Abstract
Objective
As a high-efficiency demanding department in a hospital, the outpatient pharmacy has a great need for quality improvement to provide superior medical service for patients. Little is known about the application of 5S management in a hospital pharmacy department. The aim of this study was to evaluate the impacts of 5S management on pharmaceutical service quality and staff capacity in the outpatient-emergency pharmacy.
Methods
We carried out a 5S project in the outpatient-emergency pharmacy at a local hospital that involved processes including waste elimination, workplace standardisation, and optimisation of workflow and staff quality, and then evaluated the effects of the project.
Results
The equipment and items in the outpatient-emergency pharmacy were sorted. All the drugs were categorised and put in order. The redesigned workspace and standardised workflow during the project improved the accuracy and efficiency of drug dispensing. The satisfaction rate of patients regarding the pharmaceutical service quality in the outpatient-emergency pharmacy was elevated, as well as the satisfaction rate of pharmacists about their work experiences. The optimisation of objective conditions also stimulated a positive working attitude and professional ability promotion of pharmacists in the outpatient-emergency pharmacy.
Conclusions
In this study, the 5S management method has proven useful for quality and efficiency improvement in the outpatient-emergency pharmacy, and could be generalised to other departments in a hospital, which provides further evidence of the advantages of the Lean tool in healthcare system management.
Keywords: PHARMACY SERVICE, HOSPITAL; TOTAL QUALITY MANAGEMENT; Quality of Health Care; Staff Development; Safety
WHAT IS ALREADY KNOWN ON THIS TOPIC
5S management has huge advantages in quality improvement throughout multiple fields including the healthcare system, though its application in the pharmacy department of a hospital has been investigated less.
WHAT THIS STUDY ADDS
Our study demonstrated that the application of 5S management improved the service quality and efficiency of the outpatient-emergency pharmacy in our hospital, as well as patient satisfaction rate and work initiative of the pharmacist.
HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY
These findings give a hint on management optimisation in the pharmacy department and contribute to the popularisation of Lean management in the healthcare system.
Introduction
With the rapid development of society and the economy, optimisation of the management of healthcare systems has been increasingly needed to fulfil people’s growing requirement for high-quality medical service based on the premise of guaranteeing medical safety.1–3 Any disordered operation in the hospital could possibly have serious consequences, even medical negligence, threatening the health and lives of patients. The complexity of the organisation and its target for high quality and efficiency drive the application and popularisation of Lean management in a hospital, which has been demonstrated successfully in workspace standardisation and quality improvements.4–9 As an important part of the medical service in a hospital, the outpatient pharmacy is in urgent need of a management pattern pursuing both quality and efficiency to satisfy the medication needs of patients from all the outpatient clinical departments.
The 5S management method, known as Sort, Set in order, Shine, Standardise and Sustain, is an important Lean tool and an efficient management method.10 It was originally applied in Japanese manufacturing industries and introduced to the West during the 1980s, and has been gradually recognised as a widely used management approach in all kinds of workplaces.10 11 The 5S management method is characterised by eliminating wasteful or unnecessary factors to improve organisation, standardise the workplace, increase productivity and efficiency, as well as enhance safety.12 13 This low-cost and technologically undemanding method has been increasingly utilised in the healthcare system worldwide for quality improvement with noteworthy achievements, such as in Japan, the USA, and India.14–16 Implementation of the 5S management method has been reported to improve the work efficiency of the emergency department, core laboratory, and inpatient pharmacy in hospitals.17–20 The infection rates and cost of instruments are reduced while medical safety and satisfaction of both patients and staff are increased, due to the application of the 5S management method.21 22 However, there is little information about the impact of the 5S management method on the outpatient or emergency pharmacy.
Our hospital is a cardiothoracic specialised hospital operating on a relative small scale. The outpatient-emergency pharmacy has limited space and the work duties of pharmacists are fully saturated. The insufficiency of objective conditions demands for an optimised management manner. Aiming to ensure the quality, efficiency, and safety of the outpatient-emergency pharmacy service, we designed and conducted a two-part 5S project in the outpatient-emergency pharmacy and then investigated whether the 5S management method was beneficial for workflow optimisation in the outpatient-emergency pharmacy. The effects of the 5S management method on the outpatient-emergency pharmacy have been assessed in several aspects, including utilisation of equipment and space, accuracy and efficiency of drug dispensing, fluency of drug stocking and turnover, and a satisfaction survey of both patients and pharmacists. In addition, we also attempt to enhance the professional ability of pharmacists working in the outpatient-emergency pharmacy with the progression of the 5S project.
