Lean thinking: using 6S and visual management for efficient adverse event closure

BACKGROUND: We focused on a busy Adult Oncology Department having over 130 staff members, with around 70 of them being physicians with different levels of specialties. A multidisciplinary committee was formed in the department, consisting of physicians, nurses, pharmacists, a medication safety representative and a quality specialist to look after all reported incidents. LOCAL PROBLEM: The department staff at the institution in question in this study expressed their concern about the surging number of reported incidents, delays in closing reports within the set timeframe, ambiguity of individuals’ roles at the committee level and errors in using the safety reporting system (SRS). Accordingly, this study focused on the development of a visual aid through the creation of a functional process map to help clarify team roles and stipulate the steps for adverse event closure. METHODS: The Sort, Set-in order, Shine, Standardise, Sustain and Safety and visual management lean principles, as well as the eight lean wastes—Transportation, Inventory, Motion, Waiting, Overprocessing, Overproduction, Defect and Staff underutilisation—were introduced in early May 2016 and used during SRS committee meetings over 3 years. INTERVENTION: The indicators used were the average number of days for both medication and non-medication incidents from the day of reporting until the closure. The extent that the limit was exceeded was compared. RESULTS: The average number of days until closure showed a reduction from 67 to 37 and 134 to 61 between Periods I (2016) and III (2018) for medication and non-medication incidents, respectively. CONCLUSIONS: The developed process map was a useful communication tool. It helped to sort process activities, team roles and streamline the process. It brought the average number of days until closure within the acceptable 45-day limit for medication incidents. Thus, using visual aids in the working environment is helpful in improving communication among the workers.