What’s a 3P?

Everyone who has been in healthcare for awhile can remember a building project where after it was completed, the staff said: “Why did they build it like this?” because the end result did not meet their needs. I am happy to report at GBMC we are using a powerful design tool to reduce the chance that we build something that doesn’t work. The tool is called a 3P, for production, preparation, and process. The 3P helps you design a new production process with the smallest amount of waste possible. This week, I asked Min Min Than, our Director of Pharmacy and the process owner for this PI engagement, to write a guest blog highlighting our team’s recent 3P experience.

Min says:

We recently used the 3P to begin planning for our new Inpatient Pharmacy. This 3P project was initiated and sponsored by Jody Porter, Senior Vice President of Patient Care Services. The project objectives included designing an efficient work flow process and positioning the pharmacy to meet future patient and internal customer needs.

Our team included our consulting PI Master from Next Level Partners; GBMC PI Masters Lisa Griffee, Julie Silver, Nicole Garrison and Julie Gabriele; and key pharmacy staff members including Pharmacists Paul Ku and Julia West, Technician Supervisor, Gigi Lei, and Buyer, Karen Delacruz. Joining the team was our Construction Project Manager from ProSys, Bryan Niles, and two of our architects from HMC, Usama Hassenein and Jim Albert.

In order to design an efficient work flow process, the team was challenged to evaluate not only overall square footage but also technology utilization and future needs.

Our team began the event the week of September 24 and used 3P. This process emphasizes meeting customer needs by first focusing on changes to improve flow and eliminate waste. By including cross-functional team members, we were able to bridge the gap between designing a layout to include needed storage, fixtures, machines and equipment to factoring in material flow, standard work and information flow. By encouraging a large number of ideas and thinking outside the box, the team was challenged to quickly come up with at least seven different layouts.

These were spread out on paper and documented the flow through each pharmacy process (spaghetti diagrams). They were discussed, rated, and narrowed down to the top three. These were reviewed again, and this time they were drawn to scale. Finally, we prioritized one design and we built it out in the Tulip Park garage using 1 inch thick cardboard! (We had to protect the mocked-up cardboard pharmacy from the rain and wind and our colleagues at Sheppard Pratt wondered why we had draped tarpaulins over the side of the garage!)

We filled the space with actual equipment when possible (chairs, trash cans, carts, trays, supplies) and modeled the rest (machines, desks, shelving, computers, etc.) By having 3-D, to scale representations that we could walk through, we started making modifications and testing out our design through simulations. We opened up the space for many other Pharmacists and Technicians to walk through and provide feedback for other modifications based on front line staff input.

On October 15 & 16, we conducted multiple simulations of each of the key processes to validate our final design. By implementing the right technology and efficient workflow processes, our final design accomplishes the following:

1. Freeing-up more time for Pharmacists and Technicians to spend in bedside pharmaceutical services;

2. Safer care by utilizing more bar code technology

3. Better inventory tracking and better managing of medication storage

4. Improved control and safety of narcotics, by shifting them to a secure room.

The project provided another great learning opportunity for performance improvement using LEAN tools and gave us a lot of “A-ha” moments. Also the 3-dimensional build gave a real feel for the new work flow and space to frontline staff and more ownership of the new design. Lastly, as with all LEAN projects, the 3 P process is much more cost-effective as it eliminates the need for most changes in the real build which are very costly.

Congratulations to one of our own!

Finally, on behalf of the entire GBMC HealthCare family, a warm “congratulations” to Erin Ament, BS, RN-BC, Clinical Unit Coordinator of the Acute Care for the Elderly (ACE) unit, who recently received the National Excellence in Gerontological Nursing Award for 2012! “Working in the ACE program, I consider myself lucky as I get the best of both worlds,” Erin said. “In my role I get to work with the patients I love and educate the nurses around me about the importance of their care with the elderly patient.” The Excellence in Gerontological Nursing Award is presented by the National Gerontological Nursing Association. The award was established to recognize excellence in individuals who provide care to older adults. Congratulations are also in order for a second ACE Unit nurse, Maria Baxter, who was also nominated for the award.