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UCSD Medical Center has a little angel in process improvement! Find out how Lily Angelocci (Angelocci = “little angel” in Italian) helped save $4 million dollars for UCSD, which will help this nonprofit fund more programs for students and make a difference in healthcare.

The Challenge

In 2016 the New York Times reported a study that concluded $3 billion in cancer drugs are wasted annually in the US because they are distributed in vials that hold too much for most patients. Patients receive the proper dose and the remainder is discarded for safety reasons.

Due to this waste, cancer patients could face increased costs and drug availability issues. At the very least it exposes healthcare providers to heavy financial burdens to provide these treatments. To ease this burden the Centers of Medicare & Medicaid Services (CMS) will, with the proper documentation, reimburse the care provider for some of this waste. The problem? While UC San Diego Medical Center had installed new technology to compile the needed information, it did not have processes in place to capture the needed data when dispensing the drugs.

Lily Angelocci focused her project on an Oncology IV medication process. Lily and the team discovered that not every drug qualified for reimbursement. Based on this, they identified the top 23 most costly oncology drugs. These particular drugs were good to focus on since once prepared they had to be stored in a controlled environment and discarded after 6 hours if not used.

Lily completed a 12-month analysis of recent operations and determined the saving potential to be at least $4M. Because UC San Diego Medical Center is a nonprofit organization this revenue is slated to be invested in new programs to improve patient care and the care environment.

The Discovery

Realizing they could not focus on all 23 medications, Lily dove into the data thinking if they could focus exclusively on the top waste, that would save time and effort. Fortunately, the Pareto Principle applied and she found that 8 of the 23 oncology drugs amounted to 80% of the waste.

Take Away: If everything else fails, we can capture 80% of revenue if we successfully bill for these eight drugs.
Next, it was time to look at the current process. The process was largely manual and staff were busy moving quickly to address patient needs. Lily was quick to note the staff seemed frustrated. They knew expensive drugs were being wasted but couldn’t do anything about it. There was no process in place and it was not the fault of the staff.

In order to better understand what was happening in the process. Lily surveyed the staff. Key discoveries were:

  • Staff was exhausted from running from the dispensing area to the IV Room
  • Not all the equipment was in the right place
  • Scanners did not work and significantly slowed down the process
  • Not everybody was complying with the information recording
  • There was no consistency on what information was captured
  • Some drug information scanned easily and some did not scan at all
  • Once scanned, some information did not import into the system

The Improvements

Using a Cause & Effect Diagram developed from the survey information, Lily conducted a Rapid Improvement (Kaizen) Event with staff. They applied the 5 Whys and also identified many of the 8 Wastes in the process.

The improvements included:

  • Mounting scanners at key location to avoid non-valued added motion
  • Using touch screens for the system to avoid “going to sleep” during non-valued added motion
  • Standardizing processes, clarifying tasks and responsibilities
  • Locating frequently used drugs to minimize travel
  • Adding pharmacy staff on weekends to avoid bottlenecks

The Results

The 46% increase in scanning resulted in $3.73 million in annual revenue recovery. As mentioned, UC San Diego Medical Center is a nonprofit organization and plans to use the additional revenue to improve operations and patient care. For example, from this project three additional staff were added to support patient care. The remaining revenue recovery is slated to be used elsewhere in the medical center to further support the mission.

Data Results: 46% Improvement in Total Clean Room Scanning Rate -

What’s Next

As is common, during the course of the project the team identified opportunities to reduce inventory levels and inventory discrepancy along with several opportunities to further improve the scanning process.

A key learning for the team was the need to stay focused on the process and avoid blaming anyone. As Lily stated, “It’s a structure issue and not a people issue.” It is safe to say that UC San Diego Medical Center has a “Little Angel” supporting their improvement journey.

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Success Story Transcript

Tracy O’Rourke: Hello and welcome to our Success Stories Webinar hosted by My name is Tracy O’Rourke and I’m a Managing Partner and Executive Advisor here at

We are very excited to have this offering for our learners because this is where the rubber meets the road. This is when we really talk about a project that has been implemented within an organization and we want to share these stories with you, our listeners.

