Implementation of a transformational plan of care at a Veterans Affairs medical center.

Purpose: A quality of care-focused process improvement initiative undertaken by the pharmacy service at a Veterans Affairs (VA) medical center is described.

Summary: In September 2016, near the end of VA's 2016 fiscal year (FY), pharmacy leaders at the medical center held a strategic planning retreat to develop goals and objectives for FY 2017. The retreat was facilitated through use of principles of lean methodology, including "A3 problem solving," and resulted in development of a transformational plan of care (TPOC). After identifying process improvement projects with the highest value-adding potential, retreat participants prioritized those projects in accordance with targeted value streams encompassing 5 areas of pharmacy operations: chapter 800 compliance, standard work, physical space, technology, and people. Upon retreat completion, tasks were assigned to pharmacy service managers according to their respective areas of expertise. The status of each project and the projects' impact on both pharmacy and facility outcome measures were continually assessed throughout FY 2017. Continuous reevaluation of projects within each value stream allowed for accurate outcome tracking and creation of a pharmacy dashboard. In the months after implementation of the pharmacy service TPOC, improvements in a number of performance metrics were documented.

Conclusion: Use of lean process improvement methodology and the A3 problem-solving process resulted in more efficient generation and implementation of ideas, consistent follow-up, and the ability to continuously reevaluate pharmacy service operations to ensure progress throughout the year.