IA Final Report

University Hospital
Capstone 1 Final Project

Group Members:

Zachary Klein
Leo Kummen
Maggie Fields
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Table of Contents

Executive Summary 3
Introduction 4
Company Overview 4
Objective of Assessment 4
IE Analysis 5
Pharmacy Layout and Flow 5
Rapid Plant Assessment Analysis 6
Opportunities for Improvement 8
MUDA 9
Data, IE Techniques
10
Conclusion 10
Project Charter 11
Plan 11
Data Collection and Analysis 11
Team Roles
12
Appendices 13-14
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Executive Summary
This project focuses on the University Hospital pharmacy located in the lobby of the
medical facility. They are responsible for taking care of both walk in patient prescriptions, as
well as all medication for hospital patients. The Capstone I class toured the facility, completed an
Rapid Plant Assessment (RPA) and listened to a presentation on some of the operations the
pharmacy performs.
By analysing material flow and process diagrams, some areas indicated the need for
improvement. Looking at the current layout, there is time, processing, and movement being
wasted. Pharmacists are sometimes struggling to keep up as a result and efficiency lacks in many
cases because of improper facility layout, and unwise storing decisions. From a flow perspective,
the issues remain the same, and a vast majority of the students who saw the operation came to
this conclusion. Space and timing made flow very difficult for most prescription orders and as a
result, quality and quickness suffers in the current layout.
After receiving the results from the RPA, which can be found in the Appendix under
Table 1 and Table 2, it was evident that the pharmacy had room for improvement. The main
issue noticed within the pharmacy was looking at the “visual management deployment”. With a
rating of 3.56 out of a possible 11 points, this highlighted the serious need for visuals within the
pharmacy. “Product flow, space use, and material movement means” was reported to be the next
area needing improvement. This area received a 4.31 out of 11, leaving both of these areas in the
below average category. When focusing directly on the questions that pertained to these 2 areas
of focus it was recognized that the underlying issues stemmed from the questions dealing with
signage showing customer satisfaction rates and areas that are capable of continuous
improvement. These questions were both answered 100% no from the students. Simple changes
like implementing signs can easily earn trust with the customers. Only 25% of the class answered
yes to the question “Is the plant laid out in continuous product flow lines rather than in ‘shops’?”
From these answers it is evident that the signage and flow of the pharmacy needs to be improved.
As a result of these findings, three opportunities for improvement have been designed.
The goal is to provide results that will help the pharmacy increase customer satisfaction and
trust, as well as decrease the time it takes to fill a prescription. First, by adding a pull down rack
for commonly ordered medications like Z-Packs to the front desk so as the pharmacist technician
will be able to quickly find what is needed instead of having to go through the whole process for
something menial. Second, by replacing the current hanger system with a “Burger Slide” to the
pharmacy tech station located in the the middle of the pharmacy. This slide would eliminate the
extra steps and time needed for techs to take medication around the counter and the front desk
clerks time needed to rebag the medication once taken out of the hanger system. Lastly, by
placing signs up throughout the pharmacy indicating a clear flow of the product, as well as
progress reports posted periodically.
To achieve these results, IE Techniques will need to be employed. Time studies would
need to be done to discover how long each step takes when filling a prescription. Additionally,
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data like wait time, arrival time, and prescription type would be collected as well. All of this data
would flow into simulations created through the Simio software. Also, a cognitive analysis will
be used to ensure the proper signage is implemented. Investment analysis would need to be done
to show how the cost of implementation would be worth the long term reward of increased
productivity and monetary gain. In addition, a 6S scorecard would be used to assess how lean the
system actually is. The simulations would be used to find the bottlenecks of the prescription
filling process as well as compare times of current processes with predicted times of new
processes. Once the bottlenecks are discovered, time reducing measures will be implemented in
the simulation to detect if these changes will have a significant increase.
It is believed that the project has great chances to be successful, and by working with the
representatives of the pharmacy in getting and analysing the data, the chances for improvement
are endless. The goal for this project will be to create a better flow, to identify the flow with
visuals and reduce the wait time for customers.

