Reducing Medication Waste for VA Patients


Macro MedicationObama Awards Budget-Minded Federal Employee

I saw this in the news yesterday about a federal employee from the VA, Nancy Fichtner, a clerk at the Grand Junction Veterans Medical Center. President Obama awarded her the “SAVE award,” which stands for “Securing Americans Value and Efficiency Award.”

The prize-winning idea is something I've seen put in place at private hospital, last year, in the name of “Lean.”

From the article:

Her idea? Let patients keep their inhalers, eye drops or other leftover medications when they leave hospitals operated by the Department of Veterans Affairs. As it stands, the VA throws away those medications and then helps pay for new ones after patients go home.

“So the VA is paying it twice — it's a waste, plain and simple,” Obama told reporters. “We are putting a stop to it. The change is already underway.”

A VA spokeswoman estimated the idea, which will be implemented in 2010, will save $3.8 million annually.

It's hard to believe that only adds up to $3.8 million across the entire VA, considering how large they are.

There's mention or evidence of Lean in the story, but I've seen a hospital I worked with come up with a similar improvement through the Lean process. This hospital had a cross-functional team from the inpatient unit and a rep from the pharmacy. When they were working in their silos, before Lean, they took too many of the old practices for granted.

When patients were getting discharged, the nurses would have to do a medication reconciliation and they would have to get new prescriptions written for the patients to take home from the outpatient pharmacy. This process would often cause delays in getting patients discharged, if they were waiting on the pharmacy. This could disrupt patient flow, in situations like this, all the way back through the emergency department.

There would be cases where a pack of Advair would get thrown away after just one dose. Wasted medications. The nurses realized this was waste, but figured nothing could be done about it. The pharmacy had seen their job as filling orders, which included the outpatient orders (the duplicative meds).

When they were observing the process after Lean training, the team had been taught to question everything. The simple practice of having a nurse and pharmacist together helped led to them identifying that obvious waste. They learned that the only constraint in just sending the inpatient meds home with the patient was the difference in labeling. The inpatient med labels didn't have enough information to be used as a legal label for sending the meds home with the patient.

The team brainstormed ,”why not change the label?” “Why not have one label that can work for inpatient AND outpatient purposes?”

It turned out that changing the label format and information was a relatively easy, quick, inexpensive change. So after checking with all stakeholders, they piloted the change — and it worked great. Waste eliminated.

There was no rocket science here – just teaching teams to work together, look for waste, and challenge assumptions and “the way it's always been.”

Back to the federal award. I wonder if it was truly just one employee who was involved here? Was she the only one who contributed to this idea? Possibly, but these are often team efforts. Why recognize just one person? I guess that's the American way, find the sole hero. As an aside (and at the risk of turning this into a political discussion), the LA Times saw fit to give the credit to the President himself (“Obama cost-saving: Let veterans keep their meds!“).

Another question: s an online vote the best way of determining an award like this?

The article stated the possible dysfunction in that system:

Fichtner may have had an edge in the online balloting because her employer, the Department of Veterans Affairs, happens to be the largest among the agencies the other finalists work for — namely, the Social Security Administration, the U.S. Department of Agriculture and the Department of Housing and Urban Development.

What would Dr. Deming have said?

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Mark Graban
Mark Graban is an internationally-recognized consultant, author, and professional speaker, and podcaster with experience in healthcare, manufacturing, and startups. Mark's new book is The Mistakes That Make Us: Cultivating a Culture of Learning and Innovation. He is also the author of Measures of Success: React Less, Lead Better, Improve More, the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, and the anthology Practicing Lean. Mark is also a Senior Advisor to the technology company KaiNexus.


  1. I agree that crowdsourcing, like what was used for this contest, has it’s flaws. However, a lot of people seem to think it’s a great way to harness the ideas of a large number of people. Dell is using this through ideastorm both internally and externally.

    When I was at Dell, I used it. I found that it was good for getting new ideas shared with upper management that might not have otherwise been heard. The bad part was that there were too many ideas for people to easily go through. The ones with the most votes were shown first, so they tended to get even more votes. Also, as you pointed out, the ideas that affect the biggest departments get the most attention.

    However, that’s not all bad, is it? If the biggest department in an organization has a cost savings idea, it’s more likely that the idea will have a bigger impact on the organization as a whole.

    I certainly don’t think that this should be the only way to identify and correct waste, but it’s one way to get attention for some ideas from the front line workers that otherwise wouldn’t be heard.

  2. Hi Kevin – thanks for the comment…

    I see what you’re saying about the IdeaStorm type model. I think the process here was more about voting for one of a few pre-selected ideas that were generated by who-knows-what process.

    Maybe I have it wrong. Does the federal government use a system like IdeaStorm to generate and bubble up ideas?

  3. I guess I made a leap of faith. When I heard about the program, I assumed it was an ideastorm-like process because it accepted ideas from all employees and involved voting. However, I see no evidence of that process on the official site for the program:

    Thanks for clearing that up for me. I would like to see the government set up something like Ideastorm both internally and externally. Now, I just need to figure out how to get that idea heard!

    On a side note, I did find that ran an ideastorm-like contest earlier in the year, but their site is down now. In addition, there is a site called that seems to have some good ideas, but it is not sponsored by the government. Apparently, the site was built for only $75.

    Finally, I found a site with the ridiculous name of that is trying to do the same thing. However, demonstrates the need for a good moderator and a lot of publicity since every suggestion on that site is actually an ad.

  4. Nice commentary Mark.

    I like the crowd sourcing idea for Dell (I too am a former employee) and it worked well for the company. The reality is that crowd sourcing is great when you have people who know something bout what they are voting on. Consumers know what they want form their computers so Dell’s IdeaStorm works well. If the online voting was completely open then I’m not sure if that’s the best to pick. An alternative would be to get healthcare professionals to vote on the winners.

    I’m with you on the “hero” mentality. My hunch is that it stems from the American Psyche. We were a nation of individualists when we were first formed and continue to carry that spirit with us today (ala emphasis on personal responsibility). This is great in simpler cases but in complex operations with several participants it’s the team that does the work not the individual.


  5. Mark,

    This is a great article! I am currently working on my Masters in Industrial Engineering and my thesis has to do with Prescription Waste in the VA. This article is of great interest and I wanted to know if I could somehow use it for my thesis. We are looking at waste in a different area of the VA but these cost savings data is very significant. Do you have any sources I could use to follow up?



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