Implementation of a transformational plan of care at a Veterans Affairs medical center.

PURPOSE: A quality of care-focused process improvement initiative undertaken by the pharmacy service at a Veterans Affairs (VA) medical center is described. SUMMARY: In September 2016, near the end of VA's 2016 fiscal year (FY), pharmacy leaders at the medical center held a strategic planning retreat to develop goals and objectives for FY 2017. The retreat was facilitated through use of principles of lean methodology, including "A3 problem solving," and resulted in development of a transformational plan of care (TPOC). After identifying process improvement projects with the highest value-adding potential, retreat participants prioritized those projects in accordance with targeted value streams encompassing 5 areas of pharmacy operations: United States Pharmacopeia chapter 800 compliance, standard work, physical space, technology, and people. Upon retreat completion, tasks were assigned to pharmacy service managers according to their respective areas of expertise. The status of each project and the projects' impact on both pharmacy and facility outcome measures were continually assessed throughout FY 2017. Continuous reevaluation of projects within each value stream allowed for accurate outcome tracking and creation of a pharmacy dashboard. In the months after implementation of the pharmacy service TPOC, improvements in a number of performance metrics were documented. CONCLUSION: Use of lean process improvement methodology and the A3 problem-solving process resulted in more efficient generation and implementation of ideas, consistent follow-up, and the ability to continuously reevaluate pharmacy service operations to ensure progress throughout the year.

Utilization of Lean Techniques in Pharmacy Residency Training: Modifying the PGY1 Management and Leadership Experience.

Purpose: The purpose of this study was to utilize lean process improvement principles to enhance the health-system pharmacy administration learning experience within a postgraduate year 1 (PGY1) residency program. Summary: The Richard L. Roudebush VA Medical Center adopted the use of lean to improve customer service and workplace efficiency. The Residency Advisory Council, overseeing the 6 pharmacy residency programs, felt that training residents in a proven process improvement technique would benefit the service and assist in developing problem-solving skills. Yellow Belt training was incorporated into the residency programs in 2012, and the Yellow Belt project for the 2014-2015 residency class was the modification of the PGY1 Health-System Pharmacy Administration learning experience. Residents focused on a few key areas as part of their completion plan: educating residents and preceptors on the importance of leadership activities, establishing a list of consistent topic discussions to be held during the administration learning experience, confirming a topic list for the pharmacy practice management and leadership seminars, piloting collaborative precepting for the administration experience, revising the staff development program, and increasing resident involvement in the PGY1 interview process. Two portions of the project lacked effective and timely communication, and as a result, those areas were not fully implemented. The remainder of the items achieved 100% completion. Conclusion: Lean techniques were effectively utilized within a residency program to enhance the health-system pharmacy administration learning experience. Successful implementation of lean requires engagement of stakeholders within the health-system, timely communication, frequent reassessments, and accountability.

Implementation of a Patient Medication Disposal Program at a VA Medical Center.

A pharmaceutical take-back program assisted patients with disposal of unwanted and expired medications, promoted safety and environmental stewardship, and reduced the risk of diversion.

Impact of a Regional Pharmacy Call Center on Telephone Access Metrics Within the Veterans Health Administration.

PURPOSE: To establish a cost-effective centralized pharmacy call center to serve the patients of Veterans Integrated Service Network (VISN) 11 that would meet established performance metrics. METHODS: A pilot project began in August 2011 with the Indianapolis VA Medical Center (VAMC) and the Health Resource Center (HRC) in Topeka, Kansas. The Indianapolis VAMC used a first-call resolution business model consisting of pharmacy technicians receiving tier 1 phone calls that could be escalated to a tier 2 line that consisted of lead technicians and pharmacists, while the HRC utilized general telephone agents that would transfer unresolved calls to the primary facility. Pre- and post-VISN 11 Pharmacy Call Center performance metrics were compared for each of the 7 facilities in the network with the goals being monthly average abandoned call rate less than 5% and average speed to answer less than 30 seconds. Cost per call was also compared. RESULTS: The average abandoned call rate for the network during the year prior to VISN 11 Pharmacy Call Center implementation (August 2010-July 2011) was 15.66% and decreased to 3% in July 2014. The average abandoned call rate decreased for each individual facility. In fiscal year 2014, the VISN 11 Pharmacy Call Center was operating at a cost of $4.35 per call while providing more services than the HRC, resulting in less workload being transferred back to the individual facilities. CONCLUSION: A centralized VISN pharmacy call center is a reasonable alternative to individual facility call centers or the HRC.