PDCA cycle for improving patients' waiting time in the laboratory reception area

1. Wafa Al-Ahmed
Bsc, PgD, MLS(ASCP)CM
Senior Quality Assurance Officer
Improvement of AMC Customer
Services in Reception &
Phlebotomy Room

3. 1ST VALUE: PATIENT WAIT TIME
 Definition
Wait time from the patients’ arrival to the laboratory
reception area and the time at which the blood collected.
 Problem
Patient waiting time in the reception area seem to be higher
between 10:30 AM – 12:00 PM.
 Consequences
-Excessive time spent away from work or personal activities.
-Patients might leave and seek care elsewhere. 3

4. 2ND VALUE: CUSTOMER SERVICE
 Effective Communication Skills with Patients
- Verbal Communication: face-to-face, or telephone
- Non-Verbal Communication: body language, gestures, how
we dress, act or our scent.
 Maintenance for Reception Area & Phlebotomy Rooms
- Walls & Doors Paintings
- Lining Chairs
- New Storage Cabinets
- Rest Rooms Hygiene 4

5. VALUE STREAM MAPPING
PHLEBOTOMY WORK FLOW FOR
OUT-PATIENTS
5
Enter
Patient
Data in
LIs
Payment PhlebotomyPayment Type CASH
Get
Approval
from
Insurance
Dept
Insurance

6. MINIMIZE WASTE
PHLEBOTOMY WORK FLOW FOR OUT
PATIENTS
6
Enter
Patient
Data in
LIs
Payment Phlebotomy
Payment
Type
Get
Approval
from
Insurance
Dept
CASH
Insurance
Wait
Time
Wait
Time

7. FACTS & DATA COLLECTION
DATE 17/8/2015, TIME 10:30 AM-1:50 PM
NOTE: CHILDREN WERE EXCLUDED
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Patient No. Time In Time Out Wait Time (min) Payment
Cash/ Insurance
1 10:30 10:50 20 Insurance
2 11:00 11:20 20 Insurance
3 11:00 11:15 15 Cash
4 11:05 11:20 15 Cash
5 11:10 11:32 22 Insurance
6 11:15 11:53 38 Insurance
7 11:30 11:55 25 Insurance
8 11:30 12:00 30 Insurance
9 11:40 12:05 25 Insurance
10 12:10 12:25 15 Cash
11 12:12 12:35 23 Insurance
12 12:40 12:50 10 Cash
13 12:45 12:53 8 Cash
14 12:50 01:00 10 Cash
15 12:50 01:13 23 Insurance
16 12:55 01:20 25 Insurance
17 01:10 01:23 13 Cash
18 01:15 01:35 20 Insurance
19 01:15 01:37 22 Insurance
20 01:17 01:50 33 Insurance

8. CREATE FLOW
TAKT TIME PER 24 HOURS
ON 17TH AUGUST, 2015
Takt Time Calculator
Working Shifts per Day 3 Shifts
Hours per Shift 8 Hours
Break Time per Shift 5 Minutes
Lunch Time per Shift 30 Minutes
Planned Downtime per
Shift 10 Minutes
Customer Demand per
Day 135 Units
Available Time per Shift 480 Minutes
Net Working Time per
Shift 435 Minutes
Net Working Time per
Shift 26,100 Seconds
Net Available Time per
Day 78,300 Seconds
Takt Time = 580 Seconds per Piece
Takt Time = 9.7 Minutes per Piece
88
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Definition
Takt time is the
time required to
deliver quality
services (to
produce customer
requirements)

9. ESTABLISH PULL
Minimize Waste
1. Insurance Approval by Accountant in Lab
Reception Area
2. Two Technologists for Serving the Customers
3. Two Technologists for Phlebotomy during Rush
Hours
Lean Thinking & Effective Communication
Training & Workshops 9

10. PERFECTION
5TH LEAN PRINCIPLES

11. PLAN, DO, CHECK, ADJUST (PDCA) CYCLE
• Presentation for: Lean Thinking &
Effective Communication
• Training based on Simulation & Role
Play
• Insurance Approval by Accountant in
Lab Reception Area
• Two Technologists for Serving the
• Calculate Tact Time/patient for
Phlebotomy Service
• Lab Director Assign Phlebotomy
Senior
• Quality & Safety Calendar
• Quality Rounds
• Plan Educational program based on
Communication Skills
• Collect Data for Patients’ Waiting
Time for Two Weeks
• Calculate Tact Time
• Fix Phlebotomy Rooms Wall
Paintings & Chairs Lining
•Conduct Quality Rounds
•Develop Continuous Quality
• Improvement Policy
• The change was a measurable
success
• Standardized Patient Waiting to be
10 min/patient
Act Plan
DoCheck

12. REFERENCES
 Improvement, N. H. S. Bringing lean to life. Leicester,
UK: NHS Improvement. 2010.
 https://leansixsigmahealthcare.wordpress.com/2015/0
6/24/using-lean-six-sigma-analytics-to-improve-
patient-wait-times/
 http://www.6ixconsulting.co.uk/IGLC-Application-of-
Batch-size-reduction-in-construction.pdf
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