Re-engineering for dramatic improvement in the medication-use process.

Planning for re-engineering the medication-use process at a university hospital is described. In summer 1992 the University of Cincinnati Hospital hired a consultant on quality to help with work-process improvement and re-engineering. By early 1993, re-engineering for patient-focused care was under way. Within a year of the implementation of patient-focused care in a pilot unit, it was realized that all departments that provided direct and indirect care would also have to undergo re-engineering. In August 1994 a retreat was held to begin the re-engineering effort in the pharmacy department. The retreat participants set as goals of the re-engineering (1) support of the hospital's strategic initiatives, (2) getting the right drug to the right patient at the right time, (3) improved patient outcomes, and (4) reducing the pharmacy labor and drug budget. Pharmacy activities for re-engineering were identified, and two planning teams were created, a pharmacy production team and a pharmacy knowledge-transfer team. The production team was made responsible for re-engineering dispensing, inspecting, producing, storing, and transporting, and the knowledge-transfer team was assigned teaching, recording, treating, and monitoring. A detailed plan was prepared for each team to follow using a framework provided by the consultant and consisting of strategy, technology, process, and personnel. Careful planning and a consultant helped a university hospital prepare for organizationwide re-engineering.