Automation reduces ‘seven deadly wastes’

Improving quality and efficiency at a health system

Henry Ford once said “the easiest of all wastes and the hardest to correct is the waste of time, because wasted time does not litter the floor like wasted material.” The concept of reducing waste is an important initiative at Riverside Methodist Hospital, part of OhioHealth, a health care system located in that state’s capital of Columbus.

“At Riverside Methodist we are focused on creating automated solutions to improve processes and reduce waste, with a goal of improving quality and efficiency,” said Robert Hammond, BSPharm, MS, Pharmacy Operations Manager at Riverside Methodist Hospital. “The question for us was, is our central pharmacy operating in [the] kind of environment where we’re trying to be efficient, not have delays and not have waste?”

Technology implementation

The concept of reducing different types of waste to improve the quality of care was the focus of Hammond’s presentation at the American Society of Health-System Pharmacists (ASHP) summer meeting. Over the past 4 years, Hammond and his team have installed numerous technologies such as robots, carousels, and a med shelf. “These technologies helped us improve quality because every dose that goes out of our department is either picked out by technology or bar coded and scanned as part of the dispensing process,” he said. “We’ve been able to improve our quality by decreasing errors, and we have eliminated work by not having to redo work.”

Automation is used to check expiration dates and bar codes on all doses leaving the pharmacy. “Automation had enabled us to work toward a 100% perpetual inventory so we know how many tablets we have and where they are,” said Hammond. In fact, 95% of the 15,000 doses that leave the pharmacy department daily are picked by automation. “If we manage that with automation, we have better quality and reduced errors,” he added.

E-tracking doses

Hammond and his team also implemented an e-tracking system similar to an internal FedEx- or UPS-type system so that pharmacists know where a medication is at all times during the delivery process. When Riverside Methodist first started using the tracking system, a medication was averaging about 142 minutes from when the label was printed until it reached its final destination. “By using an e-tracking system, we’ve been able to look at different areas where we had wastes such as delays, wasted motion, overproduction, and extra inventory, and we have been able reduce the waste and reduce the medication delivery time to a little less than 65 minutes,” said Hammond.

E-temperature monitoring

Medications require different kinds of storage—from room temperature to below freezing. Riverside Methodist has more than 140 refrigerators throughout the hospital, with a thermometer placed on each one. Before automation, a person would have to go around and check each refrigerator. If there was a problem, the facilities department was contacted and they sent someone out to fix it. To improve efficiency and reduce waste caused by ruined medications, “we put in an electronic monitoring  system that every 15 minutes takes a temperature reading sends it to a server on our network,” explained Hammond. If the temperature is outside a prespecified range, the system sends out an alert in the form of text messages and e-mails. “We are able to better preserve the integrity of our products by ensuring that they are maintained in the proper temperatures,” he said.

For Hammond and his team, reducing errors and improving quality and efficiency in the pharmacy comes down to automation and technology implementation. This concept is underscored by a motto coined by Riverside’s pharmacy leadership: Quality is king—if you eliminate waste, so too will you improve efficiency. “That’s not just about pharmacy, it’s about life too,” said Hammond.

Waste not, want not

Riverside Methodist Hospital uses process excellence to reduce waste in these seven categories.

  • Overproduction: Too much work in the process
  • Delays: Waiting or idle time
  • Transportation: Unnecessary movement consumes resources
  • Too much processing: Activities that do not add value
  • Inventory: Too much product on pharmacy shelves
  • Motion: Unnecessary movements by people
  • Defects: Work not performed correctly and needs to be redone