2. Outline
• Background
• The problem and Rationale
• Project objective
• Tools and techniques
• Results
• Limitations and Challenges
3. Background
Signature Healthcare is southeastern Massachusetts' premier
local provider of personalized, quality medical services.
A hospital system:
• 550 affiliated physicians and other direct care providers
• 150 employed physicians and a total of 2,200 associates
• Operates from 7 locations
• Adopts lean as a philosophy
About Signature Healthcare
Lean Management
4. The Problem
Patient needs to refill
prescription; calls
either the pharmacy
or the hospital
The Prescription
team receives the
request from various
sources: phone call,
voicemails, e-
requests and fax
The review and
approval process
may take longer
and the doctor is
frustrated that he
has to keep
seeing hundreds
of requests in his
task basket
Patient calls back
the hospital to
make a repeat
request
Patient is
waiting to
receive
medication from
the pharmacy
5. Rationale
• Primary care practices often spend a significant amount of time and
resources in the management of prescription renewals
• Need to have an accurate and efficient prescription renewal system
• One of Signature’s strategy to promote a QI culture using Lean
6. Project Objective
1. Understand the current prescription renewal
process for maintenance drugs
2. Identify points of recognition
3. Conduct a root cause analysis of recognized points
4. Develop recommendations on improving the
coordination and flow of prescription renewal
7. Tools and Techniques
• Project Charter – Objectives and scope of the project
• Gantt Chart – To set deadlines and priorities
• Process Maps – To understand the current and future state workflows
• Fish Bone Diagram and 5 whys – Root Cause analysis
• Impact/Effort Matrix – Recommendations
• A3 – Problem solving and tracking the progress of the project
8. Current State Process
Multiple channels of
request
Big overlap between
tasks of Prescription
team and physician
Redundant fax request
10. Root Cause Analysis
Fax requests
•Duplication of requests
•70% – 90% of fax requests are redundant
•Fax request is received at a different location from where Rx team is located
•Fax received is transported by mail to Rx team’s location
Overlapping
tasks
•MD can view requests along with flagged requests in the task basket
•Rx team can take as much as 48 hours to review and approve them
•Rx team experiences backlog on Mondays, which takes till Tuesday afternoon to be cleared
•No one is able to renew the request during the weekend
Multiple
stakeholders
•Multiple channels of refill requests
•No specific instructions from hospital to patients
•There is no standardized process for making a request
12. Recommendations
1- Relocating fax machines to the
prescription team’s office
2 - Reduce Rx renewal by phone calls and
voicemail
3 - Standardize the number of stakeholders
entering requests into allscripts
4 - Restrict the prescription-related tasks
physician is able to see in task basket per
time
5 – Make staff available during weekends to
review and approve requests
6 - Create a standard protocol to follow-up
with patients with no show for appointments
7 - Yearly and biyearly prescription renewal
8 - Contact external pharmacies to send
requests via Surescripts and not fax
13. Challenges and Limitations
• Defining the scope of the project
• Inadequate data for process analysis
• Developing recommendations that is acceptable to
all stakeholders
Mention percentage --- according to the literature
Develop recommendations on improving the coordination and flow of prescription renewal related tasks between the physician, physician support team and prescription team
Mention about the study –
Remove the 6th point - makes no sense
