed to potential contaminants. I am glad to speak to anyone who has questions.

Bob Yokl said...

It is obvious that Nasov and I were only viewing pictures of your Gemba and we stand corrected!

There is more than meets the eye (or picture) at a hospital the size of BIDMC. Keep up the good work!