Methods
This project was carried out at a local hospital with limited scale and size, and a limited number of staff. The emergency pharmacy has been incorporated into the outpatient pharmacy. The outpatient-emergency pharmacy in our hospital is a 24-hour pharmacy with 10 pharmacists working in shifts. Approximately 2500 patients visit the outpatient department and the emergency department daily and nearly a quarter of these patients need to get medicine. Pharmacists in the outpatient-emergency pharmacy are less experienced, since all of them are below 35 years of age and lack mature management capability.
Standardised 5S project protocol
The 5S management method was applied to standardise the outpatient-emergency pharmacy in a continuous improvement manner according to classical procedures: sort, set in order, shine, standardise, and sustain. The project consisted of two parts: the preliminary improvement stage (stage 1); and the further improvement stage (stage 2). The first stage was focused on sort, set in order and shine processes, including items clear, space alteration and environment optimisation. The second stage proceeded with standardise and sustain processes, including the standardisation of pharmacy work and improvement of staff quality. The management mode was reformed based on the revised standard workflow to enlarge the responsibility assignment. We set an incentive mechanism to motivate the staff, including the regular training programme, the regional responsibility system, and a reward/promotion system. During the whole process of the 5S project, both the management team and the pharmacists were involved, including the leadership of the pharmacy department and 10 pharmacists in the outpatient-emergency pharmacy. We also encouraged all staff to participate in the optimisation and maintenance of the working environment and process through the reform. The 5S project timeline and detailed protocol are shown in the 5S management flow chart (figure 1).
Figure 1.
5S management flow chart. 5S, Sort, Set in order, Shine, Standardise and Sustain
Data collection and analysis
To evaluate the impact of the 5S management method on the operation of the outpatient-emergency pharmacy, we collected and analysed a series of data covering equipment utilisation, space distribution and utilisation, drug dispensing accuracy and efficiency, the efficiency of drug stocking and turnover, and the satisfaction rate of patients and pharmacists working in the outpatient-emergency pharmacy.
Equipment utilisation and space distribution
We sorted all equipment and items in the outpatient-emergency pharmacy and divided them into dispensing equipment and office supply based on their function. Both categories were classified into high frequency, middle frequency and low frequency according to their usage frequency, and the numbers were counted before (stage 1) and after (stage 2) the accomplishment of preliminary improvement. We measured the actual working area and building area in the outpatient-emergency pharmacy to calculate the space utilisation rate. The actual working area referred to the area which subtracted the area of the main road, by-path and walls from the usable area. Space utilisation rate (%) = actual working area/building area×100.
Drug dispensing accuracy and efficiency
The drug dispensing error rate represented the proportion of monthly incorrect-dispensed prescriptions in the total prescriptions of a month. Drug dispensing error rate (‱) = incorrect-dispensed prescription number/total prescription number×104. Data on the total prescription numbers every month were acquired from the electronic information system of the hospital. The incorrect-dispensed prescription was reported by patients if they received incorrect drugs. The information about incorrect-dispensed prescription was recorded by pharmacists in a written form according to the feedback of patients. The number of incorrect-dispensed prescriptions was counted from the form every month.
The waiting time of a patient during drug dispensing started from the time that a patient signed in on the queuing machine until the time of clicking on the confirmation button on the computer by the pharmacist which demonstrated the accomplishment of the dispensing process. We acquired the above time data from March to August 2021 using the electronic information system of the hospital, which could work out the average waiting time of every patient in a month of about 13 000 patients. To calculate the drug dispensing time, we randomly selected 10 prescriptions from 9 am to 10 am in random 10 work days monthly, 100 prescriptions per month in total. We manually timed for a prescription from receiving an electronic prescription on the computer to finishing dispensing. The drug dispensing time was represented as the average dispensing time for the selected 100 prescriptions.
Drug stocking and turnover
Drug stocking was conducted on Monday and Thursday every week. Drug stocking time meant the duration started from the arrival of carting drugs to the finish of stocking the shelves. It was measured by an average level of two times in 1 week and was recorded five times in a month (recorded four times in May because of national holidays during the first week of May). Drug inventory turnover rate represented the times of inventory cost turnover for the outpatient-emergency pharmacy in a month and drug inventory turnover days meant the average days the monthly inventory was sold out. Drug inventory turnover rate=2 × sales amount/(opening inventory amount+closing inventory amount). Drug inventory turnover days=30/drug inventory turnover rate.
