Input of LEAN methodology to day care unit (HDJ) and cytotoxic production unit (UPAC): patient care pathway improvement

L. Escalup1, A. Hurgon1, A. Chastang1, ML. Moulard1, N. Harlez1, J. Pradelle2, C.Roussel2, P Cottu1 1 Institut Curie, Paris, France
2 3M France


Satisfaction survey and patients feedback highlighted the need to improve the patient waiting time within the day care unit (duration, reception conditions…). Despite the different solutions put in place during the last 8 years (anticipation, dose banding) and confirmed by national benchmarks, the limits of our business ideas were met.

An analysis following the LEAN method was decided in this direction by including UPAC in the project scope.
Lean management leverages all stakeholders (operational and responsible) to eliminate waste and maximize efficiency and performance of a production unit or department. It is also essential for its success to take into account the human dimensions.

The analysis took place from March to May 2016: process analysis, hidden costs analysis but also analysis of the "quality of life" of patients and staff.

The methodology was:

  • Constitution of a group of operational work, observation by a LEAN project manager of 3M France, patient care pathways monitoring, chemotherapy preparations courses monitoring, patient surveys, interviews with all professionals, impacting factors measurement…
  • Feedback to the working group: data supported malfunctions, time analysis, mapping of patient flows, IT malfunctions, chemotherapy preparations ...

Solutions have emerged from our thoughts:

Speak the same language between services, reduce exceptions, homogenize pharmaceutical practices, optimize shipments preparations per patient appointment time slots, communicate effectively, observation training in pairs (pharmacy technician - nurse) and create a visual computerized patient care pathway accessible by all, and integrating the chemotherapy preparation steps.

The interest of this LEAN analysis was the vision of an outsider, the common thoughts around the establishment of simple but also more complex solutions, always in the interest of patients and professionals.

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