We are going to be talking about a project that saved $4 million at UCSD Health. And our presenter today is Lily Angelocci. And for those of you that didn’t know, her last name means little angel. Isn’t that adorable in Italian?

How are you doing today, Lily?

Lily Angelocci: Great. How are you, Tracy?

About Our Presenter

Tracy O’Rourke: I’m great. Thanks for joining us today. We’re really excited to hear. So, let me tell you a little bit about Lily before we get started. She is a Process Improvement Specialist at UCSD in the Department of Pharmacy and she has had 12 years as a healthcare professional with experience in finance, strategic planning, clinical information analysis, and executive reporting. Her current work focus is process improvement. Woohoo! We can always use more process improvement specialist in the world.

She completed her Lean Six Sigma Black Belt training at the UCSD Extension with instructor, Rick Van Der Linden. That was last year, is that correct?

Lily Angelocci: This year, February.

Tracy O’Rourke: This year of February. And this was your Black Belt project, correct?

Lily Angelocci: Yes.

Tracy O’Rourke: Wonderful. So she also supports clinical areas on data management activities and projects with significant clinical complexity. She analyzes and interprets complex data and summarizes statistical findings. That sounds like a Black Belt job for sure. She develops corresponding reports, dashboards, presentations, and action plans and prepares and delivers executive summaries. And her role also includes analyzing statistical trends, problems, and potential issues in patient care and sources, which I’m sure patients really appreciate.

Lily Angelocci: Thank you.

Tracy O’Rourke: It must be really rewarding to work in this kind of environment.

Lily Angelocci: It is very rewarding.

Tracy O’Rourke: So, you work with the UCSD Health Care Group and there are a number of main facilities. So can you tell us a little bit about what these facilities are? Would that be OK?

UCSD Health Main Facilities

Lily Angelocci: Sure. I’m happy to. These are just a very few pictures I selected that represents our inpatients facilities are on top, Hillcrest Medical Center, and our brand new Jacobs Medical Center to the right in La Jolla, and at the bottom, there are few other facilities, Moores Cancer Center where my Black Belt training program happens. And the CTRI which is a trial, patient trial facilities, we help to cure a lot of – we carry out a lot of futuristic treatment for patient with severe illness.

About UCSD Medical Center

Tracy O’Rourke: OK. Wonderful. So just a little bit more about the actual hospital because this is the hospital and all of UCSD Health is physicians as well, is that right?

Lily Angelocci: Absolutely. You’re right, Tracy, the inpatient facilities, the acute care facilities, and outpatient as well as our physician’s office locations.

Tracy O’Rourke: Wonderful. So a little bit more. UCSD’s Health is one of five medical centers within the 10 campus university of California system collectively known as UC Health, they comprise the fourth largest health care delivery system in California and they train nearly 50% of the state’s medical students and medical residents. Wow! That’s impressive.

There are three hospitals that operate under one license with the current combined capacity of 808 beds. And there is a – to fulfill the mission of UC San Diego Health, they currently maintain a 2-campus strategy, integrating research, teaching, and clinical care at the Hillcrest and La Jolla locations.

Each medical complex supports acute inpatient care and a spectrum of outpatient primary and specialty medical and surgical services including ambulatory and emergency patient care. Amazing. Really nice facility. We are very excited to hear about your Black Belt project. And again, this is – you were trained and mentored by Ric Van Der Linden and Steve – I’m sorry, how do you say his last name?

Lily Angelocci: Spravzoff.

Tracy O’Rourke: Spravzoff. Thank you. And we’d love to hear about your project.

UCSD Lean Six Sigma Black Belt

Managing Medication Wastage in IV Room UCSD Medical Center

Lily Angelocci: Thank you, Tracy. It’s such an honor to be here today. And I have learned so much experience from this program and it’s my pleasure to share my project and my experience with you today.

Tracy O’Rourke: Wonderful.

Overall Project Benefits

Lily Angelocci: OK. Let’s jump in. So the overall project benefits, I would like to say this, it has been a huge accomplishment in terms of pharmacy department with the medical center. It has been highly acknowledged or recommended by our executive team at UC Health level.

Tracy O’Rourke: Well, for $3.73 million annual revenue recovery, that is amazing.