1.Introduction
1.1 Company Background
The University Hospital is a 247 bed medical facility that is located on the campus of the
University of Missouri in Columbia. It serves as not only a Critical Care facility for patients, but
also as a research hub for medical faculty and students needing training as nurses and doctors. It
is the only Level 1 trauma center in Central Missouri, and with the advanced research being done
at the hospital, it offers highly specialized care not found in other medical centers in the area.
With over 25,000 emergency room patients, and thousands more full time patients cared
for each year, the medication needs of the University Hospital are extensive. To provide for these
requirements, the Hospital has 9 pharmacies located around Columbia from which patients can
pick up medication. There is a primary pharmacy housed in the lobby of the hospital that serves
as the provider for not only prescription pick-ups, but for medication orders for all the in house
patients located throughout the facility. Millions of medication orders flow through this
pharmacy every year.
1.2 Objective of Assessment
The University Hospital pharmacy will be the focus of this project, with the goal of
assessing their current procedures and finding opportunities for improvement. On average, it
takes the pharmacy about 20 minutes to fill a prescription but can sometimes take up to 2 hours.
One main goal is to minimize this time in order to have the customers leaving satisfied. Another
reason to improve the processes within this pharmacy is to ensure that all of the orders are being
filled correctly. If not, a person's health could be at stake and that is what a pharmacy is trying to
prevent.
For improvement opportunities the goal was to assign Industrial Engineering techniques
that would be helpful in testing out the validity of the improvements suggested. Also, for the
analysis process of next spring information on data needed was gathered to make the most
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accurate assumptions and recommendations. A tour and some background information on the
facility was given by representatives of the hospital. That information, along with data gathered
from surveys, is what all recommendations in this paper are based off of.

2. IE Analysis

2.1 Pharmacy Layout and Flow

The Pharmacy located in the lobby of the University Hospital is a small space, and is
illustrated in the figure below. As you can see, the flow of the pharmacy requires a lot of
movement from the pharmacists. When the order comes in at the customer interaction station, the
information about the order is entered into
their computer system. The system updates
the pharmacists at the computer station on
what needs to go into the order. From that
information, the pharmacists have 3
locations they might need to visit in order
to find the proper medication. Two of the
locations are in the front room, while the
third location in is the back room. In the 2
locations in the front room, the medications
are stored in large carousels in the front and
back of the pharmacy. These carousels hold
a large number of medications on them
from which the pharmacists can grab
inventory as they need them. If the order is
for patients staying in the hospital who
needed specialized medication, the pills are
stored in the small alcove near the back (labeled bedside pills on the diagram). An additional
pharmacist sits at that location and works with the higher dosage amounts and non-common
medication sometimes needed by doctors. No matter which location holds the proper pills, the
pharmacist is required to walk to and from the computer and scale station with that medicine.
Once they are back at the computer and scale station, they scan a barcode off of the pill bottle
and count out the correct dosage to fill the prescription. Sometimes the pharmacist weighs the
pill bottle, while other times they count the pills with a machine or by hand. Once the
prescription is filled, the pharmacist places the filled prescription into a clear bag and places it on
the completed order rack. From there, the person working the customer kiosk finds the proper
order and hands it to the customer. The pharmacist then returns the medicine bottle back to its
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home with a blue label on it indicating that the bottle has been opened and some of the pills have
been used.

During the tour it was seen that the “Computer Station and Scale” area of the facility had three
employees on average working at it at all times. Whereas only one employee collected the pills
as directed by the pharmacists at the Computer Station. During the process of filling a
prescription the Computer station is used twice, as shown above in the Value stream map, the
first time is to input the pill information, and the second time is to complete pill information and
use the pill counter/scale as necessary. The queue length at the second usage of this station is
higher than the first instance, because of the Lead Time being so high. The highest queue length
however is for the Bedside Pill process, and this is because the pills required from this station are
the most complicated of all the medications the pharmacy outputs. With only one pharmacist
manning this station it makes the “Process Time” take longer than any of the others. The total
Lead Time for the process is 28 minutes, with the Processing Time being 13 minutes, giving a
total of 41 minutes for the entire prescription filling process to take place. The industry average
is roughly 20 minutes, and though this stream shows an average for the Hospital Pharmacy, the
representative did say there are instances in which it takes more than 2 hours to complete an
order.

