BOX 9-3
Application of Systems-Based Problem Solving to Improve Medication Delivery

The principles of systems-based problem solving have been applied off the front lines to improve the efficiency of clinical support services, including pharmacy, imaging, and patient handoffs. For example, after discovering that medication orders often were not ready when nurses came to retrieve them, the pharmacy staff of University of Pittsburgh Medical Center South Side used systems engineering principles to improve the efficiency and timeliness of medication delivery. By analyzing the problem, they learned that physician orders for medications were handled in batches that were entered throughout the day, filled the next morning, and delivered the next afternoon. That method meant prescriptions were delivered 12-24 hours after being written, at which point patients’ medication needs often had changed. This, in turn, led to time wasted in restocking old orders and workarounds to get patients the medications they needed.

To address the problem, the pharmacy staff worked as a team to determine what needs their unit was expected to meet and simulated their work to investigate the factors that were preventing them from meeting these needs. By addressing the identified problems, including the way drugs were stored, the delivery routes technicians took through the hospital, and the timing of medication processing, the pharmacy staff reduced the incidence of missing medications by 88 percent, the time spent looking for medications by 60 percent, the incidence of out-of-stock medications by 85 percent, and medication processing from once every 24 hours to once every 2 hours.

SOURCE: Spear, 2005.

valleys in patient flow improve both patients’ experience and hospitals’ financial position, but it also has the potential to reduce staff stress, which can lead to burnout, errors, and diminished safety and quality (Litvak and Bisognano, 2011; Litvak et al., 2005). Improvements in patient flow at Cincinnati Children’s Hospital Medical Center, for example, enabled savings of $100 million in avoided capital expenses that would have gone to the purchase of 100 new beds. Improved patient flow also led to greater work satisfaction among staff and reduced wait times for patients (IOM, 2010; Joint Commission, 2009).

Continuous Feedback and Improvement

Beyond systems-based problem solving, systems that continuously learn and improve need to be adept at transferring the knowledge they gain throughout the organization. However, several barriers prevent such



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