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Go Lean:
'til there was HUE
Allergy Immunotherapy takes a lean approach

Allery ImmunotherapyUsing lean strategies, the team reduced immunotherapy order times and incorporated a color-coded system for vials.“I hate rework,” says Christine L. Holland, M.D., clinical assistant professor of Internal Medicine in the Division of Allergy and Immunology. She was frustrated by the time required to write allergy immuno­therapy—another name for allergy shots.

Holland teamed with Kiela Samuels, PharmD, at the Domino Farms Allergy Clinic, to lead a team to streamline and improve the immunotherapy process. “We are one of the largest allergy divisions in the United States. We wanted to improve and do it better and more consistently,” says Holland.

After discovering that inconsistent processes, forms and dosing were used by different sites and physicians, the team sought ways to stream­line workflow, avoid rework and save time.

Allery ImmunotherapySamuels analyzed the antigens in various strengths and mixtures, resulting in two major changes. They will continue to use custom U-M mixtures of trees, grasses, weeds and molds to avoid maintaining separate supplies. And, they will standardize stock mixtures to eliminate multiple preparation work.

“As our immunotherapy program grows, providing a time-saving and efficient system is critical to our success,” says Samuels.

Over several months, the team standardized immunotherapy concentrations, incorporated a color-coded system for vials, standardized forms and built error-proofing into the forms. Forms now include information about antigen mixtures, suggested dosage ranges and a handy conversion sheet to change the patient’s dosage—safely, efficiently and consistently.

The team reduced the time for immuno­therapy orders from around 28 minutes per order to between two to five minutes per order. “What used to take me four hours a week now takes me 20 minutes,” says Holland.

“It has only been eight months since we started and the hardest work is this first year as we start all our new immunotherapy patients on this system and convert each of our existing patients as they require refills. The nurses have been fantastic as they adjust and now deal with handling both the old and the new processes, but, in a few months, the conversion will be complete and we will have a uniform process that also allows for individual patient’s needs,” says Holland. “The improvements are exciting.”

Holland hopes that every group taking on lean thinking has a secret weapon: leadership support. “Our division director, Dr. James Baker Jr., supported and affirmed this effort.” —CM

FOR MORE INFORMATION ABOUT IMMUNOTHERAPY'S LEAN PROJECT, CONTACT KIELA SAMUELS AT ksamuels@med.umich.edu.

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