Méthode d'amélioration des processus métiers pour optimiser et pérenniser l'activité de soins pharmaceutiques à l'hôpital

The activities of hospital pharmacists are evolving from production centered activities to patient oriented activities called pharmaceutical care (PC) with higher added value for patients. In our hospital, several activities of PC have been implemented in the last ten years. These activities are growing, and new needs are continuously emerging. At the same time, we noticed a partitioning and an heterogeneity in their daily realization. The reorganization of these activities became essential to harmonize, decompartmentalize and sustain these activities. A collaborative process oriented approach was used over four months. Two process maps were established, and measurements of volume, duration of these activities and human resources available were collected. The processes were analyzed (heterogeneities, irritants and wastes) leading to different categories of improvements using an affinity matrix. A reorganization was proposed, refined with the pharmaceutical team and then implemented and measured using performance indicators. The daily organization of the PC has been formalized. Pooling and decompartmentalization of resources have been associated with the creation of a rotating position (with constant resources): A pharmaceutical facilitator in charge of the daily coordination of the PC activities. PC continuity has been established using two types of schedules: Advance macro planning and day-to-day planning with visual management tools. An PC competency grid has been developed to maintain and develop the skills of the team. The PC have been fully reorganized in a collaborative way. These activities, being harmonized, rely on a learning organization to ensure continuity of care to the patient. The challenge is to ensure sustainable pharmaceutical care to demonstrate long-term pharmaceutical value-added for the patient. A constant review of the PC processes is essential for the latter and our work suggests that the lean method is adapted to do so.