CLIENT:
Academic Medical Center CASE STUDY
Mid-Atlantic Region
Our goal was to investigate what the space needs were for consolidating multiple compounding pharmacies at an academic medical center Whether for projection and development of new environments of care, or for analyzing your existing practice spaces, lean operational and facility planning studies are critical to understand the investment needed for service growth.
CHALLENGE
EXECUTIVE SUMMARY
To investigate the consolidation of two restrictive
Our client, a Mid-Atlantic Academic Medical Center, had been
and non-compliant compounding pharmacies by analyzing their current and future compounding throughput needs. Array was also tasked with evaluating an inefficient main pharmacy and storeroom space to “rightsize” the client’s operations based on their current deficiencies and future growth needs.
experiencing facility related and operational challenges in three separate pharmacies currently operating in different locations on the main campus, including the central pharmacy and two compounding satellite pharmacies. The Infusion compounding pharmacy had the most deficiencies and is experiencing the most growth, as it is the infusion pharmacy for a rapidly growing outpatient infusion center. One of the satellite pharmacy supports both outpatient and inpatient demands for any investigational drugs and research studies. Our client requested the services of Array Advisors to study the
SOLUTION
operational and facility-related factors and to consider if these
Current State mapping exercises were used to uncover challenges in both process and experience
separately operated facilities should be consolidated into a single facility to be located within newly vacated space on the main campus.
in the areas being studied. Years of compounding data were analyzed along with in-depth discussions on processing times vs. idle time of various drug types to provide insight on actual hood needs. A program was created to demonstrate to Medical Center administration how current spaces were operating versus our suggestions for not only right-sizing their spaces, but opportunities for sharing resources and consolidating compounding areas. This included detailed information to help them estimate the durations and costs that would be associated with consolidation.
PROJECT HIGHLIGHTS
Figure 1: Floor plans of Central Pharmacy & Storeroom
6
Proposed Sterile Hazardous Hoods
9
Proposed Sterile Non-Hazardous Hoods
1
Proposed Non-Sterile Non-Hazardous Hood
CLIENT PROFILE Academic Medical Center MidAtlantic Region
Data Collection & Analysis Main /Central Pharmacy This pharmacy is currently located on the first floor and includes receiving, storage, a narcotics vault, unit dose, order entry and staff offices. The staff receive deliveries
Out client sits at the heart of a vibrant city
specific to the Pharmacy from the dock freight elevator, which creates a significant
with a myriad of health concerns. It is one
bottleneck at the Receiving Area.
of the nation’s oldest academic medical
Approximately 80% of medicines are individual doses and most go into three
centers and is distinguished by discoverydriven tertiary and quaternary care for the state and region for its innovative, highly specialized clinical programs.
carousels. These carousels are nearing the end of their life cycle and the client is considering future automation. Both the Storeroom and Carousel areas require more counter and work space. Dose Prep (of non-sterile compounds) needs to be closer to the Storeroom. The IV Lab (old compounding area) is currently not used; however,
The Medical Center provides
the goal is to make this space fully operational for robotic compounding. Overall, too
comprehensive care for many
many people are working in undersized spaces with inefficient layouts.
communities and is a regional resource. The Medical Center has more intensive care beds than any other hospital in the state.
Infusion Compounding Pharmacy In the current Infusion Compounding Pharmacy, hazardous drug prep happens in two compounding aseptic compounding isolators (CACIs) and a Chemo Robotic Compounding Device in a dedicated negative-pressure room. All non-hazardous drug doses are prepared in a compounding aseptic isolator (CACI) located in the anteroom. The order entry window is cramped, which causes technicians to congregate trying to move their compounding prescriptions through more quickly. The order checking space is also tight with four pharmacists all working in a small area along with a refrigerator and IV bag pass-through. This satellite pharmacy experienced a 15% growth for outpatient infusion within the last year and continued growth is expected. It is where 75% of IV medications are created and is severely undersized, including a lack of compounding space, pharmacist work space and inadequate storage space. The Infusion Compounding
TOOL
Pharmacy also needs space for another hood to provide a true separation clean room. In addition, hazardous storage is currently located in the Central Pharmacy’s Storeroom and will need to be upgraded to comply with USP <800> standards.
Investigational Drug / IDS
Throughput Analysis The processing rates of each step combine to create total throughput time. Steps with longer durations occurring later in the process create bottlenecks, and non-value-added waiting time will increase the time it takes to get through the system. Array’s experienced team works with users to determine the optimal process-steps configuration that maximizes the value quotient in each system.
