SlideShare a Scribd company logo

Process Improvement - 10 Essential Ingredients

Identifies 10 essential ingredients for complex process improvement in the hospital laboratory.

1 of 58
Copyright© 1999-2010 Management Decision Systems, Inc.
1
Streamlining Process Improvement
10 Essential Ingredients
Richard Ouellette, FACHE CLSSMBB MT(ASCP)H
San Antonio, Texas
November 2, 2010
Management Decision Systems, Inc.
PresentationPresentation
OutlineOutline
AvailableAvailable
OnlineOnline
Copyright© 1999-2010 Management Decision Systems, Inc.
2http://mandecsys.com/labconfab/SPI10Ingredients.pdf
Process Improvement JourneyProcess Improvement Journey
Copyright© 1999-2010 Management Decision Systems, Inc.
3
1. Organization & Leadership
2. Understand The Customer
3. Rigorous Implementation Methodology
4. Understand Testing Demands
5. Design Space to Optimize Production
6. Instrumentation
7. Eliminate Process Bottlenecks
8. Establish Performance Metrics
9. Variation Reduction
10.Performance Visualization
A portion of this presentation based on…A portion of this presentation based on…
 Major Academic Pediatric Medical Center
 1.5 Million tests annually
 STAT TAT - 4 to 11 Hrs. 20% <= 1 Hr.
 60% of all testing ordered STAT
 High variability for routine TAT > 24 Hrs.
 Misplaced specimens
 High physician dissatisfaction
 Staffing vacancies (core lab ~ 35%)
 70% testing drawn by nursing
 New Cerner Millennium install
 Major laboratory reorganization
Copyright© 1999-2010 Management Decision Systems, Inc.
4
Referred to as… Pediatric LaboratoryReferred to as… Pediatric Laboratory
Fusion Management:
Harnessing the Power of Six Sigma, Lean, ISO, 9001:2000,
Malcom Baldrige, TQM, and Other Quality Breakthroughs
of the Past Century by Stanley A. Marash 2004
Copyright© 1999-2010 Management Decision Systems, Inc.
5
#1 Organization & Leadership
Chapter 1 Management by Fad (or Confusion Management)
Majors Reasons For Failure:
1.Lack of Executive Leadership – “commitment by deeds”, “lead by
mid-level managers with little if any involvement by executives”
2.Failure to Deploy – “management fails to support”
3.Seeking Shortcuts – “management adopts superficial aspects of a
program”
4.Inadequate Measurement – “management does not measure
success properly”, “measurements detached from business results”
#1 Organization & Leadership
 No such thing as "Just A Lab Project"
 Silos & Matrix Management
 Money & Budget
 Executive Sponsorship
 Project Leadership
 Role of Lab Management & Staff
 Goal Congruency
Copyright© 1999-2010 Management Decision Systems, Inc.
6
“Understand dynamics, priorities, urgency & politics!”

Recommended

G2 Financial Boot Camp - Laboratory Outreach
G2 Financial Boot Camp - Laboratory OutreachG2 Financial Boot Camp - Laboratory Outreach
G2 Financial Boot Camp - Laboratory OutreachRichard Ouellette
 
Chattanooga sme oee down time presentation
Chattanooga sme oee down time presentationChattanooga sme oee down time presentation
Chattanooga sme oee down time presentationJames Mansfield
 
OEE for Process Improvement
OEE for Process ImprovementOEE for Process Improvement
OEE for Process ImprovementEdward Brown
 
Electronic Batch Records
Electronic Batch RecordsElectronic Batch Records
Electronic Batch RecordsJason Corder
 
Lean in healthcare (ugm)
Lean in healthcare (ugm)Lean in healthcare (ugm)
Lean in healthcare (ugm)Jorge A. Gaspar
 
The Critical KPI to Drive Manufacturing Productivity
The Critical KPI to Drive Manufacturing ProductivityThe Critical KPI to Drive Manufacturing Productivity
The Critical KPI to Drive Manufacturing ProductivityCorey Vodvarka
 
Roadmap to next generation digital lab
Roadmap to next generation digital labRoadmap to next generation digital lab
Roadmap to next generation digital labStephan Gürtler
 
Are Your Process Automation Assets in Tune with Your Manufacturing Assets?
Are Your Process Automation Assets in Tune with Your Manufacturing Assets?Are Your Process Automation Assets in Tune with Your Manufacturing Assets?
Are Your Process Automation Assets in Tune with Your Manufacturing Assets?ARC Advisory Group
 

More Related Content

What's hot

QMS Effectiveness: Tracking and Trending Quality Data - OMTEC 2017
QMS Effectiveness: Tracking and Trending Quality Data - OMTEC 2017QMS Effectiveness: Tracking and Trending Quality Data - OMTEC 2017
QMS Effectiveness: Tracking and Trending Quality Data - OMTEC 2017April Bright
 
The Critical KPI to drive Manufacturing Productivity
The Critical KPI to drive Manufacturing ProductivityThe Critical KPI to drive Manufacturing Productivity
The Critical KPI to drive Manufacturing ProductivityJason Corder
 
Six Sigma Case Cart Project Final Report Jan. 2011
Six Sigma Case Cart Project Final Report Jan. 2011Six Sigma Case Cart Project Final Report Jan. 2011
Six Sigma Case Cart Project Final Report Jan. 2011dpjphx
 
