Statistical Thinking in Health Care

Introduction

Provision of quality healthcare in an efficient manner is a challenging task. Quality improvement process adopted by pharmacists is not able to identify and manage the drug-related problems experienced in a facility. The goal of such an initiative is to maximize patient benefits using the resources available. To achieve this, pharmacists need to redefine their tasks, establish whether they are working to achieve it, and apply the information to point out to areas that need improvement. Pharmacists need to establish the drug-related problems that proper management can yield to greatest benefits for a majority of the patients. Such is the task that Ben, a pharmacist assistant and Juan his manager have at HMO’s Pharmacy. Failure to achieve a considerate improvement will lead to Juan’s dismissal. The pharmacy has had a number of complaints and a couple of lawsuits due to inaccurate prescriptions. This paper will include the development of a process map depicting the prescription filling process using the SIPOC model to identify the main root causes of the problem. The paper will also categorize the main root causes into either special causes or common causes. A suggestion will be provided on the main tools that can be used to gather data necessary to analyze the business process and rectify the issue.

Prescription Filling Process at HMO’s Pharmacy

From the review of the above prescription process, a key problem is likely to arise from the first stage of the process where the physicians give handwritten prescriptions. This poses a great risk to the possibility of medical errors. Illegible handwriting is likely to affect the accuracy of the pharmacy assistant tasked with the responsibility of entering the prescription into the computer system. An error that occurs at this level is most likely to be carried forward down the process causing a prescription error.

Another key problem in the process above is lack of control in the process. A prescription may be entered into the system correctly but an error later occurs in the later stages of preparing and administering the medication. The issues that may arise in this area include the wrong dosage, wrong form or route, wrong drug, and drug interaction. The dispensing process is also prone to errors such as incorrect labeling. Other problems related to administration errors include administering drugs to wrong patients, wrong drugs, and the wrong time.

Analysis of the Prescription-Filling Process under the SIPOC Model

The SIPOC model is comprised of elements such as suppliers, inputs, process steps, outputs, and customers. The prescription filling process at HMO’s maybe broken down into the above-mentioned elements as indicated below:

Element	Process
Supplier	Physicians
Inputs	Handwritten medication prescriptions
Process Step	Writing prescriptions, Entry of prescriptions into the computer system, printing medicine label, labeling of medication, packaging the medicine
Outputs	Filled medication to the customer
Customers	The patient receives their medication prescription

Main Root Causes of the Problems

The problems identified in the prescription process ultimately lead to a single main problem of inaccurate prescriptions. A major root cause of the problem is the lack of computerized systems that would provide a link between the physician and pharmacist. Another major root cause to the problems is lack of critical events control points. This allows errors such as wrong labeling and wrong dosage to pass through the process. The control point would offer an extra protection by having the results of one stage of the process verified by an individual at a higher authority level. The two root causes can be categorized as common cause variation. This is because the problems are related to human errors within the process that have gone unchecked.

Main Tools and Data for Analyzing the Business Process and Correcting the Problem

Ideally, evidence indicates that the use of a bar-code system is an effective tool for dealing with dispensing errors. One study identified a reduction in dispensing errors from 0.19 to 0.07 in a healthcare facility in the U.S. Another important tool that may be used to analyze the business is the Lean management model. This model seeks to develop a culture of improvement with an organization by adhering to principles such as continuous improvement, value creation through the elimination of waste, creating a unified purpose, use of visual standards, and adherence to a standardized process (Shiu & Mysak, 2017). The application of Lean in healthcare has been noted to enable the definition of value, map value streams, and eliminate non-value-added activities. Within the pharmacy, the principles have been indicated to mainly relate to the distribution process. The techniques applied here lead to the reduction of waste and improved workflow by checking and remedying causes of wrong dosage, medication errors, wrong delivery time, and lack of verification (Shiu & Mysak, 2017).

Solution

A proposal to deal with the HMO’s ongoing problems is the human factors approach. This approach deals with issues, which are specific to human and may influence how people interact with the environment and people around them. The human factor approach seeks to understand the aspect of the manner in which humans relate to their environment, their capabilities and limitations and how these can be used to improve performance and safety. The approach will focus on issues such as personnel, training, and operating approaches. The categories of the measures include training of individuals to make them fit for the work and the environment and selection of the most ideal individuals who are a perfect fit for the job, environment design to make it conducive. Others include equipment design to include systems for automation and task design where supervisory roles are offered to some staff (The Health Foundation, 2012). A strategy to measure the solution mentioned above will entail the use of a checklist to monitor specified quality indicators. Quality indicators refer to the measures that are based on standards of care that assess a certain healthcare process of outcomes (Bruchet, Loewen, & De Lemos, 2011). In this case, the quality indicators to be used will focus on the process, with the main quality indicator being a reduction in the number of inaccurate prescriptions. 

References

Bruchet, N., Loewen, P., & de Lemos, J. (2011). Improving the quality of clinical pharmacy services: a process to identify and capture high-value “quality actions”. The Canadian journal of hospital pharmacy, 64(1), 42-47.

Shiu, J., & Mysak, T. (2017). Pharmacist Clinical Process Improvement: Applying Lean Principles in a Tertiary Care Setting. The Canadian journal of hospital pharmacy, 70(2), 138-143.

The Health Foundation. (2012). Reducing Prescribing Errors. Retrieved from https://www.health.org.uk/sites/health/files/ReducingPrescribingErrors.pdf