Reengineering of the chemotherapy production process in Antoine Béclère hospital using a lean approach

Lean is a system of work management that strives for operational excellence. Since 2011, Antoine Béclère hospital has implemented lean projects in order to develop continuous improvement. In this context, the centralized chemotherapy compounding unit has been reengineering its production process since 2015. The objective was to optimize the production process using a lean approach. The production process was analyzed using lean. The information flow and the workflow have been studied: the process was divided into a set of elementary tasks. Non-value added activities were identified to be eliminated and those with positive added value were kept. Evaluation of the new process was based on the comparison of activity indicators. Non-value added activities were eliminated: the control of preparations and management of stocks were optimized. Three priority levels for chemotherapy production have been set up and early-preparation (before chemo prescription) was established. The number of days for which the first preparation was released before 10 AM was significantly higher with the new process (p=0.034) while the non-conformity rate was not significantly different. The production is now carried out with a production team composed of only 3 persons with a similar or even higher quality (lower delay for the release of the first preparation). The simplification of operations (control, inventory management) and the early-preparation production enable better control of activity fluctuations. To spread and strengthen the culture of continuous improvement, a visual management tool, the Obeya, was established.