August 25, 2006

Bulfinch Medical Group: Learning from Toyota

The staff at MGH's Bulfinch Medical Group (BMG) recently applied methods developed by the automobile manufacturer Toyota to implement changes enhancing the workflow of their prescription processing system.

The Toyota Production System (TPS) approach encourages the workforce to identify and report problems when they occur in order for immediate small changes to be incorporated. Every work problem is seen as an opportunity to learn and improve.

At the BMG, up to 1,000 prescription refill requests are received each week, and despite a dedicated staff of assistants, there were breakdowns in the refill process, which negatively affected support staff, providers and patients. During a period of three months, assessments and solutions were generated.

"Our staff collaborated with the assistants to identify difficulties and disturbances in the prescription refill process," says Marcy Bergeron, RN, MS, ANP, director of BMG's Quality Innovation. "Our aim was to redesign the system so that those working so hard to complete these refill requests would find it 'easy to succeed and hard to fail.' We aspired to create 'smart systems' rather than rely solely on individuals' vigilance, verbal communication or memory. With clearly communicated and easy-to-follow steps and responsibilities, we have made great strides towards developing a defect-free prescription refill process."

Prior to the TPS implementation, the medical assistant (MA) would deliver the prescription request to the physician for approval, go back to pick up the approval, go to the workstation to print the prescription and then deliver it to the physician for a signature. To streamline the process, the requests for approval were removed and MAs simply printed the prescription and delivered these to the physicians for signatures. Eliminating extra steps has saved time and improved efficiency.

"Our refill requests requiring a second request from patients have diminished by 80 percent," says Bergeron. "Not only have our MAs reported increased efficiency and accuracy in the refill process, but they also report increased job satisfaction. The process improvement program has succeeded in large part because the staff members are all fully engaged."

Look for more process improvement success stories in future issues of MGH Hotline. For more information, call Sally Iles at (617) 726-8283.