Question

Assignment topic - Any one

1- Implementing 5S in Healthcare

2-Eliminating errors in healthcare

Expectations from the assignment

1.       The selection of the topic should be relevant both, to the area of healthcare, as well as the subject matter of the course

2.       The problem should be clearly defined, i.e., what is the paper setting out to achieve?

3.       The work done during the project should be explained clearly and be understandable for a non healthcare professional (like myself).

4.       The conclusions should be clear.

5.       One or more of the techniques/methods covered during the course should be used in the project.

6.       If there are books/papers referenced, these should be clearly mentioned.

7.       The overall presentation should be “professional”

8.       The work should represent work worthy of a Masters’ degree course.

9.       The length of the paper can be between 8-10 pages. But this is a general guideline, not an absolute must.

Answer 1

1. Implementing 5 S in healthcare

THE CHALLENGES IN HEALTHCARE

Technology is altering the profile of healthcare industry with a whirlwind and healthcare delivery systems are moving from a conventional care to the most advanced AI enabled ones. Unfortunately, the basic challenges of cost, quality, and inequity in health services are well intact across demographies. Worldwide healthcare has always been grappled by the challenges of doing more with less and many times quality of service, profitability and sustainability comes in complete conflict with each other. Under pressure to reduce costs and improve quality, many hospitals and healthcare systems adopt approaches to improve their operational processes. Improving the efficiency of processes also depends on eliminating waste in the environment in which the processes are being performed. 5S is one such methodologies that provide a framework for improving efficiency in the hospital environment, right at the hospital floors where people are working.

What is 5S

5S is a structured methodology directed to improve the work environment, it’s a simple and a highly effective technique to a better workplace organization. 5S is the foundation for an efficient and safe workplace, as it ensures quality, productivity and act as a pillar for continuous improvement in a hospital. It organises the workplace from the physical to the functional aspect, therefore, is the fundamental basis for any Kaizen or TQM initiative in a hospital. It’s one of the most cost-effective Lean techniques available, and is the base of all other lean principles, that makes it the perfect starting point for bringing the benefits of lean to your workplace. 5S can improve the work environment and motivate the employees working in the hospital. It includes a set of actions that needs to be conducted systematically with the full cooperation of employees serving the hospital. 5S is a highly participatory activity and improves the quality of work environment and the service components delivered to the clients.

WHY 5S IN HOSPITALS?

• It does not require the understanding of the difficult terminologies & the concepts
• Enhances teamwork & engagement among employees
• It empowers the employees and gives them a sense of ownership
• It is simple, driven by logic and natural to the human behaviour
• Hospitals have human intensive processes and are very prone to wasteful activities which can be minimised by implementing 5S
• Properly implemented 5S can cut huge on costs and improves the process efficiency

WHAT DOES “5S” STANDS FOR?

It is called 5S based on the five Japanese words starting with “S” and describe the five steps involved in this methodology. The words are:

Seiri — Sort

Seiton — Set in order

Seiso — Shine

Seiketsu — Standardize

Shitsuke- Sustain

1ST S — SEIRI — SORT

Identify the equipments, medical supplies and the resources pertaining to work performed in a particular area and remove the unnecessary stuffs. Sort means separation, hence it is the removal of the unwanted items from the workplace. This is the first step in 5S, without “Sorting”, it is impossible to move on to the next step of putting things in an appropriate order i.e. setting.

How it works:

• Organize the “Big sorting day”
• Start with red tag events
• Engage the owners
• Identify and segregate the unwanted items
• Sort from indoor to outdoor
• Initiate “Reduce, Reuse & Recycle Concept” with “Sort” activities
• Learn from the event

2ND S — SEITON — SET IN ORDER

“Set” is the second step of 5S after Sorting. Its the orderly arrangement of everything. The goal is to put everything in it’s place neatly and organising the workstations for maximum efficiency and productivity. This requires teamwork and involvement of the employees to achieve specific targets. Neat and functional arrangement of all the necessary items on the hospital floors can make everyone’s life easier.