Patient satisfaction and staff perception
To assess the satisfaction rate of patients and pharmacists regarding the quality improvement in the outpatient-emergency pharmacy, respective questionnaires for patients and pharmacists were developed. The questionnaires were acquired from visiting patients at the consultation window which was set in our outpatient-emergency pharmacy and was responsible for the reception of patients and answering their questions. The questionnaires were designed to survey the experience of drug acquisition and working experience in the outpatient-emergency pharmacy. The questions were based on a five-point Likert scale, in which 5 pointed to ‘strongly agree’, 4 pointed to ‘agree’, 3 pointed to ‘neither agree nor disagree’, 2 pointed to ‘disagree’, and 1 pointed to ‘strongly disagree’. The total score of a patient questionnaire was 40 and the total score of a pharmacist questionnaire was 50. For the patient satisfaction survey, we collected 30 questionnaires from the voluntary patients or accompanying person (age ≥18) every month from March to August 2021, 90 questionnaires in total for each stage. For the pharmacist satisfaction survey, 10 questionnaires from pharmacists working in the outpatient-emergency pharmacy were acquired every month from March to August 2021, with a total of 30 questionnaires for each stage. All the questionnaires were anonymous. The satisfaction rate was calculated by mean scores for the questionnaire. Patient satisfaction rate (%) = mean scores for patient satisfaction questionnaire/40×100; pharmacist satisfaction rate (%) = mean scores for pharmacist satisfaction questionnaire/50×100.
Statistical analysis
Statistical analysis was performed using the t-test. All data are expressed as the mean±SEM. Values of p<0.05 were taken to be statistically significant. Analyses were performed using GraphPad Prism 9.2.0 (GraphPad Software, Inc, San Diego, CA, USA).
Results
Equipment utilisation and space distribution
To sort out the requisites, we separated drugs from other items in the outpatient-emergency pharmacy and assessed all equipment and other items according to the frequency of use and equipment status. The excessive and unnecessary equipment and items were removed during the progression of the 5S project, with a 9.3% reduction in total. The proportion of whole high-frequency equipment increased slightly (+4.8%), while the whole low-frequency equipment proportion reduced by 42.2%, especially the office supply which decreased by 87.7%.
The space of the outpatient-emergency pharmacy was redistributed to attain a more fluent work line (online supplemental figure S1) and a higher space utilisation rate. Previous workspace division included the dispensing equipment area, a living zone, and a shareable area of dispensing and storage, leading to a disordered work line. The original mixed area in the outpatient-emergency pharmacy was replanned and divided into the dispensing equipment area, dispensing area, storage area, and living zone, resulting in a more effective and comfortable working environment (figure 2). The more reasonable partition also elevated the space utilisation rate of the outpatient-emergency pharmacy. The building area of the outpatient-emergency pharmacy was 98.00 m2. After the redistribution, the actual working area increased from 45.16 m2 to 51.64 m2, resulting in a 16.8% elevation of space utilisation rate which rose from 46.1% to 53.8%.
Figure 2.
Space redistribution of the outpatient-emergency pharmacy during the 5S project.
ejhpharm-2022-003449supp001.pdf (15.6MB, pdf)
Drug dispensing accuracy and efficiency
The 5S project conducted in the outpatient-emergency pharmacy helped to increase the accuracy and efficiency of drug dispensing. The drugs in the outpatient-emergency pharmacy were reorganised based on classification. A location system for drugs and rules for drug replacement were established. We made a catalogue of drugs with special storage requirements and put them in specially marked locations to ensure the safety and efficacy of the drug. The drug variety and quantity in the dispensing machine were also adjusted according to the drug consumption. The numbers and types of prescriptions at each dispensing window were distributed reasonably after analysing the characteristics of the prescription composition, in order to shorten the waiting time. The accuracy of drug dispensing was indicated by the drug dispensing error rate. We counted the incorrect-dispensed prescription number, total prescription number, per capita prescription number and patient number during 3 months before and after the accomplishment of preliminary improvement. The drug dispensing error rates in stage 2 displayed a downtrend compared with stage 1 (1.81‱, 1.18‱, 1.19‱ vs 2.06‱, 2.82‱, 2.79‱, figure 3A), and the monthly average drug dispensing error rate in stage 2 was 45.6% lower than stage 1 (p<0.05, figure 3B). The waiting time of patient and drug dispensing time were measured to evaluate the efficiency of drug dispensing. Both the two time indices decreased with the progression of the 5S project (figure 3C) and the monthly average levels of the two time indices in stage 2 were much lower than stage 1, –36.9% and −37.9% for the waiting time of patient and drug dispensing time, respectively (p<0.05, figure 3D).
Figure 3.