Lily Angelocci: That is amazing. And taking out all the cost expenses, we need to put in in order to get this accomplished that we have left still $1.6 million net income. And at the same time, we had the opportunity to hire three full-time employees and we have improved our clean room scanning rate from 34% to 63%. As of today’s data, I just had looked at it this morning. It was 80% in June 2017.

Tracy O’Rourke: Wow! And I’m sure you’re going to tell us what scanning rate is in the project.

Lily Angelocci: Yes, yes, yes. We will go through that. So eliminated two steps, manual verification which could easily cause medication error, identify top root causes to improve scanning rate. Again, scanning is a key step for my project.

We gained insights from IV Room stuff that can be done to make this process more optimized.


Tracy O’Rourke: OK. So now, we’re going to move into the Define Phase.


Lily Angelocci: A little bit of background. By this article from the New York Times in 2016, overall in the United States, there’s a waste of $3 billion each year for the cancer drug costs.

Tracy O’Rourke: Wow!

Lily Angelocci: And starting January 1, 2017, CMS released a new policy. I will explain it in the next slide that kind of helped us to recover this waste. And at the time the program – my programs started, UCSD has not had a process in place to embrace this opportunity.

Tracy O’Rourke: OK.

Problem Statement

Lily Angelocci: So my problem statement, this is a really complicated project so I have to break them down into two portions for my problem statement. Part A is more of a bigger size at UCSD Health level project. Fortunately, our pharmacy IT team already had taken this project on a couple of months prior to my Black Belt program started. So basically, they are building the infrastructure in our EMR, Electronic Medical Record system, in order to be able to enable us to accurately track and bill the waste.

My focus which is part B is an IV room medication scanning process. This is a crucial stop. If we don’t scan, the information cannot be imported to our EMR in order for the next step to be able to track and bill and get our waste reimbursed by Medicare.

And to define the scope of this process, we discovered that not every medication that we use on the patient is qualified to get reimbursed. So we identified top 23 most costly oncology drugs. We’re going to put into this process in order to get reimbursement.


Tracy O’Rourke: So we are going to move into the Measure Phase.

A Few Jargons Used Frequently Here

Lily Angelocci: Yes. Measure phase, in order to – I know not everybody is a pharmacy specialist, myself included, so I just want to get a few jargons out of the way through this discussion. These are a few pictures. This is where my process happened. Our clean room in our Moores Cancer Center and in the middle is the “hood” that all the process happens in there to keep the single dose vial medication safe and viable for patients.

Tracy O’Rourke: Both safe in the “hood.”

Lily Angelocci: Yes, but only safe for 6 hours. If we don’t use, that’s when the waste occurs. We have to throw that away.

Tracy O’Rourke: Oh, interesting.

Lily Angelocci: Yes. And to the left is where my process focus. So in the left-hand side, it’s a pharmacist holding this expensive vial, single vial medication and in his right hand is a scanner. So once he scanned that drug’s label, the drug dose, the expiration date, and lot number goes into the laptop where our EMR exists. So this is a big backdrop of my process environment.

Tracy O’Rourke: OK. Thank you. That’s helpful.

Overall Process Change and Financial Outcome

Lily Angelocci: Thank you. Overall process changed. So I dive into where we are, our current process. So these are some of the findings. I’ve done a 12-month of Moores Cancer Center’s data analysis in order to figure out how much exactly the waste we are facing with. It has been happening. And what are the potential reimbursements we can get?

And process change required to do this. We need to change our processing model in our EMR system and the crucial to that is the scanning process. It has to be a hundred percent in place. Remember, if we don’t scan, we don’t get to bill them.

Tracy O’Rourke: And I think what’s important about all this money is you guys are nonprofit, correct?

Lily Angelocci: Correct.

Tracy O’Rourke: So that means, are you state-owned or how does that work?

Lily Angelocci: We are a state-owned public health system.

Tracy O’Rourke: Yes.

Lily Angelocci: And everything we saved in revenue occurred, we’re going to reinvest into the patients, our new programs, to help improve our patient care.

