LEAN INITIATIVE TOWARDS IMPROVING WAITING TIME AT AMBULATORY PHARMACY HOSPITAL SULTAN ABDUL HALIM (HSAH)

Abstract

Introduction: One of the elements influencing patients' satisfaction and impression of service quality is their waiting time. The MoH HPIA criterion, which states that 95% of prescriptions (Rx) received must be filled within 30 minutes, has never been met by HSAH's ambulatory pharmacy. Problem statement: The average performance from January to June 2022 was only 72.31%. Serving the high workload of mixed prescriptions during office hours with limited workstations equipped with IT infrastructure, especially during peak hours causes delays in prescription preparing processes hence long patient waiting time. HSAH Ambulatory Pharmacy serves two types of prescriptions which are new prescriptions i.e., for patients who come for clinic appointments or emergency cases and refill prescriptions i.e., for patients with long-term prescriptions who come to obtain medicine supplies monthly without any clinic appointment. To enhance HPIA performance, the LEAN initiative was started in August 2022. The medication preparation processes for 4 categories of prescriptions from patient registration till the prescription is delivered were identified and examined using Value Stream Mapping (VSM) tools and touchpoint data obtained in December 2021. The lean metrics for each process were computed. In addition, 19 value-added and 29 non-value-added (waste) activities have been identified. Results & Discussion: A total of 22 including five high-effort kaizen bursts, determined by an effort impact diagram were conducted to address the key contributing components identified by fishbone diagrams—man, method and machine related to the wastes. The implementations were focused on human resource empowerment, process restructuring and equipment enhancement. These kaizens were implemented internally and across departments from August through December 2022, with the support of the hospital's top management. The HPIA standard showed an increased trend after lean implementation from 65.19% in January 2023 to 80.80% in June 2023. Conclusion: Even though the ambulatory pharmacy's lean initiative had helped to raise the HPIA, it was still far from the specified standard.