Variation trends about efficiency and quality of pharmacy work during the 5S project. (A, C, E) Drug dispensing error rate, waiting time of patient, drug dispensing time and drug stocking time during the progression of the 5S project. (B, D, F) Comparison of average drug dispensing error rate, waiting time of patient, drug dispensing time and drug stocking time before and after the accomplishment of preliminary improvement. n=3 in (B, D), *p<0.05, #p<0.05 versus before. n=14 for the before group of (F), n=15 for the after group of (F), ***p<0.001 versus before.
Drug stocking and turnover
The fluency of drug stocking and the appropriate turnover of drugs are important for maintaining the high-efficiency running of an outpatient-emergency pharmacy. The drug stocking time decreased with the progression of the 5S project (figure 3E) and the average drug stocking time in stage 1 was 39.9% lower than stage 2 (p<0.001, figure 3F). Besides, the number of participants for drug stocking was reduced from previously 3.5 to 2.5 (0.5 as flexible) after the accomplishment of preliminary improvement. The turnover of drugs was estimated by the drug inventory turnover rates and turnover days. We found that drug turnover was accelerated after the accomplishment of preliminary improvement as turnover rates were elevated and turnover days were reduced. The monthly average turnover rate in stage 2 was 21.5% higher than stage 1 and the monthly average turnover days in stage 2 was 18.2% less than stage 1.
Patient satisfaction and staff perception
A standard workflow was developed and continuously optimised. The satisfaction questionnaires for patients and staff were developed to obtain the feedback of patients and pharmacists working in the outpatient-emergency pharmacy about the effects of the 5S project. The evaluation was conducted throughout the progression of stage 1 and stage 2 by completing a questionnaire survey. The mean scores of each question and all questionnaires and the frequencies of the responses were calculated (tables 1 and 2). The satisfaction rates of patients and pharmacists in stage 2 were increased by 41.8% (88.3% vs 62.3%) and 80.4% (86.6% vs 48.0%), respectively, compared with stage 1 (p<0.001, figure 4). In the patient questionnaires, satisfaction rates increased by more than 20% in six of the eight questions (except questions 3 and 5), especially environment comfort (+103.3%, 81.3% vs 40.0%) and waiting time for the medicine (+180.0%, 84.0% vs 30.0%). In the pharmacist questionnaires, nine of the 10 questions (questions 2 to 10) had increased satisfaction rates by at least 20%, especially the efficiency of drug stocking (+104.2%, 98.0% vs 48.0%) and information clearness (+138.1%, 100.0% vs 42.0%).
Table 1.
Mean scores of patient satisfaction questionnaire survey and frequencies of responses during the 5S project
| Question items | Before (n=90) | After (n=90) |
| 1. You felt comfortable in the environment where you were waiting for your medicine | ||
| Mean scores | 2.00 | 4.07 |
| 2. You felt the time you spent in the outpatient-emergency pharmacy waiting for your medicine was reasonable | ||
| Mean scores | 1.50 | 4.20 |
| 3. The number and type of medicine you have got from the outpatient-emergency pharmacy are right | ||
| Mean scores | 4.97 | 5.00 |
| 4. You were clear about how to take your medicine based on the guidance from the pharmacist | ||
| Mean scores | 3.23 | 4.23 |
| 5. You felt satisfied with the service attitude of the pharmacist at the dispensary window | ||
| Mean scores | 3.30 | 4.10 |
| 6. You felt satisfied with the attitude of the pharmacist dealing with the consultation and complaint | ||
| Mean scores | 3.13 | 4.50 |
| 7. You felt the time that the pharmacist spent dealing with your complaint was reasonable | ||
| Mean scores | 3.27 | 4.53 |
| 8. You felt satisfied with the outcome of dealing with your complaint | ||
| Mean scores | 3.50 | 4.67 |
| Mean scores for all (total=40) | 24.90 | 35.30 |
Table 2.