Tracy O’Rourke: So to me, the fact that you’re saving upwards of $4 million, it’s not profit if you will. It’s reinvested into things that are going to make patient care better, maybe more research, those kinds of things.

So to me, the fact that you’re saving upwards of $4 million, it’s not profit if you will. It’s reinvested into things that are going to make patient care better, maybe more research, those kinds of things.

Lily Angelocci: Absolutely.

Tracy O’Rourke: That’s exciting.

Single Dose Vial Medication Financial Analysis

Lily Angelocci: OK. So this is a complicated spreadsheet that took me a lot of time to figure these numbers out. But I’ll go through it just a couple of highlights. This is 12-month worth of historical data just from Moores Cancer Center and it represents 80% of our cost of the goods.

So on the left-hand side, you’re going to see how much it cost per vial for these expensive oncology drugs. That’s a dollar amount. And in the middle, it’s our current model and these are $2.7 million waste.

Tracy O’Rourke: Waste as in eliminate.

Lily Angelocci: Yes.

Tracy O’Rourke: OK.

Lily Angelocci: And then to the right side is our future model that we are going to use in order to bill and get reimbursed by Medicare. So, there are a few numbers at the bottom, additional charges, eliminate drug waste $2.7 million, increased person cost that is already involved in the processing. Later, I will go through some of the details later. But these are just highlights on the numbers. OK?

Return on Investment for JW Modifier Billing

A brief summary on return on investment. On top is what kind of cash we’re going to receive, so that is where the $3.7 million or approximately $4 million per year recovery from the waste that we mentioned in my problem statement or accomplishments. And in order to do that, we have to hire extra employees to make it happen. And also, it incurs the drug purchasing cost. So bottom line is we have – we will gain $1.7 million in terms of net income.

Tracy O’Rourke: Right. Well, I think what’s interesting about a Lean Six Sigma process and project is a lot of people sometimes think it’s all about cutting heads and laying people off. And in this case, you’re hiring people.

Lily Angelocci: Correct. Yes.

Tracy O’Rourke: Well, that’s nice.

Lily Angelocci: Yes, very highly high paid and highly educated employees to come to join our team.

Tracy O’Rourke: Wonderful.

Findings on Cost of the Wasted Medications at MCC

Lily Angelocci: So in order to get the noise out of my data, I take a brief look at it, spread it out to 12 months. And other purpose is just to figure out if there’s any potential seasonality throughout the year caused by a certain specific events.

So overall, I find is or I was able to find that a) for 2016, there was a peak at this month, the waste was costing more than double than some of the other months. So I dive into the data. There are two additional leukemia patients that were being treated in that month and 25% of that drug has to be wasted unfortunately. So that led to the $325,000 waste compared to average $200,000, around $200,000 per month.

So the blue bars are basically dollars counts and the yellow line, you should read from the right-hand of the axis is basically how it was a percentage of the total drug were wasted on a monthly basis. It’s significant. It averaged 12-13% of the drugs we’ve been wasting.

Control Chart

Control chart is wonderful. It easily identified what is out of control, a few spots here. So this helped me visually to track down what’s going on on a monthly basis.

Medication Waste Cost Pareto

This is a Pareto Chart. I find it’s very interesting too. Given that all the tight resources we have, the budget, we don’t have the staff or resources and time to do everything. So what if I can only focus on the top cost and top waste? And maybe that will help me to save time. So this chart shows me $2.1 million waste occurred by those top 8 drugs. So if I cannot have time to do anything, if I can only bill these 8 drugs that will help me achieve 80% of my goal.

Tracy O’Rourke: Wonderful. A great use of Pareto.


Lily Angelocci: Yes. Thank you. SIPOC, this is our current process basically to just give you a visual of what’s happening, who is owner or suppliers and who are the customers.


Tracy O’Rourke: And finally, moving into Analyze.

Lily Angelocci: So with all of the waste dollars, now it’s time for us to look at what our current process is. So this is our current process. It doesn’t look too advance, right? To your right-hand, it’s all handwritten. And our technicians and pharmacist are so busy. By the end of the day, they’re tired. They’re ready to go home. And so, they write down a few drugs and they estimate how much is wasted they put on the board. And it’s not done by everybody. It’s not done by – it’s not guaranteed to be done by the end of the day. And sometimes, they’re coming back in the morning and they fill it up. So there are a lot of errors, a lot of estimations. So basically, we do not know how much we’ve been wasting.

