Transcript Slide 1
Sutter Solano Laboratory
Lean Six Sigma Project
“Getting Our Ducks In A Row”
Joe Wells, MT, MA, Laboratory Supervisor
Progress as of July 22, 2008
Business Process Management
Key Process Mapping
Clinical
Laboratory
Processes
PreAnalytical
Process
Collection
Labeling
Delivery
Receiving
Specimen
Processing
Analytical
Process
Post
Analytical
Process
Define: ProcessExpressSM Project Charter
Business Case:
Expected laboratory turnaround times are not being met for ER
samples and early morning draws. This impacts laboratory customer
satisfaction, patient care and finances.
Problem Statement
Sutter Solano laboratory is not consistently meeting stated
turnaround times for ER samples and early morning draws.
Variability in testing turnaround times is resulting in customer
dissatisfaction.
Results for early morning draws should be on the charts by 7:30am
for ICU and 8 am for Med/Surg.
Target= 95%
2007 Average= 85%
Organizational Pillars
Service
TAT AM & ER
Physician & Patient Satisfaction
Quality
Reporting Timeliness
Order entry errors
Drawing Issues
Finance
Workload Balance
Variance
Overtime
People
Employee Satisfaction (EOW)
Growth
Community
Define: Process Map Routine AM
Routine
AM Run
Tests ordered
Morning Run
prints at 4:30
am
STAT?
Sort by floor
in blue bin
Sort by
patient
Get Cart
Yes
Is Cart
Ready?
No
Stock Cart
Go to Floor
Is there a
Button on
Patient
Name?
No
Draw
Transport to
Laboratory
Sort Samples
Yes
Nurse Collect
Fishbone & Brainstorming Notes
Root Causes
Supported by data
Phlebs start time does not allow for
completion by goal time
Many ER calls for draw throughout
the day
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Process imperatives
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Communication of PIC line patients
is key to decreasing time in early
morning draws
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Batching in early morning rounds
needs to be reduced
Initial “Just do its”
List of patients with lines on floor
Pick up of specimens by morning CLSs
ER sample rack
Share patient satisfaction survey comments at staff meetings
Eliminate 2 sets of labels printing
Labels for UA sent to departments: 2-3 labels
STAT notification: Dynamic pending log
Quick reference on floors for order codes
Update physician phone directory
Back time (duplicate) IT fix
Provide charge nurse cell phone number for critical values
Measure: Phone Calls
60
50
40
30
20
10
0
Transfer
Information
Results
Draws
Other
Micro
Grumbles
Majority of phone calls deal with:
Transfer, Information or Results
Improve: Brainstorming Results
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Weekends should be staffed as
weekdays (7)
Autoverification (6)
If ER prints order just go (6)
Nurse education (6)
CLS help if phlebs are short (5)
Schedule break times (5)
Use volunteers to run ER
samples to lab (5)
Monitor for pending draws (4)
Critical value call process (4)
Lab personnel in ER during peak
times (4)
Change phleb times (and
possibly techs) to start earlier (4)
Revise parameters for 8am TAT
report
Buttons for line draws on floors
Add ons added as a test
Stat spin centrifuge for coag
Have dedicated person to receive
labs in computer
Second microscope set for AM diffs
Have techs drawing pre-AM ask if
can combine draws
Scanners for quick entry
Redesign of Heme and Chem (in
process)
Slidemaker/Stainer
Add call in phlebs
Improve: Solutions Implemented
Dynamic Pending
Monitor
Standardized
Phlebotomy Carts
Improve: Additional “Aha” Moments and
“Just Do It’s”
Fix lab intercom
I-Stats in ER (Go-Live July 30, 2008)
Phlebotomy carts standardized and ready for use
in AM
2-way cell phone for ER communication (Coming
soon!)
Regular pick up times on floors for early morning
draws and nurse draws
Getting current SRMF list of doctors
How We Track Our Success- Daily Report
Daily metrics tracking keeps everyone focused
Share Results & Celebrate!
Week Of July 20, 2008
% of Tests
Completed
on Time
95% Target
M
on
Tu
es
W
ed
Th
ur
Fr
i
Sa
Su t
W n
ee
k
100
71
80
60
40
20
0
98 99 98 93 92 100 92
TAT target goal of 95% achieved, significant
improvement from 2007 average of 85%
8am Turnaround Time Data Since Beginning of LSS
Project (1/6/08)
100
98
96
90
85
80
94
94
91
91
91
91
89
83
88
84 85
84
79
93
98
96 96
98
95
94
9695
92
90
88
87
83
79
75
70
65
64
60
1/
6/
20
08
1/
20
/2
00
8
2/
3/
20
08
2/
17
/2
00
8
3/
2/
20
08
3/
16
/2
00
8
3/
30
/2
00
8
4/
13
/2
00
8
4/
27
/2
00
8
5/
11
/2
00
8
5/
25
/2
00
8
6/
8/
20
08
6/
22
/2
00
8
7/
6/
20
08
7/
20
/2
00
8
8/
3/
20
08
8/
17
/2
00
8
% Target Met
95
98 97
96
Week
Between 1/6/2008 and 4/13/2008, the standard deviation was 5.4 and
between 5/25/2008 and 8/17/2008 the standard deviation was 2.4. This
represents a 54% reduction in the process variation.
Patient Satisfaction Scores
Ju
ly
Au
Se gus
t
pt
em
be
r
O
ct
ob
N
ov er
em
be
D
ec
r
em
be
r
Ju
ne
ay
M
Ap
ri l
100
80
60
40
20
0
Ja
nu
a
Fe ry
br
ua
ry
M
ar
ch
Percentile Rank
2008 Inpatient Satisfaction Scores for Courtesy of Person
that Took Blood Since
Start of Lean Six Sigma Project
Month
Improved patient satisfaction percentile
rank from 15 to >60 within six months
Reducing Waste: 5 S Applied to Lab Closet
Before
After
Kan-Ban in Lab Supply Closet
Before
After
Lessons Learned
Keep employees informed-communicate the good,
bad and the ugly along with the project goals
Make sure everyone knows their role and are
included in the decision processes
Simple rewards and reminders keep everyone aware
that the process is always active-never stops just
because we hit the mark
Advertise to the facility-share the information and
get other departments involved (IT, nursing,
physicians, other hospital staff)