2.2 Rapid Plant Assessment Analysis

To Substantiate these ideas, a Rapid Plant Assessment (RPA) was filled out by all of the
individuals who toured the pharmacy. The results can be found in the Appendix section labeled
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as Table 1 and Table 2. This questionnaire is an initial evaluation of a production facility meant
to be carried out in a short amount of time.
When looking at the questions presented in Table 1, some areas indicate a positive
reaction from the students. Question 20 received 100% yes votes, meaning that the pharmacy as
a whole is doing well enough that everyone agrees that they would buy their medications from
this facility. Other questions (1 and 14) were answered positively including being welcomed to
the pharmacy and the students felt that the pharmacists and pharmacist technicians were well
trained and working on ongoing improvements. Additionally, questions 3, 5 and 19 were all in
the top 75 percentile. Since these areas received high ratings, they will not be addressed within
this project.
On the other hand, some of the questions scored below the 25th percentile. Looking at
questions 2 and 16, the entire class rated these 0% yes, indicating these as problem areas. Both of
these questions pertain to posting signage about customer satisfaction, product quality,
timetables, and continuous improvement ideas. Other low scoring questions include 4,6,8,9,11,
and 17. Again, some of these issues deal with signage and visuals which can easily be fixed
within the project. Referring to question 11, product lines are not something the pharmacy is
necessarily capable of performing due to a single pharmacist filling the prescription. It is
believed that if more people aid in this process there is more room for confusion and human
error. That is why it is believed that the pharmacy is set up in a job shop fashion, since most
orders are personalized to the written prescription.
After analyzing questions asked in Table 1, 2 main areas highlighted room for
improvement when focusing on the rankings in Table 2. The ranking system extends from 1 to
11, with the 11 numbers further divided into subcategories of poor (1-2), below average (3-4),
average (5-6), above average (7-8), excellent(9-10), and best in class (11). The overall rating of
the pharmacy was a 59 out of a possible 121 points. This score indicates that the pharmacy is
about average and that there is room for improvements.
Looking at the individual scores, number 7 and 8 received the highest scores with 6.19
and 6.13 respectively. Theses 2 categories, people teamwork, skill level and motivation and
equipment and tooling state and maintenance, reflect similarly as the outcomes found on Table 1.
It is evident of the skill level of the pharmacist and the pharmacist technicians and this drives
people to feel 100% comfortable purchasing their medication from this pharmacy.
Looking at the opposite end of the ratings number 3, visual management deployment,
received the lowest score with a 3.56. This rating is below average, indicating a serious need for
improvement. In second to last place was number 5, product flow, space use, and material
movement means, with a rating of 4.31. With these two as the lowest ratings, it was decided to
focus the project around these 2 main issues.
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2.3 Opportunities for Improvement