Tracy O’Rourke: Right. And ultimately, it’s the manual process, right? It’s the manual process and not captured and automated, and that can create issues.

Lily Angelocci: Correct.

Tracy O’Rourke: Yeah. OK.

Lily Angelocci: And they know we’ve been wasting, the expensive drugs, but they say, “Well, we really can’t help it. We don’t have a process in place.”

“Well, we really can’t help it. We don’t have a process in place.”

Tracy O’Rourke: Right, right. And just to point out too, you’re not saying it’s the people. It’s not the fault of the people.

Lily Angelocci: No, absolutely. It’s a structure. It’s the technology that has not been available for us.

Tracy O’Rourke: OK.

Process Map – Past, Current and Future

Lily Angelocci: Process mapping, my favorite part. So basically, this is our past, current, and future process. To your left-hand side with a two yellow boxes, that’s where the manual process happened by technicians and they have to – the outcome has to be reviewed by pharmacists but sometimes when pharmacists start to review, it can be too late. So you see the big no. If there’s medication error, it goes back to beginning. So there’s occurred drug waste and also occurred patient delay.

So in the middle, it’s our process. Once you scan, remember the picture, once you scan it now, it’s not manual. It’s in our EMR. Our EMR system will help to verify if the dose and the expiration date and lot number is correct for that specific patient. So it eliminated that potential human error to the left-hand side.

Tracy O’Rourke: OK.

Lily Angelocci: And the filter, the bill, and recover, recover the revenue is on the right-hand side. This is basic – very, very basic fundamental bill at the bottom of the box. What is – how much is wasted? How much can we bill? It’s to your right lower corner.

Tracy O’Rourke: Yeah. OK. And that wasn’t currently in place.

Lily Angelocci: It is. It is starting January 1, 2017.

Tracy O’Rourke: Got it.

Charging for Waste During Dispense Preparation

Lily Angelocci: We started building. This is more of a detail illustrated. You can’t key in on the number that how much a 150 gram, 150 mL wasted. And then click on “Accept.” So this only applies for those top 23 most costly drugs we are building right now. So just a visual.

IV Room Dispense Preparation Scanning Implementation Overview

Now, let’s look at – we figured out how we’d do this, how we’d get there to get our money to cover the cost of the waste. Now, where are we in terms of our EMR scanning system?

So this is the implementation timeline, very briefly. 2015, we had one site. 2016, we had three more sites joined. And by 2016, September, actually when my project started, all five locations are in place. The scanning process has been implemented.

But look at the top chart. These are scanning rates. So at the very beginning, we went through really valley and hills and went through ups and downs because of different technical issues, different move, new hospital opening, there are pollution in different environment so we have to clean it up, shut the facility down, et cetera. And also, there’s technology hiccups. There’s technical equipment not being provided timely, and technician training, et cetera.

So we have experienced struggling. However, in order to make this revenue to be recovered, to be reimbursed, we have to have the scanning in place. By December, we improve a lot of it but it’s still was at 63%. Remember, we would have to have 100% scanned in order to get to the full recovery.

Tracy O’Rourke: Got it.

Lily Angelocci: So drill down to each side. Each side has its own performance. We have really tough performers, average 95% and above. And we have some issues like the purple line. We have issues again, new hospital opening, equipment problems, training issues. But what a difference it is between the five locations.

Tracy O’Rourke: Yes, a lot of variability.

Root Cause Analysis

Lily Angelocci: Yes. So in order to drill down to find a real actionable information, I send out a SurveyMonkey, which turned out to be a really good tool I would definitely recommend to use if you have – your company has this tool.

And I’ve got great, really a timely feedback in order to pull me to figure out this puzzle of what had happened. So you can tell on the right hand side, the lower chart is I have so many very dissatisfied technicians and pharmacists who took this survey and somewhat dissatisfied. So what happened there? I want to hear their voices.

SurveyMonkey also has a very good function that gave you the detailed voice of customer. So let’s go through a few highlights. There’s a few out of hundreds feedback I’ve got.