Mean scores of pharmacist questionnaire survey and frequencies of the responses during the 5S project
| Question items | Before (n=30) | After (n=30) |
| 1. You felt it was easy to find a certain drug you were looking for in the outpatient-emergency pharmacy | ||
| Mean scores | 3.10 | 4.00 |
| 2. You felt it was smooth and convenient to stock and organise the drugs in the outpatient-emergency pharmacy | ||
| Mean scores | 2.40 | 4.90 |
| 3. You felt it was quick and simple to make an inventory of drugs in the outpatient-emergency pharmacy | ||
| Mean sores | 2.80 | 4.90 |
| 4. You felt it was convenient to stock the drug shelves and put the drugs in the right place | ||
| Mean scores | 2.10 | 3.90 |
| 5. You felt it was convenient to supplement drugs into the dispensing machine. | ||
| Mean scores | 2.30 | 3.80 |
| 6. You felt the entire dispensing process was reasonable and easy to operate | ||
| Mean scores | 2.40 | 4.20 |
| 7. You felt it was easy to guarantee the high accuracy and efficiency of dispensing | ||
| Mean scores | 2.70 | 4.10 |
| 8. You felt clearly informed during daily work | ||
| Mean scores | 2.10 | 5.00 |
| 9. You felt it was easy to keep the work environment clean and tidy | ||
| Mean scores | 2.00 | 4.20 |
| 10. You felt satisfied with the work environment | ||
| Mean scores | 2.10 | 4.30 |
| Mean scores for all (total=50) | 24.00 | 43.30 |
Figure 4.
Satisfaction rates of patients and pharmacists for the outpatient-emergency pharmacy during the 5S project. n=90 for the patient group, n=30 for the pharmacist group. ***p<0.001; ###p<0.001 versus before.
Discussion
In this study, we elucidate the positive impacts of the 5S management method on service quality of the outpatient-emergency pharmacy in a cardiothoracic specialised hospital. As a well-developed refined management method, 5S management is widely used in many production fields worldwide. Recently, this management method has been gradually applied to the management of various departments in hospitals, such as hospital logistics, the laboratory department, operating room, intensive care unit, etc, proving effective in workspace planning and work quality improvement. The 5S method is easy to operate and learn, and could be effective within a short period of time. It is also convenient to establish an assessment system to obtain a better result.23–25 On account of the limited space and the number of staff, the outpatient-emergency pharmacy in our hospital is a 24-hour pharmacy, responsible for drug dispensing and distribution to both emergency and outpatient patients. More than 90% of prescriptions are prescribed during the outpatient period from 8 am to 5 pm. The shortage of workspace and pharmacists, as well as the relatively concentrated peak time for drug prescription, call for a high-efficient working manner in the outpatient-emergency pharmacy. As a result, the reform of the outpatient-emergency pharmacy focusing on space alteration, working standardisation and staff management relying on the 5S management method is imperative.
During the 5S project of the outpatient-emergency pharmacy, one of the most important improvements is space alteration. In the first step of the 5S project, the removal of redundant space for the pharmacy laid the foundation for subsequent rearrangement. Before the start of the project, unreasonable area division and space arrangement led to a crowded and cluttered environment of the outpatient-emergency pharmacy. High-efficient space utilisation, more reasonable shelf arrangement and fluent work lines have been achieved after the preliminary improvement stage, as well as working in comfort (online supplemental figures S2–S5). The space utilisation rate in the outpatient-emergency pharmacy has been increased by 16.8% and the work line has been reduced by 39.6%. The separation of the dispensing area and the storage area resulted in a smaller range of movement for dispensing, which could bring benefits by reducing drug dispensing time and waiting time of patients for their medicine. These modulations directly influence the satisfaction rates of patients regarding the comfort of the environment and the patient waiting time for medicine (table 1). Even though the satisfaction questionnaires were collected from March to August, the temperature outside the outpatient-emergency pharmacy where the patients wait has been kept at a constant room temperature of about 20℃ via central air conditioning, which could help to eliminate the influence of temperature alteration on mood when patients are answering the questionnaires. The satisfaction rates of pharmacists regarding the working environment and convenience have also been improved after the alteration of space and work line (table 2).
Although the incorrect dispensing of prescriptions in the outpatient-emergency pharmacy was discovered and reduced in a timely manner, the accuracy of drug dispensing is always crucial for the medication safety of patients.26–28 The drug dispensing error rates in the outpatient-emergency pharmacy before the accomplishment of the preliminary improvement stage were all above 2‱, which has been decreased to below 2‱ since June. In the later 2 months of the further improvement stage, the drug dispensing error rates have been reduced to nearly 1.00‱. Although the monthly total prescription numbers in stage 2 were slightly less than stage 1, probably due to seasonal factors, the numbers of per capita prescriptions during the project were stable (approximately equal to two). Even so, we could not exclude the possible influence of workload reduction per unit time on the drug dispensing error rate, which might result from the decreased total prescription number. Incorrect dispensing is usually caused by the high pressure of pursuing working efficiency.29–31 The shortened dispensing distance and reasonable planning of drug position make the dispensing process faster and easier, which is probably helpful for decreasing the drug dispensing error rate.
