Using Lean to Develop Frontline Clinical Staff Pharmacists as Residency Program Primary Preceptors

Abstract

BACKGROUND AND LEAN JOURNEY In 2007, a 4-hospital community health care system located in the East Metro area of St. Paul, Minnesota, started a system-based residency program that began with a single resident and later expanded to 2. In 2013, the program was modified and expanded to 3 site-based postgraduate year 1 (PGY1) residencies. This was done to help grow the residency programs and secure pass-through funding to financially support the resident positions within the organization. One of the sites is a 230-bed acute care facility with an average daily census of 190 patients. Twenty full-time equivalent clinical staff pharmacists are employed to manage over 11,000 admissions annually. In late 2012, the health system began its process improvement journey to implement the Toyota Production System (ie, lean) across the enterprise. This initiative is called value-based improvement (VBI) and involves everyone in the organization, from frontline contributors to senior leadership. A key to the Toyota Production System is the implementation of the frontline management system (FMS), which engages the employees who do the work in the problem-solving and improvement process. Leaders coach and are "barrier busters" for improvement work done by frontline staff as part of FMS. This model puts the ownership of the change in the hands of those who are closest to the work. Worth et al define lean as a set of concepts, principles, and tools used to create and deliver the most value from the customer's perspective while consuming the fewest resources by fully utilizing the skills and knowledge of those who do the work. 1 In a lean system, frontline staff drive the majority of process improvement. A successful lean program improves

A Scoping Review of Pharmacy Preceptor Training Programs

“…Years of publication ranged from 2004 to 2018, with over 75% of the articles being published in the latter half of this period. Eight of the 21 articles described studies relating to pharmacy preceptor training programs in general, 1,3,8,24-28 while 10 focused specifically on hospital pharmacy 10,13,[29][30][31][32][33][34][35][36] and two on community pharmacy. 37,38 Of the 10 hospital-focused articles, eight discussed residency preceptors, with one article covering both student and residency preceptors 35 and one looking at student preceptors only.…”

“…26 All three of the articles from Australia outlined various aspects of the same preceptor training program, including the design, 8 delivery, 24 and evaluation of this program. 24,27 Across the 21 articles in this review, 15 different preceptor training programs are described, 3,4,10,13,[24][25][26]28,[32][33][34][35][36][37][38] with eight of the articles including a formal evaluation of the program. 3,10,25,26,28,32,37,38 The majority of evaluations used preceptor or student surveys, but a few were conducted via post-training preceptor focus groups or interviews.…”