A Few Key Points From Survey (VOC)

So some of our staff says, “Desperately need to improve the process.” We’re exhausted. It’s exhausting to run back and forth from standard dispensing area to IV Room. Obviously, not all equipment are in the right place. Scanner does not work and slowed down the process. Not everybody is complying. Somebody is scanning. Somebody is not. There’s no consistency. Why do some drug lot and expiration date can be scanned? Why some are not ,when scanned, it’s not imported into the EMR? And all of this, this great feedback, so with this knowledge, I’ve created this root cause fishbone.

So we looked at a few areas or working environment, people, process, machines, measures, and system. Again, as a Lean process – Six Sigma process, I would like to focus on the process, machines, system, and take the blame out of people, the reasons why they’re not doing it.

Tracy O’Rourke: Yes, exactly. That is the premise of process improvement. It’s not the focus with people. It’s focus on the process.

That is the premise of process improvement. It’s not the focus with people. It’s focus on the process.

Lily Angelocci: Right.


Tracy O’Rourke: And with that, let’s move to Improve.

Prep/Check Process Current and Future State

Lily Angelocci: Yes. So again, let’s focus on the key steps. So these are the – my current situation, we’re only scanning 63%. And again, we want to move it to 100% in order to bill and get our wasted revenue back.

So I had a kaizen event on February 5th in our conference room with most of our technicians on that shift. And the two major tools I used from Lean and Six Sigma, toolbox which I highly recommend are the 5 Whys and 8 Wastes. It really generated a really robust and active discussion among these frontline workers. They know what they experience every day and they are very open and openly discussed. So another suggestion, there was no supervisor on site. So they could speak freely. I want to hear all the voices.

Tracy O’Rourke: Right, and important thing to think about when you’re actually asking people for feedback.

Lily Angelocci: Yes.

Tracy O’Rourke: OK. What else?

Output of Kaizen Event

Lily Angelocci: So, the outcome of the kaizen event, I’ve listed very few here. But a few quick wins. So the manager actually later on was brought in onboard do hire extra FTEs in order to encourage and implement of the scanning process as it does slow down the process. So the manager was onboard.

The frontline staff, they have beautiful feedbacks like instead of having the scanner in hand and we’re exhausted and tired and could have caused health issues, why can’t we mount the scanner and then scan the drug, et cetera. So a lot of good, very practical quick wins came out of this kaizen event.

Tracy O’Rourke: Reduced motion.

Lily Angelocci: Right.

Tracy O’Rourke: Good. Wonderful.

Actions Taken to Improve Process to Improve Processes

Lily Angelocci: So, to summarize the actions I’ve taken to for the improved this process are listed here. I’m sure you’re familiar with this once you get into the training for the Lean process improvement. So I just listed a few here.

Tracy O’Rourke: Wonderful.

Results Achieved – Qualitative

Lily Angelocci: Results achieved, qualitative. So of course, in order to get your executive leaders’ ears to hear your voice why we’re doing certain things, why we need to invest in certain areas, dollar amount always is very loud and clear. So I spent a lot of time in the beginning of the project to do the financial spreadsheet and we presented it a few minutes ago.

So – and also introduced the Lean process and Six Sigma ideas to immediate team members and generate idea for future quick and feasible projects.

Actually, a couple of projects came out of this process for future such as infantry reductory to eliminate infantry discrepancies. It all came out of this process because we started to realize there are other problems existed. However, I wanted to just bring out one, maybe one of the lessons I learned too is the scope. We have to keep it small. Keep it doable for the 6-month of the project.

Tracy O’Rourke: Yes.

Lily Angelocci: Because you find it’s not going to be surprising. You’re going to find more and more problem you want to fix, get a lot of in the way.

Tracy O’Rourke: That is typically what happens for Black Belts is they’re trying to solve one problem and all these other problems come up that could be solved and you just got to stay the path.

That is typically what happens for Black Belts is they’re trying to solve one problem and all these other problems come up that could be solved and you just got to stay the path.

Lily Angelocci: Right, right. It’s very hard. Sometimes it’s so tempting to get other problems fixed. But lesson learned, in order to have our scope to have our timeframe to reach out goal in a timely manner that we have to keep that in mind.