In addition, drug stocking has become more efficient with less stocking time and fewer participants. Reasonable partition for the separate storage area changed the stocking manner in the outpatient-emergency pharmacy, resulting in an acceleration of drug stocking. Before the 5S project, the process of drug stocking needed pharmacists to guide the delivery person to place intact drug boxes correctly in the entire range of the pharmacy, and one pharmacist could only deal with one drug cart at one time. After rearrangement of the division of the area, the position of drug boxes has been fixed so that the participants of drug stocking only need to confirm the type, number and expiry date of drugs. Then the drug boxes can be placed directly into the storage area when delivered. Drugs in two carts could be processed simultaneously. Therefore, the number of pharmacists that participate in drug stocking has been cut by 28.6%. These modifications in the drug stocking process contribute to an elevated satisfaction rate of pharmacists about the stocking work (table 2).
Besides the reasonable arrangement of space, the 5S project is also used for the optimisation of workflow and staff management in the outpatient-emergency pharmacy, covering multiple aspects from standardisation of daily work and professional training to evaluation of the work performance of pharmacists. Standard operating procedures around daily work in the outpatient-emergency pharmacy such as drug dispensing, drug stocking, routine cleaning and clearing up have been planned. The order delivery and information communication have therefore become explicit as the score about the clearness of information in the pharmacist questionnaire has been increased from 2.10 to 5.00. Driven by an improvement of objective conditions, the promotion of subjective attitudes and the initiative of pharmacists in the outpatient-emergency pharmacy, as well as their professional ability, is another important target during the 5S project.32 33 Based on the working requirements, pharmacists have undergone a specific training programme. Furthermore, a strict examination of their performance including working mistakes and service attitudes has been conducted to evaluate whether they have met the established standards. With the progression of the 5S project, we found the overall work attitude and professional service have been improved according to the feedback of patients from the satisfaction questionnaire (table 1). The promotion of integral staff quality and the reformation of working conditions in the outpatient-emergency pharmacy can be supported by each other, leading to the improvement of pharmacy work such as the decrease in the dispensing error rate and dispensing time.34–36 The elevation of the professional capability of pharmacists verified by the increased satisfaction rate of patients could help them establish and realise their career planning and acquire more developmental opportunities, which could be the future direction of continuous improvement programmes in the outpatient-emergency pharmacy.
5S management has a variety of advantages in improving the working environment and enhancing the quality of staff. However, limitations still exist in this method, such as less attention being paid to safety problems and saving consciousness, as well as maintaining the achieved effects. In our study, we did not investigate the safety problem and cost management in the outpatient-emergency pharmacy, which was important in pharmacy operation or benefits management. The well-established incentive mechanism and a reasonable assessment system to improve continuously the service quality and staff ability were not completely accomplished in our project. Further optimisation of the management pattern and persistent improvement of the pharmaceutical service quality in the outpatient-emergency pharmacy will be conducted in our future investigation.
Conclusions
5S management, as one of the Lean management methods, has promoted the reform of service patterns in the healthcare system. This study provides an example of the application of 5S management in an outpatient-emergency pharmacy involving management manner transformation and work standardisation. 5S management is beneficial for changing the service pattern of pharmacists into active mode, consequently entirely improving the quality of pharmaceutical service and medication safety, as well as patient satisfaction. Therefore, 5S management is applicable for promoting the development of a pharmacy service and could be generalised to other departments in a hospital.
Footnotes
W-JH and M-WZ contributed equally.
Correction notice: This article has been corrected since it was first published. Wen-Jing Huang and Meng-Wan Zhang are joint first authors and they contributed equally to this manuscript.
Contributors: W-JH was closely involved in the conception and design of the study, and conducted the whole project in this research. M-WZ was closely involved in data analysis and interpretation, and wrote the original draft of the manuscript. B-YL and X-HW conducted the data collection and literature search. C-HZ conducted the visualisation of the data. J-GY led the conception and design of the study, and edited the manuscript. All authors read and approved the final manuscript. J-GY is responsible for the overall content as guarantor.
Funding: This work was supported by Hospital Management Construction Projects of Shanghai Chest Hospital (YJGL-2022-01).
Competing interests: None declared.
Provenance and peer review: Not commissioned; externally peer reviewed.
Supplemental material: This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.
Data availability statement
All data relevant to the study are included in the article or uploaded as supplementary information.
Ethics statements
Patient consent for publication
Not applicable.
Ethics approval
Not applicable.