How it works:

• Select the target places for setting
• Break down the areas into sections and clearly label everything
• Expand one by one to other sections
• Use the visualised informations
• Keep future standardisation in mind

3RD S — SEISO — SHINE

The third stage, “Shine” is a highly participatory activity for maintaining the cleanliness at every workplace regardless of the category and the location. All employees in the hospital are allocated a specific territory and is expected to join in the “Shine” activity. Territories having costly equipment and important reports cannot be cleaned up only by the cleaners. Hence, the process owners should have a participative role to take care of their work areas and put their own cleaning efforts. For a 5S System to be successful, the first three “S” should be an integral part of the daily work routine and must be inculcated in the hospital’s culture.

How it works:

• Everyone should participate
• Be ready with the cleaning tools & supplies
• All equipments should be clean
• Heavy equipment maintenance is included
• Special emphasis on hospital waste management system

4TH S— SEIKETSU — STANDARDISE

The “Standardize” stage of 5S is for the development of standards for the initial 3S activities, i.e., Sort, Set and Shine. In this stage, you will set in place the rules and the policies that supports the first three steps. Always remember, 5S system will only work if its followed with discipline and standards. The objective of this step is to make “Sort”, “Set”, and “Shine” as a part of routine work for all the employees in the hospital. Once standards are set, it should be circulated to all the employees through visualisation, sensitisation and regular trainings.

How it works:

• Make 3S a culture
• Visualisation of slogans
• Standardize for safety
• Standardisation of color coding system
• Standardisation of checklists
• Recognition and appreciation by the supervisors
• Training & documentation

5TH S— SHITSUKE- SUSTAIN

All the changes made till now by applying 4S activities need to be sustained. This requires, self-discipline with change in the mindsets and the attitude of the hospital employees. In this step, the self-discipline is instilled by encouraging a quality culture that will sustain the program. Its very likely that over a period of time, a 5S system may become less effective due to slackness of the people. Hence, to sustain a 5S system a continuous improvement culture is a must in the hospital, because 5S is not the final goal of the hospital’s service improvement quest, but is just the starting point of a Kaizen culture.

How it works:

• Employee’s orientation
• Instill self-discipline
• 5S contest, encourage a positive competition
• Hands on training
• Create a culture of continuous improvement

IMPLEMENTING 5S IN A HOSPITAL — THE LAUNCH

• Educate the employees about the 5S System
• Come up with a plan and seek the management’s approval and support
• Set up 5S zones
• Create a 5S team, educate them and plan the 5S System launch
• Do it in phases, phase 1 and 2 are the “Enablers” & phase 3 and 4 are the actual “Results providers”
• Examine each of the 5S steps to see how it fits into your hospital
• Get all the materials needed for the launch and support of the 5S program
• Develop a culture of 5S & continuous improvement in your hospital
• Benchmark the goals and carry out internal auditing
• Reward and recognise efforts made by the employees
• Foster a healthy competition

ADAPTING THE RIGHT KPIs’

While employing 5S in a hospital, each of the work groups need its own set of KPIs’ for monitoring the progress. These KPIs’ must describe how the group influences productivity across their own work areas. Some of the most common KPIs which are used:

Productivity

Lead time

Number of accidents

Inventory levels

Inventory cost

Searching time

Equipment breakdown

Rejection rate

Rework

Patient complaints

WRAP UP

5S is an extremely robust approach that hospitals can adopt to promote service excellence in the eyes of their customers. Though it sound really simple and straightforward to implement, but it’s highly toilsome to sustain the results. The management’s task is to inspire new work habits, support positive mindsets and empower individuals to continually improve their workplace. Post 5S implementation, there is improved work efficiency, more discipline in the team to sustain the results and a new wave of enthusiasm on the hospital floors which is directly proportional to the employee satisfaction and a sense of ownership. The happier, the safer and the less fatigued the hospital employees are, the better they will take care of the patients and deliver high quality services. So till the time healthcare is a human intensive industry and not everything is replaced with technology and AI in this space, 5S could be a good start to promote a continuous improvement culture in your hospital.