Tracy O’Rourke: Yeah.

Lily Angelocci: Also, build the morale of the team and bring our leadership online, onboard to reinforce this process to put in a very controlled environment to everybody on top of this project was another side benefit out of the kaizen event.

Tracy O’Rourke: That’s always nice. So people are a little happier you think?

Lily Angelocci: Very happy. They feel like the exact – the leadership are listening to their problems and trying to improve their working environment. You have to work anyway, why not work in a safe and happy environment?

Data Results: 46% Improvement in Total Clean Room Scanning Rate -

Action and Result Summary

This is just quick view of action and result summary. And after picture – actually, I have way better picture now as I mentioned in June 2016, our scanning rate is up to 80%.

Tracy O’Rourke: Wow!

Lily Angelocci: Yes.


Tracy O’Rourke: 80%. And now, we have to make sure it stays fixed, the Control Phase.

Lily Angelocci: Yes, yes. I can’t emphasize enough to – after all this hard work of people and the team we put in, we need to sustain that. So many times, we sent in our Black Belts, Green Belts to solve problems and consultants. But when they finished the project and pull out, leave the ownership to the current team, somehow with time, it falls apart or it goes to where it was.

Control Plan

So controlled plan for this process is we have bi-weekly meetings with our PMO Office which holds a very high level of management capacity and oversees the whole health systems, big significant projects. So we keep them in the loop and keep them informed what’s happening and what’s good and what’s working, what’s not.

And we also have monthly financial report from Revenue Cycle Department to track how much revenue we actually are capturing.

The monthly Pharmacy QAPI Club, the snapshot of this dashboards which I managed for my department, I recommended to include this one line item which is number 11 so the executives of our department can have a monthly view of where our scanning rate is. Right now, it’s still in red but because we’re really aiming high, setting the target at 75%, actually, this is older data. If I put in June data 2017, we should be right now.

So these are the few key points to keep the process improvement outcome under the radar of the executive team so we make sure the whole team is communicated clearly and to make sure we monitor the outcome.

Lessons Learned

Tracy O’Rourke: Lessons learned, sometimes my favorite slide.

Lily Angelocci: Yes, lessons learned. How much I wanted – I knew this before I started the learning process but we’re only learning by doing it. So stating the specific problem without giving solution, this has been a tough task because everybody who was doing the Black Belt project probably is very smart. You want to get to the solution. Get your problem fixed as soon as possible.

So we jumped with sole intent. It’s very tempting to jump into solution. I have an answer for this.

It’s very tempting to jump into solution.

Tracy O’Rourke: Yup. We’re trained. We’re trained to have solutions always.

Lily Angelocci: Yes, so don’t do that. Don’t jump into – go through the DMAIC model with patients. You might find other solutions than the initial ones you had on your mind. Highly recommend that.

Scope of the project, we mentioned it could change. You have to be flexible. Something – you run into the wall, you have to scale back. Other teams are not available. They have other priorities. They can’t help you. You have to respect that and scale back. But don’t be discouraged. Just be flexible. Stay focused.

So expected resistance from process owners and working through. Again, I want to emphasize this. There should never have been finger point blaming games. We should always focus on this is targeting – we’re targeting the process. They should always focus on these were targeting the process. Nobody should be blamed. Its structure is not people issue.

There should never have been finger point blaming games. We should always focus on this is targeting – we’re targeting the process.

Tracy O’Rourke: And did you find that you had to remind people of that a lot throughout the project?

Lily Angelocci: Yes, absolutely. These are all – the stakeholders are senior professionals at UCSD, have a very great reputation, professional-wise and when you first see, “Wow! We have this opportunity. We exist. Does that mean we didn’t do a good job?” No. It’s nothing like it. It’s a structure not available. It’s technology not up-to-date. Nothing personal.

Tracy O’Rourke: Good. That’s wonderful to hear because I do find that sometimes people forget that. If you want people to come with you, they have to feel safe. That you’re focusing on processes and not a witch hunt, if you will.