References
- 1. Rotter T, Plishka C, Lawal A, et al. What is Lean management in health care? Development of an operational definition for a Cochrane systematic review. Eval Health Prof 2019;42:366–90. 10.1177/0163278718756992 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2. van Rossum L, Aij KH, Simons FE, et al. Lean healthcare from a change management perspective. J Health Organ Manag 2016;30:475–93. 10.1108/JHOM-06-2014-0090 [DOI] [PubMed] [Google Scholar]
- 3. Mancosu P, Russo S, Antonucci AR, et al. Lean thinking to manage a national working group on physics aspects of stereotactic body radiation therapy. Med Phys 2021;48:2050–6. 10.1002/mp.14783 [DOI] [PubMed] [Google Scholar]
- 4. Trakulsunti Y, Trakoonsanti L. The use of lean tools to reduce inpatient waiting time in a Thai public hospital: an action research study. Leadersh Health Serv 2021. 10.1108/LHS-10-2020-0080 [DOI] [PubMed] [Google Scholar]
- 5. Stark HE, Graudins LV, McGuire TM, et al. Implementing a sustainable medication reconciliation process in Australian hospitals: the World Health Organization high 5S project. Res Social Adm Pharm 2020;16:290–8. 10.1016/j.sapharm.2019.05.011 [DOI] [PubMed] [Google Scholar]
- 6. D’Andreamatteo A, Ianni L, Lega F, et al. Lean in healthcare: a comprehensive review. Health Policy 2015;119:1197–209. 10.1016/j.healthpol.2015.02.002 [DOI] [PubMed] [Google Scholar]
- 7. Lihua Y. Construction and application of a refined hospital management chain. World Hosp Health Serv 2016;52:14–16. [PubMed] [Google Scholar]
- 8. Borges GA, Tortorella G, Rossini M, et al. Lean implementation in healthcare supply chain: a scoping review. J Health Organ Manag 2019;33:304–22. 10.1108/JHOM-06-2018-0176 [DOI] [PubMed] [Google Scholar]
- 9. Fernandes HMdeLG, Jesus MVNde, Silva Dda, et al. Lean healthcare in the institutional, professional, and patient perspective: an integrative review. Rev Gaúcha Enferm 2020;41:e20190340. 10.1590/1983-1447.2020.20190340 [DOI] [PubMed] [Google Scholar]
- 10. Kanamori S, Shibanuma A, Jimba M. Applicability of the 5S management method for quality improvement in health-care facilities: a review. Trop Med Health 2016;44:21. 10.1186/s41182-016-0022-9 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 11. Hubbard R. Case study on the 5S program: the five pillars of the visual workplace. Hosp Mater Manage Q 1999;20:24–8. [PubMed] [Google Scholar]
- 12. Haynes B. Of studies, syntheses, synopses, summaries, and systems: the "5S" evolution of information services for evidence-based healthcare decisions. Evid Based Nurs 2007;10:6–7. 10.1136/ebn.10.1.6 [DOI] [PubMed] [Google Scholar]
- 13. Ikuma LH, Nahmens I. Making safety an integral part of 5S in healthcare. Work 2014;47:243–51. 10.3233/WOR-121576 [DOI] [PubMed] [Google Scholar]
- 14. Kanamori S, Castro MC, Sow S, et al. Impact of the Japanese 5S management method on patients’ and caretakers’ satisfaction: a quasi-experimental study in Senegal. Glob Health Action 2016;9:32852. 10.3402/gha.v9.32852 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 15. Kanamori S, Sow S, Castro MC, et al. Implementation of 5S management method for lean healthcare at a health center in Senegal: a qualitative study of staff perception. Glob Health Action 2015;8:27256. 10.3402/gha.v8.27256 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16. Farrokhi FR, Gunther M, Williams B, et al. Application of lean methodology for improved quality and efficiency in operating room instrument availability. J Healthc Qual 2015;37:277–86. 10.1111/jhq.12053 [DOI] [PubMed] [Google Scholar]
- 17. Al-Araidah O, Momani A, Khasawneh M, et al. Lead-time reduction utilizing lean tools applied to healthcare: the inpatient pharmacy at a local hospital. J Healthc Qual 2010;32:59–66. 10.1111/j.1945-1474.2009.00065.x [DOI] [PubMed] [Google Scholar]
- 18. Rutledge J, Xu M, Simpson J. Application of the Toyota production system improves core laboratory operations. Am J Clin Pathol 2010;133:24–31. 10.1309/AJCPD1MSTIVZI0PZ [DOI] [PubMed] [Google Scholar]
