Implementation of a collaborative method for the improvement of the dispensing process of experimental anti-cancer drugs: feedback at M+6

Introduction
The quality of care improvement is often achieved through top-down hierarchical approaches with little space given to operators in the decision-making process, making it difficult to change the organisation. Delays in dispensing clinical trials (CT) and dysfunctions were highlighted by an audit and mapping of the CT process. Our objective was to improve the dispensing process using a collaborative method, involving all the protagonists to drive change.

Method
Four problem-solving workshops were selected to be conducted in the form of KAIZEN workshops in 4 stages: problem definition, research and prioritisation of root causes, research and prioritisation of solutions according to the impact-feasibility ratio, elaboration and piloting of the action plan. The managerial animation of the workshops was based on a facilitator’s posture for the manager encouraging listening and creativity. The facilitator was coached by an experienced pharmacist. Each session lasted 35 minutes and included pharmacists, intern, pharmacy technicians, manager, storekeepers. The techniques used encouraged the collaborative aspect: brainstorming, rephrasing, weighted voting, filling in the live impact/feasibility matrix, visual management, team involvement, weekly meetings. A hot evaluation was carried out by analysing the manufacturing sheets (MaSht) over 2 days.

Results
Two solving-problem workshops were carried out corresponding to 8 KAIZEN workshops. They concerned real incidents related to essential stages of the process: manufacturing without medical validation, delay in sending preparations. 10 causes were found, 5 of which were prioritised (50%), 14 solutions identified, and 7 solutions implemented (50%), including the rearrangement of workspaces, the creation of a monitoring and scheduling system and the updating of procedures. The hot assessment shows that 95.7% (90/94) of the MaSht were compliant with the new system and no manufacturing was carried out without medical validation. An evaluation of the dispatch times after procedure changes is underway. Two other workshops are in progress on scheduling (high waiting time at each stage of the process: 3 on 4 causes prioritised, 5 on 7 solutions implemented) and parcel reception (6 causes identified, 3 prioritised, 5 on 12 solutions implemented).

Discussion – Conclusion
This method made it possible to facilitate change (i.e. change in the most reluctant speeches), promote team cohesion (assiduity of the participants), launch a dynamic of continuous improvement (the implemented solutions must be re-evaluated). A total of 7/10 pharmacy technicians have been trained and driving pharmacy technicians have been revealed through the workshops. The staff members’ experience, planning of the workshops and the change in managerial thinking were the main difficulties encountered.

Keywords: clinical trials, lean healthcare, kaizen, process, hospital reorganization, managerial innovation

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