Page 2 | Case Study
This satellite pharmacy is the home base for all clinical trials studies, 75% of which are hazardous (inpatient, outpatient, IVs, orals, etc.). Over 95% of these deliveries come straight to IDS via vendors or sponsors and must be secured and separated from other items. Approximately half of these drugs are compounded. Currently, both hazardous and non-hazardous compounding are done in the same room. The pharmacy does not have adequate separate space for the separation required and this is not consistent with current USP <797> regulations or the upcoming USP <800> regulations. This pharmacy also lacks proper shipping and receiving space.
TRANSFORMATION Our core mission is the same as that of our clients: improve the quality of our work, increase our efficiency, and motivate our staff to reach for success. At Array, we Figure 2: Current State Gemba Map
Tasks Space challenges Operational challenges Path of Travel
are establishing a culture of continuous improvement at all levels of our organization. We seek to empower team members to be agents for good change.
Simulation Model Array received data from each of the three pharmacies for compounding volumes. The Medical Center collected some of the data manually and extracted some from electronic medical records. The Healthcare Systems Engineer at Array analyzed the data to determine the current daily compounding volumes for each pharmacy. Array used this information to develop a simulation model for testing more efficient workflows. We compared each of the volumes in the simulation model to the actual data, ensuring that the model accurately represented the current state of pharmacy compounding operations. After validating the simulation model, we tested new workflows with a focus on consolidating the three separate compounding pharmacy areas into a consolidated compounding pharmacy, allowing for more flexible resource utilization. The simulation model allowed staff to better understand the impact of combining the separate workflows into a single pharmacy operation. It also helped illustrate how the number of available resources affected the efficiency of the system’s performance.
Results & Recommendations 1. 2.
process before exploring solutions. Our team can guide your organization through pre-design, ensuring clear goal-setting; target outcomes; process analysis and design; and decision support. Our Lean-led approach to project definition provides a clear path to the right project before you begin to design.
How can we ensure effective resource utilization? Every aspect of the healthcare industry relies on resources, including staff, equipment and space. It’s imperative that organizations utilize their resources effectively. Our skilled and experienced consulting team can help your organization develop a strategy for utilization optimization, ensuring that
Consider merging the compounding operations of the two satellite
every resource is providing the highest
pharmacies, if IDS has a dedicated hood and separate drug storage.
value while improving process flow.
Move as many of the pharmacy services as possible from the first floor for needed growth in the Infusion area.
3.
We begin all endeavors by considering
Share compounding space with other pharmacy functions if storage and staff work areas are separate and secure.
Figure 3: 12-Hour Compounding Operations - Chart includes 5.4% growth total over 5 years
Tools used: Capacity & Utilization Assessment, Current State Assessment, Observation, Simulation Modeling, Time Study
“Sometimes it takes unbiased eyes to see the potential for improvement.” Laura Silvoy Healthcare Systems Engineer
Cast Study | Page 3
DISCOVERING YOUR HEALTHCARE SOLUTIONS TOGETHER We are innovators who specialize in the areas your system seeks out to leverage its valuable operational and facility resources. Array Advisors has the expertise and skills to reach beyond your milestones and provide you the decision support you need.
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We are dedicated to improvement.
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Problem-solving and forward-thinking
We are Array Advisors, your trusted partners in Strategy Development, Organizational
individuals lead our efforts, which focus on your unique place in the healthcare delivery spectrum. Our knowledgeable staff can help you solve strategic business problems and develop a method to improve efficiency and utilization.
Transformation, and Facility Informatics. The challenges you face are not unique, but your solutions should be. Through a partnership of Strategy and Transformation we help you achieve and sustain. Our process begins by understanding your current operations and clearly defining your systemâ&#x20AC;&#x2122;s goals before generating options. We employ a variety of integrated methods tailored to your strategic challenges, such as process mapping; operational planning; and healthcare real estate portfolio optimization, to help position your organization for future success.
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Informatics Building Information Model management (BIM) is an enabler of most other technology trends in the Architecture, Engineering, Construction, Operations (AECO) industry, including but not limited to: sustainable design, offsite fabrication, LEAN construction, and energy efficient operations. Carefully considering how best to leverage virtual/digital representations of physical buildings can provide significant returns on innovation throughout the entire lifecycle of your facilities.
Strategy The need for healthcare real estate portfolio optimization has never been greater. With the acceleration in mergers and acquisitions, as well as the evolution of clinical models, healthcare organizations must continuously evaluate their physical assets and maximize the value they derive from them.
Transformation Transformation and lean methods are very useful when focusing on operational process improvement. By bringing all constituents together and giving them the tools to experiment and test new ideas, current state barriers can be identified and transcended.
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Published: MONTH 2017