Lily Angelocci: Absolutely, Tracy. That’s so true. And build effective SurveyMonkey. Like I said, I really like this tool. And sometimes with 300 people department, it’s just hard to get people together in a face-to-face meeting or a conference call because everybody has – they are busy on their shifts. They can’t leave the patient just to come to a meeting to provide you feedback.

So SurveyMonkey is a great tool to use. They can use any time they want. Just log in. Provide their feedback.

During this process for SurveyMonkey, 1 person, 1 vote. I didn’t care what role you play, you’re executive leader or you’re a frontline technicians. Everybody’s votes count.

And during the kaizen event, I find helpful to – I always remind myself, 10 feet but don’t overpower the team with my own ideas because I’m not the expert. I’m not a pharmacist. I’m not a technician. So I have to basically drive the conversation. But not provide solutions again.

And teach and share the Lean Six Sigma methodology whenever you can. Three out of my four staff right now have either Green Belt or Yellow Belt Training now. So the whole department, we have so many opportunities. We need to carry the word and spread the knowledge and utilize, apply the toolbox this wonderful program provides us any time we can use them.

And lastly but not least is have fun. Just do it. Don’t hesitate if you’re not an expert in the field. We’re not supposed to be the expert in the field. We’re supposed to work with the expert to get the ultimate results.

Q & A

Tracy O’Rourke: Yes, wonderful. Well, I love your philosophy and the lessons that you stated and learned from, Lily, are amazing because it really shows that you care about the people that you’ve been working with. You maintain respect for the workers. And I don’t know. I just really appreciated the lessons that you shared because it really wasn’t even about the technical pieces or the technical application. It was around change management and some of the things that people need to think through and work through because if you don’t have the right approach in how you approach people and treat people, you’re not going to be successful. So, kudos to you, Lily.

Lily Angelocci: Thank you, Tracy.

Tracy O’Rourke: So I guess my question is have you talk to the people lately and how do they feel about the process now?

Lily Angelocci: They are happy. They are constantly being recognized by our leaders in the department. Their scanning read is high. And so in their staff meetings, they are applauding and they are celebrating with kegs because this is a key performance indicator for their working area. They have accomplished a lot. So, the team is very happy because of the improvement.

Tracy O’Rourke: So, probably the toughest question I’m going to ask you now is what are you going to work on next?

Lily Angelocci: This is not tough. Thank you, Tracy, for being considerate. As I mentioned, actually during this process, we have identified our inventory. So my project for the next Black Belt project is to decrease or eliminate some of the unnecessary medication inventory at both of our locations, Hillcrest and La Jolla, which approximately sum at about $10 million on a daily basis.

Tracy O’Rourke: Wow! Well, I can’t wait to hear about that one. And we would love to have you on again as a guest speaker for your presentation, any project that you do. And I think your last name is very appropriate, Angelocci, because I think UCSD has a little angel.

Lily Angelocci: Thank you. Thank you. I’m happy to share.

Tracy O’Rourke: Thank you. So, thank you again for listening. I’m Tracy O’Rourke with Lily, thank you for sharing your project success story with me and our audience at Our goal here is to really share those stories and get examples of great applications of Lean Six Sigma out there for the world to see. So thank you so much.

Lily Angelocci: It’s my pleasure. Thank you for having me.

Tracy O’Rourke: So if you have success story out there and you want to share your project success story with the world, let us know. Contact us at [email protected] And also, we’ve got lots of free blogs and success stories on our website as well as a podcast and free tools and templates to use as well. So don’t forget to learn with all that free stuff and build that community of Lean Six Sigma.

Goodbye for now. Until next time.

Lily Angelocci: Bye.

Get the inside scoop on many other successful Lean Six Sigma projects at our Super Stories of Success page. Do you have a story to tell? We’d love to hear about your own project success! Please contact us.

Tracy O'Rourke

Tracy is a Master Black Belt at, the co-author of The Problem-Solver’s Toolkit and co-host of the Just-in-Time Cafe. She is also a Lean Six Sigma Green Belt Instructor at UC San Diego and teaches in San Diego State University’s Lean Enterprise Program. For almost 20 years, she has helped leading organizations like Washington State, Charles Schwab and GE build problem-solving muscles.
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