Application of Lean methodology to the pre-production stage in a preparation unit of cytotoxic drugs

5 October 2016

J. Daupin1, H. Aboudagga1, N. Valin1, G. Jaillet1, F. Atout1, E. Caudron1,2 1 Georges Pompidou European Hospital (AP-HP), Pharmacy unit, Paris, France
2 Paris-Sud University, Groupe de Chimie Analytique Paris Sud Lip(Sys)², Chatenay-Malabry, France

An efficient logistical circuit limits handling heavy loads, stock-outs and costs of over-stocking, optimizes storage capacity, and ensures final product quality and staff security. To optimize flows, Lean methodology was used in pre-production process step (from order to storage) in our preparation unit.


Pre-production flows were mapped by a working group, including a warehouseman, two pharmacy technicians, a technicians’ manager, two pharmacists and a pharmacy resident. Problems in the Value Stream Mapping (VSM) were identified and classified. The working group has defined priorities by majority vote and targeted actions to resolve them. Action plans were drawn up and their implementation has been monitoring by a follow-up chart.


The VSM has divided pre-production step into 5 supply chains of drugs and medical devices. 53 problems have been identified and classed into 9 categories; 3 of them have been considered as a priority:

  1. Stock difference and traceability errors,
  2. Order and
  3. Hygiene and chemical risk.

5 actions have been implemented: increase of ordering frequency (based on computerized order recommendation) in order to avoid storing off-controlled atmosphere area, deployment of a two-bin inventory control for medical devices in order to simplify their order, equipment purchase adapted to the needs, revising of the hygiene rules in storage area (no packaging boxes, sterile dressing), securing of cytotoxic drugs’ receipt (separate delivery and logo identification on packaging boxes).


The reduction in stock and in storage sites has made the pre-production step more efficient with the same resources. Lean methodology and its tool, the VSM, allow a global view of a process and its dysfunctions. This encourages team work and staff involvement in a continuous-improvement process.

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