IHI Announces Winner of David Calkins Memorial Scholarship

Chi Chu, a second year medical student at UMass Medical School, won this year's David Calkins Memorial Scholarship, good for a free seat at the National Forum and up to $1,000 for travel, lodging, and expenses.

Here is his winning esssay:

For years, St. Anne’s free clinic has opened every Tuesday evening to provide free medical care to communities in and around Worcester, Massachusetts. St. Anne’s is the busiest free clinic in the area, often seeing over 80 patients in one night. Frequently, searching for medications is the most time consuming step in patient care. Because medications are almost all donations, they are notoriously difficult to track, and there is little in the way of record keeping for what comes in. Thus, searching for medications that may not be in stock takes up a significant amount of time per patient, forcing them to wait and occupying a volunteer who could be caring for others.

I am working on a process improvement project to eliminate waste in the medication management process using Lean methodologies. The goal is to decrease the total time spent managing drugs by 50% in 3 months. This includes time spent logging the incoming donated medications, searching for medications, and counting medications to dispense to patients.

Currently, I am collaborating with the clinic coordinators and volunteer “regulars.” These are the people who are most familiar with the clinic’s processes, and who show other volunteers what to do when they come for the first time. Therefore, they are in a prime position to help map out current state processes and implement tests of change.

The primary outcome measures include average time spent logging donations, searching for medications, and dispensing medications. We also plan to track volunteer ratings of the ease of finding and dispensing drugs. These balancing measures will check that changes are not making the process too complicated, which is particularly important given the week-to-week turnover of most volunteers.

So far, the medications have been sorted into bins according to the class of each medication. We have also nearly finished entering the in-stock medication quantities into an electronic spreadsheet. Because the medications are shared with other local free clinics, we are collaborating with coordinators of the other clinics to keep the spreadsheet updated. This real-time inventory will help drive decisions going forward.

Our focus is on designing an efficient, robust, and sustainable process for determining if we have a certain medication, finding it, and then dispensing the correct amount. Change ideas we are considering include prepackaging commonly dispensed quantities of certain drugs (which would reduce patient waiting time and avoid recounting) and using visual management principles (to allow easier identification of drugs that need restocking). In short, we have many ideas – we now need to put them to trial. We plan to pilot small tests of change, targeting the most frequently dispensed medications according to our data. In this manner, we hope to get actionable feedback each week regarding what worked and what did not, such that we can determine how to proceed in the next week. Ultimately, we hope to instill a culture of continuous quality improvement that persists through changes in leadership, allowing St. Anne’s to provide ever better care for all future patients.

Editor's note: Click here for more on the David Calkins Memorial Scholarship.