Case Analysis: Computerized Physician Order


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The vast majority of hospitals used hand-written paper prescription process, which caused a to of errors that generated costs and deaths, viewing the current and wanted state allows to make changes and improvements where needed. Pokka yoke – it is used via the COPE system that simply addresses illegibility and incomplete orders by having the prescribed enter the Information into a computer. The system must offer prompts that warn against possible drug Interactions, patient allergies and over or under doses of the drug.

Drug specific information must be available that will eliminate confusion about sound-alike or look-alike drug names. SEEMED – The setup time that he nurses used to take in order to change drugs from patient to patient, is now reduced because the COPE allows them to get the right medicines, for the right patients In the right time. Continuous flow – This Is exemplified with fact that the doctor or nurse upload the prescription, that later can be followed by all of the people Involved In the process, Including the pharmacist and the drug store.

Waste elimination – With a total financial cost of $77 billion per year and costs increasing with double digits yearly, several Institutes across the US, decided to apply lean in order to reduce costs. The overproduction of orders is eliminated using the COPE, at the same time the reduction of rework is reached because there’s no more need of checking several times the prescription. The transportation Is also reduced by the system, due to the fact that the nurses don’t need to come and go several times for different drugs.

There’s an “excessive Inventory’ which should be eliminated using other lean tools. Kanata – The system acts as “Kanata cards”. The computer, prints out the order that is used by the rest of the value stream the same as a hand-written order. The order is also sent to the pharmacist, who revises and quotes the restriction, he uploads the results to the system, allowing the people In charge of the Inventory to give the drugs to the nurses, who at the time have access to the COPE.

The system must Improve communication between all the characters Involved. Key activities performed related to the success of lean application in the case assigned One of the key activities performed that is related to the success of the lean application in the hospital of the case is the translation of the benefits from implementing lean tools, and in the case the COPE system and value stream maps, to language that is comprehensible by the hospital administration.

Such language includes financial figures, administrative metrics like number of deaths related to drug prescription, drug supply mistakes, and the economical value of such mistakes. Such a translation of the benefits will ensure that the directive or administrative boards of the hospital give their support to the implementation of the COPE systems. Another key activity was making the Value Stream maps in a way that everyone could understand them.

By making a physical representation of the process, it is easier to explain the areas of opportunity in them and to further explain the modifications that can be made to improve the process or processes. In the case the physical representation ensured that the improvement that can be made by implementing the COPE system. In this same activity not only the present Value stream was mapped but also the future state. A third activity that was performed and that is related to the success of lean application was the analysis made in a customer focused way.

The improvements proposed address problems that the users of such a system have like he doctor that prescribes the medicines, the clerks and pharmacists in their daily activity. The system tries to solve and make easier their Job by understanding their own way of working and the natural mistakes they may generate. Also, the System will be able to detect all of these mistakes made, and furthermore, the COPE system will be able to inform and assist the prescribed and pharmacists on the different negative effects and interactions that a medicine could have with the patient.

Another activity done related to the success of lean implementation was the effort add to correctly identify the value embedded in the process. In this sense preventing mistakes and defects were not only the objective of the analysis but also ensuring the correct administration and in the correct time of the drugs. For this the prescriptions where divided in according to their importance and the ability of the improvement (The COPE system) to manage such differences in prescriptions was taken into account.

Finally along with the translation of the benefits from implementing the COPE system, a cost benefit analysis was also elaborated and included. This will finish convincing the administration and all those resistant to the implementation of lean to understand the advantages in a better way, by ensuring that the implementation of the COPE system will in fact save more money and patient lives than the work, money and difficulties that its implementation may cause. What have you learned?

By Reading the case we were able to see a real application of lean tools to make a determine the current state of the process, they were able to understand the problems that the activities had. These problems were related to waste. In the same way, we can say that making a VS. of a process or activity is of great help to determine the limitations of such process. Another thing we were able to identify, was the use of the future state. The members involved on the project created the future state considering the way the COPE works.

Additional to this, we learned that systems such as the COPE can be used as a Pokka yoke in order to make an activity safer. This is related t the quality of the medical system, by applying this system, there is a minor chance of making a mistake, and with this, more there will be a deduction on the amount of patients that end duo dead due to medical mistakes. After viewing the case, we understood that lean goes beyond a manufacturing enterprise or an office; it can be used for industries such as medicine or even government projects.

The only thing that can vary are the types of tools that can apply to the industry, but aside from that lean can be used to improve almost any process or sector. Application of Lean to no-manufacturing areas In every industry or process that follows a sequence for the transformation of a determined entity or entities into a finished good the utilization of the principles of mean is very valuable and can have substantial impacts on the performance and development of organizations that use them.

The principles and techniques of continuous flow, problem solving, Single Minute Exchange of Dice, total productive maintenance and production leveling, among others are very useful in the pursuit of an increase of the productivity of a certain process as they allow the consistency of operations to be achieved with only the necessary resources. It is important to notice and mention that the application of the principles of lean in these kinds of processes requires of a vast and thorough comprehension of the hilltop’s and its roots, as well as a knowledge and understanding of the process itself.

This last requirement is harder to achieve in a no-manufacturing area that in the other due to the limited or lack of visibility of different kinds of wastes. This argument also has an impact on the implementation of lean in the mentioned areas, due to a higher level of difficulty of achievement of commitment and ownership of the philosophy by the workforce which required of a higher level of abstraction to identify the wastes and develop an ever increasing problem solving capacity.

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