PDSA

The folks at the Denver Regional Pharmacy found their unit-based team to be a major improvement over the steering committee it replaced.

Team members found the committee to be unwieldy, and felt it largely bred distrust and miscommunication between union and management.

So, they regrouped.

A major problem they had encountered was the time pharmacy technicians wasted researching prescriptions that weren’t properly "batched." Often missing was the required electronic stamp from a pharmacist that tracks and closes the prescription.

Technicians spent roughly 1-4 hours a day per pharmacy tracking down misbatched prescriptions. The team aimed to cut that time by 50 percent.

"The biggest thing is if you view your situation as a failure you'll never succeed," management co-lead Luanne Petricich says. "When something is not working that's where your opportunity is. Don't be afraid to change something if it's not working."

The team modified the way pharmacists attached their electronic signature. That saved technicians hours of research time and freed them to spend more time with patients. Almost immediately the team saw a drop in the number of prescriptions that needed to be researched.

In the two pharmacies where the team instituted new batching practices, they saw a 75 percent drop in the number of prescriptions requiring research. The new protocol was introduced to 20 pharmacies in the region, and 70 percent of those saw similar gains.

This collaborative effort produced positive results as their projects improved customer service and affordability. The new UBT also gained some hard-earned trust.

Since that success, the regional team has become a model and a sponsor for smaller, pharmacy-specific UBTs launched in the region.

"I like the focus on efficiencies and waste because it ends up translating to a better work environment for employees," Petricich says. "Especially with this project, we found the technicians were doing redundant work that did not provide job satisfaction. So taking that away allowed for more time with patients, which is what many would rather be doing."

The MRI unit at Kaiser Sunnyside Medical Center had a challenge.

The department was receiving an average of 120 cases each day, but they were able to see only 71. As a result, patients were being referred outside of the Kaiser Permanente system. This drove up referral costs, inconvenienced KP members, and increased dissatisfaction.

In addition, referring patients to outside services posed a delay in getting results back to the ordering doctors. Schedulers who received the request for appointments also had a tough job—when they were not able to accommodate patients within the KP system, they had to make arrangements with outside services, which took additional time.

And finally, the patients didn’t like it.

The feedback from patients to department manager David Barry, was that they didn’t want to have to go elsewhere for services. Patients preferred to have their MRIs performed at the Sunnyside Medical Center.

The team's first step was to increase capacity to see more patients and reduce outside referrals by at least 10 per week within two weeks. To acccomplish this, they reduced the overlap in staffing and changed the schedules of two technologists, increasing their ability to see more patients.

The new staffing schedule, which didn’t infringe on union contracts, came out of a brainstorming session and was supported by staff and physicians.

After the first two technologists adjusted their schedules, a third technologist, seeing the difference it made, offered to adjust his schedule. By the end of one week, about 15 more patients were added to KP’s schedule and not referred to outside services. This resulted in a cost savings of about $7,500 per week, or about $30,000 per month.

"One of the big advantages that we have found is that we have openings for certain appointment types within a day or two, not a week or two," says labor co-lead Heather Thompson.

In addition to the work done in the UBT, a mobile scanner was added to the department. This enabled an additional 11 patients per day to be seen—or about 55 patients per week—for an additional per week savings of $30,000 in outside referral costs.

"There is a downside to that, though,” Thompson says. “Since patients are able to get the appointment so quickly, it seems as though we have a lot more short-notice cancellations and we do not have a wait list to fill them with. That is something that we will need to monitor and try to come up with a solution to."