2 . Elimination of errors in healthcare

10 Strategies for Preventing Medication Errors

Oct 23, 2017 | Blog

It is important for all nurses to become familiar with various strategies to prevent or reduce the likelihood of medication errors. Here are ten strategies to help you do just that.

1. Ensure the five rights of medication administration.

Nurses must ensure that institutional policies related to medication transcription are followed. It isn’t adequate to transcribe the medication as prescribed, but to ensure the correct medication is prescribed for the correct patient, in the correct dosage, via the correct route, and timed correctly (also known as the five rights).

2. Follow proper medication reconciliation procedures.

Institutions must have mechanisms in place for medication reconciliation when transferring a patient from one institution to the next or from one unit to the next in the same institution. Review and verify each medication for the correct patient, correct medication, correct dosage, correct route, and correct time against the transfer orders, or medications listed on the transfer documents. Nurses must compare this to the medication administration record (MAR). Often not all elements of a medication record are available for easy verification, but it is of paramount importance to verify with every possible source—including the discharging or transferring institution/unit, the patient or patient’s family, and physician—to prevent potential errors related to improper reconciliation. There are several forms for medication reconciliation available from various vendors.

3. Double check—or even triple check—procedures.

This is a process whereby another nurse on the same shift or an incoming shift reviews all new orders to ensure each patient’s order is noted and transcribed correctly on the physician’s order and the medication administration record (MAR) or the treatment administration record. Some institutions have a chart flag process in place to highlight charts with new orders that require order verification.

4. Have the physician (or another nurse) read it back.

This is a process whereby a nurse reads back an order to the prescribing physician to ensure the ordered medication is transcribed correctly. This process can also be carried out from one nurse to the next whereby a nurse reads back an order transcribed to the physician’s order form to another nurse as the MAR is reviewed to ensure accuracy.

5. Consider using a name alert.

Some institutions use name alerts to prevent similar sounding patient names from potential medication mix up. Names such as Johnson and Johnston can lead to easy confusion on the part of nursing staff, so it is for this reason that name alerts posted in front of the MAR can prevent medication errors.

6. Place a zero in front of the decimal point.

A dosage of 0.25mg can easily be construed as 25mg without the zero in front of the decimal point, and this can result in an adverse outcome for a patient.

7. Document everything.

This includes proper medication labeling, legible documentation, or proper recording of administered medication. A lack of proper documentation for any medication can result in an error. For example, a nurse forgetting to document an as needed medication can result in another dosage being administered by another nurse since no documentation denoting previous administration exists. Reading the prescription label and expiration date of the medication is also another best practice. A correct medication can have an incorrect label or vice versa, and this can also lead to a med error.

8. Ensure proper storage of medications for proper efficacy.

Medications that should be refrigerated must be kept refrigerated to maintain efficacy, and similarly, medications that should be kept at room temperature should be stored accordingly. Most biologicals require refrigeration, and if a multidose vial is used, it must be labeled to ensure it is not used beyond its expiration date from the date it was opened.

9. Learn your institution’s medication administration policies, regulations, and guidelines.

In order for nurses to follow an institution’s medication policy, they must become familiar with the content of the policy. This is where education comes into play whereby the institution’s educator or education department educates nurses on the content of their medication policy. These policies often contain vital information regarding the institution’s practices on medication ordering, transcription, administration, and documentation. Nurses can also familiarize themselves with guidelines such as the Beers’ list, black box warning labels, and look alike/sound alike medication lists.

10. Consider having a drug guide available at all times.

Whether it’s print or electronic is a matter of personal (or institutional) preference, but both are equally valuable in providing important information on most categories of medication, including: trade and generic names, therapeutic class, drug-to-drug interactions, dosing, nursing considerations, side effects/adverse reactions, and drug cautionaries such as “do not crush, or give with meals.”

Utilizing any or all of the above strategies can help to prevent or reduce medication errors. Nurses must never cease to remember that a medication error can lead to a fatal outcome and it is for this reason that med safety matters.