- 19. Gumba H, Waichungo J, Lowe B, et al. Implementing a quality management system using good clinical laboratory practice guidelines at KEMRI-CMR to support medical research. Wellcome Open Res 2019;3:137. 10.12688/wellcomeopenres.14860.2 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 20. Pertence PP, Melleiro MM. [The implementation of a quality management tool at a university hospital]. Rev Esc Enferm USP 2010;44:1024–31. 10.1590/s0080-62342010000400024 [DOI] [PubMed] [Google Scholar]
- 21. Withanachchi N, Karandagoda W, Handa Y. A performance improvement programme at a public hospital in Sri Lanka: an introduction. J Health Organ Manag 2004;18:361–9. 10.1108/14777260410560820 [DOI] [PubMed] [Google Scholar]
- 22. Waldhausen JHT, Avansino JR, Libby A, et al. Application of lean methods improves surgical clinic experience. J Pediatr Surg 2010;45:1420–5. 10.1016/j.jpedsurg.2009.10.049 [DOI] [PubMed] [Google Scholar]
- 23. Sommer AC, Blumenthal EZ. Implementation of Lean and six Sigma principles in ophthalmology for improving quality of care and patient flow. Surv Ophthalmol 2019;64:720–8. 10.1016/j.survophthal.2019.03.007 [DOI] [PubMed] [Google Scholar]
- 24. T' L-L, Polancich S, Pilon B. The application of the Toyota production system lean 5S methodology in the operating room setting. Nurs Clin North Am 2019;54:53–79. [DOI] [PubMed] [Google Scholar]
- 25. Take N, Byakika S, Tasei H, et al. The effect of 5S-Continuous quality improvement-total quality management approach on staff motivation, patients' waiting time and patient satisfaction with services at hospitals in Uganda. J Public Health Afr 2015;6:486. 10.4081/jphia.2015.486 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 26. Pratt N, Roughead E. Assessment of medication safety using only dispensing data. Curr Epidemiol Rep 2018;5:357–69. 10.1007/s40471-018-0176-6 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 27. Brown JN, Britnell SR, Stivers AP, et al. Medication safety in clinical trials: role of the pharmacist in optimizing practice, collaboration, and education to reduce errors. Yale J Biol Med 2017;90:125–33. [PMC free article] [PubMed] [Google Scholar]
- 28. Anacleto TA, Perini E, Rosa MB, et al. Medication errors and drug-dispensing systems in a hospital pharmacy. Clinics 2005;60:325–32. 10.1590/S1807-59322005000400011 [DOI] [PubMed] [Google Scholar]
- 29. Tariq RA, Vashisht R, Sinha A, et al. Medication dispensing errors and prevention. In: StatPearls. Treasure Island (FL), 2021. [PubMed] [Google Scholar]
- 30. Chuang M-H, Wang Y-F, Chen M, et al. Effectiveness of implementation of a new drug storage label and error-reducing process on the accuracy of drug dispensing. J Med Syst 2012;36:1469–74. 10.1007/s10916-010-9607-8 [DOI] [PubMed] [Google Scholar]
- 31. James KL, Barlow D, Burfield R, et al. Unprevented or prevented dispensing incidents: which outcome to use in dispensing error research? Int J Pharm Pract 2011;19:36–50. 10.1111/j.2042-7174.2010.00071.x [DOI] [PubMed] [Google Scholar]
- 32. Shoji M, Onda M, Okada H, et al. The change in pharmacists’ attitude, confidence and job satisfaction following participation in a novel hypertension support service. Int J Pharm Pract 2019;27:520–7. 10.1111/ijpp.12550 [DOI] [PubMed] [Google Scholar]
- 33. Selvaraj A, Redzuan AM, Hatah E. Community pharmacists' perceptions, attitudes and barriers towards pharmacist-led minor ailment services in Malaysia. Int J Clin Pharm 2020;42:777–85. 10.1007/s11096-020-00973-x [DOI] [PubMed] [Google Scholar]
- 34. Mansur JM. Medication safety systems and the important role of pharmacists. Drugs Aging 2016;33:213–21. 10.1007/s40266-016-0358-1 [DOI] [PubMed] [Google Scholar]
- 35. James KL, Barlow D, McArtney R, et al. Incidence, type and causes of dispensing errors: a review of the literature. Int J Pharm Pract 2010;17:9–30. 10.1211/ijpp.17.1.0004 [DOI] [PubMed] [Google Scholar]
- 36. Gillani SW, Gulam SM, Thomas D, et al. Role and services of a pharmacist in the prevention of medication errors: a systematic review. Curr Drug Saf 2021;16:322–8. 10.2174/1574886315666201002124713 [DOI] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
ejhpharm-2022-003449supp001.pdf (15.6MB, pdf)
Data Availability Statement
All data relevant to the study are included in the article or uploaded as supplementary information.