Use of Lean Six Sigma methodology to improve access to biologic drugs for the treatment of rheumatoid arthritis

Abstract

 Objective: to propose an optimized flow of access to biologic drugs using the Lean Six Sigma methodology. Method: A cross-sectional study carried out in an Infusion Center in Salvador, Bahia, and the processes for requesting biologic drugs for rheumatoid arthritis were processed during one year (2016). The Lean Six Sigma method was used, following the application of the DMAIC methodology through Project Charter, SIPOC, PMAP, VSM and FMEA tools. Results: 63 processes were included in the analysis. The procedure has three critical steps: the delivery of patient documentation, the technical assessment by the authorizing physician and the drug dispensation. The average times were 30, 11 and 73 days, respectively, making a total average of 83.4 days. Steps 1 and 3 take more time, especially the last one. The main causes for a delay are the insufficient and inadequate orientation of the patient, and the failure to deliver the complete documentation by the patient. About 54% of the data are out of specifications, demonstrating an inefficiency of the process and that it is necessary to manage as special causes in order to reduce the variability and improve the process of access to these drugs. Conclusion: The process of accessing biologic drugs at the Infusion Center is time-consuming and can be improved. Several causes have been identified, such as, the patient’s lack of knowledge of the medicine’s infusion location, which can be corrected. The Lean Six Sigma methodology applicable has good applicability to improve the process of access to biologic drugs.