Preventable medical errors result in the loss of 200,000 lives per year with associated financial and operational burdens on organizations and society. Widespread preventable patient harm occurs despite increases in healthcare regulations. High reliability organization theory contributes to improved safety and may potentially reverse this trend. This single case study explored the introduction of a safety culture and subsequent improvements in patient safety in a reliability-seeking organization. Fourteen participants from a subacute nursing facility were selected using purposeful sampling criterion. Data were collected through participant interviews, document reviews, and group observation. Five themes emerged from an analysis of collected data including process standardization, checks and redundancy, authority migration, communication, and teamwork. The themes uncovered the need for extensive education and training, communication, and teamwork to improve patient safety. The results of the study may be useful to improve safety and enhance leadership to promote a culture of safe patient care.
ArticleThe basic goals of inventory management are to minimize inventory investment while maintaining a balance in supply and demand that meets customer expectations. 1 Exploring and understanding the optimal utilization of inventory is critical to pharmacy operations. Health care service organizations, such as pharmacies, have lagged behind industrial and retail sectors in developing and implementing effective process improvement strategies and techniques. 2 Although representatives of pharmacies and other health care service organizations have made significant efforts implementing strategies to improve the delivery and quality of health care products and services, less effort has been spent on actual process improvement. The improvement focus of these organizations has been the end products or services rather than the actual processes that yield the end products or services. 1 Out-of-stock (OOS) events are indicators of inventory process failures in need of improvement. 3 An OOS event refers to an event that occurs when an item is unintentionally not available for sale for a certain contiguous time period. OOS events represent both a failure to meet customer expectations and an inventory control process failure. We defined inventory control for this study as the process of minimizing the investment in inventory while balancing supply and demand such that OOS events are reduced to customer specifications.One protocol designed to improve operational performance and eliminate process defects is Six Sigma. Six Sigma is a rigorous and focused implementation of data and statistical analysis. Six Sigma involves a simple model known as Define-Measure-Analyze-Improve-Control, or DMAIC. 4 BackgroundOrthodox inventory theory is founded on classical economic order quantity (EOQ) methodology, developed in 1915 by a Westinghouse employee. 5 According to orthodox 534073P MTXXX10.1177/8755122514534073Journal of Pharmacy TechnologyWatson and Moliver research-article2014Abstract Background: Current inventory theory is based on simulated data and unrealistic formulae. Inventory replenishment processes are therefore commonly disrupted, and out-of-stock (OOS) events are unnecessarily frequent. Objective: OOS events at a large-volume, long-term care pharmacy in North Carolina were compared among 4 sequentially applied methods of inventory control: (a) a manual system without Six Sigma protocol, (b) a manual system with Six Sigma protocol, (c) a computer-assisted system with Six Sigma protocol, and (d) an automated system with Six Sigma protocol. Methods: Daily OOS rates were recorded for 11 weeks during the implementation of each method. Between-group comparisons were performed, and time-series analyses were conducted during each implementation to determine the significance of the change in OOS rates over the evaluation period. Results: In terms of the 2 manual systems, OOS rates were lower for the system to which a Six Sigma protocol was applied. In terms of the 3 Six Sigma systems, ranked differences were significant. The computer...
Everyone interested in the quality of the human services agrees that it should be largely determined by the interaction between the client and their caregivers. Unfortunately, this exchange has proven to be very difficult to measure in an accurate and timely manner. The resulting uncertainty has prevented smooth adaptation of the caring process to client needs; it has also made it virtually impossible for managers to devise workable quality control systems. This paper describes the use of miniaturized barcode technology for collection of real-time data at the point of care. With the addition of laptop computers, this technology provides for immediate feedback of information to address quality issues in care planning and management. The data bases produced by this system are sources of documentation for quality assurance as well as a dynamic foundation for quality control.
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