Lean analysis in a chemotherapy production unit

L. Carrez Pharmacy, Geneva University Hospitals, Geneva, Switzerland

The Geneva University Hospitals (HUG) have centralized the production of their chemotherapies at the pharmacy since 2002. The pharmacy produces all cancer treatments recognized as carcinogenic, mutagenic and toxic to reproduction and all monoclonal antibodies conjugated to a cytotoxic molecule. Production rise continuously, reaching 12554 chemotherapy in 2006 and 16402 in 2014, corresponding to an increase in demand of 31% over 8 years.

To deal with the constant increase of the production demand in a context of cost containment that does not allow funding of additional human resources, the pharmacy had to rethink its organizational strategy. Decisions were taken to introduce automated manufacturing for some preparations, to start the development of batch production of fixed dose (dose-banding) and to revise the production processes through Lean.

Lean is a production management philosophy developed in the automobile industry and used for the first time at Toyota in the 50s. It is based on the elimination of waste, Muda (overproduction, expectations, transport, unnecessary steps, stocks, unnecessary movements, corrections / alterations), excesses, Muri (work overload, over-stocking), and variability, Mura (fluctuation of activity, quality and process variability). Like any quality approach, it aims to increase the quality and safety of products, production efficiency and customer satisfaction through continuous improvement. The originality of the method is the strong involvement of field staff, who are mainly at the origin of improvement proposals.

The implementation of the method is based on a 5-step process:

  • The first step corresponds to the drafting of a project convention involving all staff and defining the objectives, performing a value stream and process mapping and the definition of different families (identification of major processes).
  • The second step is to measure the time dedicated to each step of the process.
  • The third step is the analysis of time and identification of steps with high and low added-values.
  • The fourth stage is the search for an improved process efficiency with the elimination or reduction of low added-value steps and the use of organizational tools:
  • 5S
    • Seiri: Sort, clearing, classify
    • Seiton: Straighten, simplify, set in order, configure
    • Seiso: Sweep, shine, scrub, clean and check
    • Seiketsu: Standardize, stabilize, Conformity
    • Shitsuke: Sustain, self discipline, custom and practice
  • Visual workplace management
  • Standard work instructions
  • Quick changeover time (SMED single minute exchange of die)
  • Smoothing the workload (heijunka)
    • Production pull flow (JIT just in time)
    • Define a production limit (Kanban)
    • Define a production time rate (Takt time)
  • Using fool-proofing (Poka-Yoke)
  • A work organized in the shape of a ‘U’ (U-shaped cell)
  • Organizational Management (Obeya)
  • The fifth stage is a control to measure improvement.

Lean experienced a new development since 2010 notably in the field of health. It has its supporters and its opponents. Lean is often accused of pushing to Taylorism and be used in a sole objective of productivity gains at the expense of human beings. But it is often an abuse contrary to the philosophy advocated by Lean.

We propose an example of application of Lean through the reorganization of our chemotherapy unit. The aim is not seeking economic gain but an optimized efficiency of processes and safety of preparations by improving the working conditions of operators, including limiting the workloads phases. The participatory approach deployed within our unit will be illustrated and the organizational operational gains will be presented.

The author declared no potential conflicts of interest with respect to the research and received no financial support for the research.

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