After analyzing the data from the RPA, it was clear what issues needed to be addressed in
the pharmacy. The first issue we looked at was the product flow, space use and material
movement. The current process the pharmacy follows is that every medication has a place on the
rotating racks found in the back, or in one of the caroseols located throughout the facility. This
forces workers to find a medication everytime it comes up as needed, and oftentimes that means
using the computer to locate the drug, followed by looking through the rack until found. For the
complicated prescriptions the use of a computer is logical, however for common medications like
a Z-Pack, this is an inefficient way of operating. We suggest the pharmacy takes this opportunity
to analyze which medications are most popular among their orders. The most popular selections
can be placed in pull down racks located above the front counter closest to the customers. This
would allow for when a prescription comes in for something like a Z-Pack, the pharmacist can
immediately pull down on the rack and select a bottle. This could be tested analytically by
conducting time studies. The study would reveal the difference in time it takes from the current
model, to when the more common drugs are simply added to the order at the counter. This would
allow for smoother transitions for the common medications, and prevent wasted time from
pharmacists having to look through inventory for a common pill.
Considering product flow specifically, the process the pharmacists follow once they have
filled a prescription seems redundant. When an order is received the pharmacists go to the
computer station to find where the drug is located, then find the drug and fill the order on the
scale station. Once an order is filled, the pharmacists must walk around the computer and scale
station, place the order in a clear bag, and hang the bag on the finished orders bar. This process
creates unnecessary motion for the pharmacists and additionally creates more work for the
people working at the customer counter. To eliminate the time it takes the pharmacist to walk
around the counter and place the finished products in the bag, a slide system is proposed to be
implemented in place of the hanger rack. The slide would be a similar approach to how the fast
food industry issues their cooked food to the kiosk workers. From the computer and scale station,
the pharmacists would place the filled prescription in their take away bags and place them on the
slide. Eliminating the clear plastic bags that have no value added. The slide would have
alphabetical dividers according to last name so that the workers at the front counter could
quickly find the correct prescription once the patient arrives. A stopper would be placed at the
end of the sliding system so none of the orders would fall to the floor. This process will be
proven to be more efficient by conducting time studies. The data could be collected while the
pharmacy is using the current system, as the elimination of steps in the current process will be
the primary source of time reduction. This would eliminate the walking time, the time it takes to
place the order in the clear bag, and rid the front desk workers the time it takes to take the
prescription out of the bag and place in a to go bag.
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The hospital pharmacy was severely lacking in visual management. Currently during the
filling process if a pharmacist is unaware of the location of a drug or tool they have to look up
the location at the computer station. We propose to label each carousel with the category of drug
that is stored on it. The carousel will be further labeled on each layer with a more descriptive
label that would lead to a pinpoint location of each drug or tool. Additional signage will be
placed around the pharmacy, such as arrows on the tight isles. This will clearly represent the
direction all workers in the pharmacy must travel as the isles are so narrow only one person can
fit at a time. This will help with the overall flow of the pharmacy. It is recommended to post
reminders at the filling stations to be sure and to double check that the correct drug is being
poured into the prescription bottle. To monitor this effect, it is planned to post the product quality
report for the entire pharmacy to see. Adding signage pertaining to instructions of a process in
the respective area will help with confusion any pharmacists have. This would decrease the
learning curve for temporary workers, as well as help experienced employees in the instance they
forgot how to complete a task the correct way. By adding the instruction sign, this would allow
the confused worker to not interrupt their coworkers when are adding value, as well as workers
who are unsure to be confident they were completing the process correctly. To test the
improvement of all of the labeling systems a cognitive analysis will be performed. By adding all
of the mentioned signage around the pharmacy, it is predicted that throughput will be increased
as well as an improvement in correctly done procedures.

2.4 MUDA

Transportation -​​ The isles are narrow so only one person can be in an isle at one time.
Inventory -​​ There is excess inventory in the back storage room. They are a central warehouse to
the other eight pharmacies so less common drugs are placed here.
Motion -​​ The pharmacy technicians are traveling further than needed after they have completed
filling a prescription.
Waiting -​​ The pharmacy technician must wait on a pharmacist to confirm the accuracy of the
prescription.
Over-Processing -​​ The bag used by the pharmacy technician to hold the filled prescriptions. The
worker at the front counter then takes the prescriptions out of the bag and into a seperate bag.
Defects -​​ Over or under filling prescriptions is possible. Also a pharmacy technician could fill a
prescription bottle with the wrong drug.
Overproduction -​​ All prescriptions that are ordered are all filled. If a patient does not come to
pick it up the drugs will be placed back into inventory.
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Data, IE Techniques
To show ensure the changes would increase productivity, multiple observations and
calculations could be carried out. To start, a spaghetti chart could be created for the pharmacists.
It is predicted that there would be a lot of back and forth lines going to and from the front and
back of the computer and weighing counter, showing the inefficient process of completing an
order.
Time studies examining the processes of filling a prescription would benefit when
looking for data to support the process improvements. With the overhead common pills, the time
study would clearly show the time eliminated looking for the regularly distributed drugs.
Similarly, specifically looking at the time it takes the pharmacist to place the completed product
in the see through bag, walk the bag around the counter, and to rebag the final product for the
customers would show the benefits of implementing the slide tactic. If the scale were
implemented, the time study would be focused around the time it takes the pharmacists to
manually count the smaller pills. A simulation could be created to predict the time it would take
for the kiosk worker to find the correct filled prescription on the slide as well as implementing
the overhead pill dispensers and scales. Comparing the times found in the simulation to the times
found in the time study would give us an answer if the new process would be a more efficient
effort for the pharmacy.
In addition to time and motion studies and simulations, researching case studies about
other pharmacies implementing a weighing station versus a counting station would help generate
predictions. By using data found in previous trials, a statistical analysis could help forecast future
results. We will be completing a 6s scorecard to assess the leanness of the system. By
implementing the overhead bin and addressing the visual management problem we predict the
overall leanness of the system will increase.
The next issue to consider is if it would be cost effective to implement the new ideas. By
comparing the cost of the overhead holders,slide, and scales to the time the pharmacists and
kiosk workers would be saving, it would show if the change would be cost effective and worth
while. If the investment shows the return on investment can be made up within the first year and
a half through savings then the investment is worthwhile for the pharmacy.

