Process Improvements Must Support Technology

Recently, I wrote a skeptical posting about a hospital that was installing a huge machine to dispense medication in its pharmacy. What concerned me was that the story about the installation gave no indication the hospital had done anything to improve the processes by which medication is dispensed.

Please understand: I like technology. I’m all in favor of any organization installing new technology that can make things better – provided it is trying to make its business processes better as well.

A recent article from Most Wired magazine (published by Health Forum, Inc., a company of the American Hospital Association) describes the efforts of three hospitals to automate their respective pharmacies.

None of the installations seems to involve the kind of huge machine described in my previous posting, though the technology in these case studies is still fairly sophisticated.

However, I believe that the information in this article (written by Lee Ann Runy) supports my point – that technology alone is not enough, that process and cultural issues are key.

In the case of Central DuPage Hospital, a 313-bed facility in Winfield, Illinois, improvements did not begin with technology.

The first step was remodeling the pharmacy to enable a more efficient workflow and building a sterile IV room that met U.S. Pharmacopeia 797 standards.

That was followed by adoption of a variety of technologies, which did help achieve significant improvements. But some of the biggest challenges were not technological, but cultural (a reality well-known by lean advocates).

One of the biggest hurdles was coping with the nursing workflow changes that followed adoption of the bar-code system.

“The technology doesn’t improve flow, and it doesn’t make anything go quicker,” says Deborah O’Donnell, R.N., chief nursing officer. “I wish we had a better idea of the learning curve prior to implementation. We have lots of tenured nurses, and it required more education than we thought it would.” She recommends that organizations carefully develop schedules to support the education component. Lowering the patient-to-nurse ratio during the learning curve can reduce some frustrations because nurses will feel that their patients are being adequately monitored.

Riverside Health System, a group of four hospitals in Newport News, Virginia, also achieved gains with technology. As with most pharmacy automation projects, the technology involves the use of bar codes.

But the system’s experience also illustrates that managers must study how people actually use technology, identify any problems and – lean principle here – address the root cause of those problems.

Riverside carefully tracks usage of the bar-code system to ensure it’s being used to its full capacity, says Cindy Williams, director of pharmacy services. One key metric is whether nurses are overriding the system prior to administering medications, which can be tracked to the unit and individual user level. “We want to be as close to 100 percent as possible,” she says, adding that bar codes are currently scanned at the point of care about 96 percent of the time. Several factors that lead nurses to override the system have been identified, and most of them can be solved by additional training. Some IV bags, for example, have two bar codes. If the nurse scans the wrong one initially, she must override the system to scan the right code.

Do you have experience installing significant new technology? Did you have issues related to the underlying processes? Or to cultural resistance? What were your lessons learned?