Mejora de la calidad y seguridad del proceso farmacoterapéutico del paciente onco-hematológico atendido en el hospital de día, aplicando la metodología lean seis sigma

The main objective of this Doctoral Thesis was to improve the quality and safety of the pharmacotherapeutic process of the onco-hematological patient treated in the day hospital by applying the Lean Six Sigma methodology, to reduce the delay times of the pharmacotherapeutic process, reduce errors in medication, increase patient satisfaction and reduce the costs of the service provided. A 4-year longitudinal, prospective, analytical study was carried out, based on direct observation methods and experimental studies. The integral antineoplastic pharmacotherapeutic process was included with intravenous chemotherapy of the onco-hematological patient treated at the day hospital. The Lean Six Sigma methodology was applied following the 5 DMAIC stages (define, measure, analyze, improve and control) that were developed sequentially, with the support of the Minitab v.17 software package. The Lean Six Sigma methodology applied to the pharmacotherapeutic process in the onco-hematological patient attended in the day hospital of the Dr. Peset University Hospital has allowed to select and prioritize 33 improvement actions, oriented 24% to the human factor, 56% to the factor of process design and 10% to the logistics factor. The application of the Lean Six Sigma methodology has optimized the micromanagement of the process, to create value in the client and reduce the activities that generate waste or some avoidable risk, variability, reducing changes and bottlenecks, resulting in a reduction of 48 % of interruptions, 37% in the number of daily preparations and 16% in non-compliance with standardized work procedures. It has been an efficient tool in terms of quality, in terms of the reduction of delay times by 51% (47 minutes) from the confirmation to the dispensing of the integral antineoplastic treatment, reaching the pre-established goal of a delay of less than 150 minutes in 70% of patients. It has also been an effective tool in terms of safety, making it a 4.6 process, compared to the initial 4.2, reducing defects by 21%, referenced to the number of preparations and 17% referenced to the number of patients- day. The results of the implementation of the Lean Six Sigma methodology have been perceived by the patient, decreasing the dissatisfaction of patients by 52% in relation to waiting times for medical consultation and by 28% in terms of time wait until the treatment. The global economic impact of the implementation of the Lean Six Sigma methodology ranged between € 403,855-500,117, 87.5% of which was related to the reduction of time of activities of staff and 6.6% by reduction of medication errors and breaches of standard work procedures. In this sense, the healthcare process has been optimized with the implementation of improvement actions in the service provided, related not only to the patient, but to all the clients and processes involved, reducing costs, making the National Health System more sustainable.