Conclusion
The product being produced by the pharmacy is one that saves countless lives in the
course of a year. The quality has to be of the highest standing, and the faster it is produced for
the patients in need the better for the hospital, and the human beings involved. While it is
currently getting the job done in an adequate fashion, the flow and process management as well
as signage could be much better. More importantly, the lives of the thousands of patients a year
depending on the University Hospital to get them their medicine would be far more at ease. We
look forward to working with this facility in an effort to improve what we can.
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4. Project Charter

4.1 Plan

The main issues discovered in the RPA results stem from the “visual management
deployment” and the “product flow, space use, and material movement” areas of the survey. As a
customer visiting a pharmacy, no one wants to see a hectic and messy pharmacy. It is up the the
pharmacy to present themselves as organized and knowledgeable to their customers in order to
gain their trust. In any instance, if a pharmacy gives the customer the wrong medication, all of
that trust is now gone. This could be from grabbing the wrong medication, counting out the
incorrect number of pills, or taking someone else's order. By having an identified flow of product
and a clearly labeled step by step process, the customer will be reassured that they are receiving
the proper prescription. With a smooth flow of materials, the pharmacy will have a shorter wait
time for customers.
Through variations of a simulation of the pharmacy, it can be recognized where the
bottlenecks lie within the pharmacy flow. Once the bottlenecks are identified, process
improvement plans will be constructed. By adding these new improvements to the simulation, a
forecast can be created looking at the time it takes to fill a prescription before and after the
process improvements are implemented.
In addition, the Six Sigma Project Charter is located in the appendix labeled as Table 3.

4.2 Data Collection and Analysis

To ensure the process improvements increase productivity and flow of the pharmacy, a
few data collections and calculations must be conducted. First, a time study must be carried out
for each step the pharmacist takes while filling a prescription. Since the type of prescriptions that
are filled each day vary, data will need to be collected multiple days to ensure the information we
collect is accurate. The time study is planned for 5 days in a row, specifically from 8AM-11AM
each day. These times were determined because the morning has heavy foot traffic and the early
afternoon starts to settle down. With varying amounts of demand it will be easier to observe
more of the process. This time study will show the time it takes the pharmacist to fill a
prescription with the current layout design. Data will also be collected for customers entering the
queue, customer wait time, and times of high foot traffic versus a slow period in the mornings.
A simulation will then be created, entering in the average numbers and times that were
recorded in the data collection phase. After redesigning the layout of the pharmacy, another
simulation will be created. The two simulations can be run and the overall time should show that
the second layout plan is more efficient.
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By receiving access to the pharmacy’s historical data, it can be recognized how many
prescriptions were filled incorrectly in the last few years as well as discover the most frequently
requested medicines. Through software like excel and R, we will be able to analyze the large
amount of data the pharmacy has. Pivot tables will help categorize the data and make it easier to
interpret. Once the data is analyzed, it will be clear what medication is commonly prescribed and
that medication should be placed in the easily accessible locations.

4.3 Team Roles

All three members of the team intend on working together on each portion of the project,
and Zach will be the individual responsible for turning in completed work.
Maggie will be responsible for conducting the time study and data collection to ensure that the
data collected will be consistent throughout the entire study. Leo will be in charge of the log
book and the creation of the simulations once the data is collected. Zach will perform the data
analysis on the pharmacy data, looking into defects specifically. Together we will look at the
analyzed data and pull our recommendations from the numbers. These calculations will provide
the proof we need to ensure the pharmacy that by making these changes, they will better their
processes.
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Appendix

Table 1
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Table 2

Table 3