A Manager's Guide to OEE (Overall Equipment Effectiveness)
A Manager's Guide to OEE (Overall Equipment Effectiveness)A Manager's Guide to OEE (Overall Equipment Effectiveness)
A Manager's Guide to OEE (Overall Equipment Effectiveness)OEEsystems International
 
Sourcing and Procurement: Glossary of Terms
Sourcing and Procurement: Glossary of TermsSourcing and Procurement: Glossary of Terms
Sourcing and Procurement: Glossary of TermsSertus, LLC
 
6 OEE overview
6 OEE overview6 OEE overview
6 OEE overviewWebseology
 
How to Implement TOC Principles and Tools in State Government and Achieve Gre...
How to Implement TOC Principles and Tools in State Government and Achieve Gre...How to Implement TOC Principles and Tools in State Government and Achieve Gre...
How to Implement TOC Principles and Tools in State Government and Achieve Gre...commonsenseLT
 
Leveraging Performance Standards to Reduce Risk - Houston SMRP MaRS 2013
Leveraging Performance Standards to Reduce Risk - Houston SMRP MaRS 2013Leveraging Performance Standards to Reduce Risk - Houston SMRP MaRS 2013
Leveraging Performance Standards to Reduce Risk - Houston SMRP MaRS 2013Mike Poland, CMRP
 
3 steps-to-ensuring-mechanical-asset-integrity-en-3293790
3 steps-to-ensuring-mechanical-asset-integrity-en-32937903 steps-to-ensuring-mechanical-asset-integrity-en-3293790
3 steps-to-ensuring-mechanical-asset-integrity-en-3293790Jose Quintero
 
Plan for Success Strategies to Align Reimbursement and Commercialization - OM...
Plan for Success Strategies to Align Reimbursement and Commercialization - OM...Plan for Success Strategies to Align Reimbursement and Commercialization - OM...
Plan for Success Strategies to Align Reimbursement and Commercialization - OM...April Bright
 
genpact-white-paper-driving_hospital_performance_to_the_next_level
genpact-white-paper-driving_hospital_performance_to_the_next_levelgenpact-white-paper-driving_hospital_performance_to_the_next_level
genpact-white-paper-driving_hospital_performance_to_the_next_levelAbi Karun
 
Regulatory Affairs Outsourcing Considerations and Models
Regulatory Affairs Outsourcing Considerations and ModelsRegulatory Affairs Outsourcing Considerations and Models
Regulatory Affairs Outsourcing Considerations and ModelsPaul Kuiken
 
SDLC Control
SDLC ControlSDLC Control
SDLC Controlbenji00
 
PPD Competitive Analysis
PPD Competitive AnalysisPPD Competitive Analysis
PPD Competitive AnalysisThomas Lawrence
 
Benefits of Collecting OEE Data with Production Tracking Software
Benefits of Collecting OEE Data with Production Tracking SoftwareBenefits of Collecting OEE Data with Production Tracking Software
Benefits of Collecting OEE Data with Production Tracking SoftwareWintriss Controls Group, LLC
 
The Coming Age of Continuous Auditing
The Coming Age of Continuous AuditingThe Coming Age of Continuous Auditing
The Coming Age of Continuous Auditingcarlabrut
 

What's hot (20)

QMS Effectiveness: Tracking and Trending Quality Data - OMTEC 2017
QMS Effectiveness: Tracking and Trending Quality Data - OMTEC 2017QMS Effectiveness: Tracking and Trending Quality Data - OMTEC 2017
QMS Effectiveness: Tracking and Trending Quality Data - OMTEC 2017
 
The Critical KPI to drive Manufacturing Productivity
The Critical KPI to drive Manufacturing ProductivityThe Critical KPI to drive Manufacturing Productivity
The Critical KPI to drive Manufacturing Productivity
 
FMEA Final Project
FMEA Final ProjectFMEA Final Project
FMEA Final Project
 
Six Sigma Case Cart Project Final Report Jan. 2011
Six Sigma Case Cart Project Final Report Jan. 2011Six Sigma Case Cart Project Final Report Jan. 2011
Six Sigma Case Cart Project Final Report Jan. 2011
 
A Manager's Guide to OEE (Overall Equipment Effectiveness)
A Manager's Guide to OEE (Overall Equipment Effectiveness)A Manager's Guide to OEE (Overall Equipment Effectiveness)
A Manager's Guide to OEE (Overall Equipment Effectiveness)
 
Sourcing and Procurement: Glossary of Terms
Sourcing and Procurement: Glossary of TermsSourcing and Procurement: Glossary of Terms
Sourcing and Procurement: Glossary of Terms
 
6 OEE overview
6 OEE overview6 OEE overview
6 OEE overview
 
OEE Fact sheet
OEE Fact sheetOEE Fact sheet
OEE Fact sheet
 
How to Implement TOC Principles and Tools in State Government and Achieve Gre...
How to Implement TOC Principles and Tools in State Government and Achieve Gre...How to Implement TOC Principles and Tools in State Government and Achieve Gre...
How to Implement TOC Principles and Tools in State Government and Achieve Gre...
 
Leveraging Performance Standards to Reduce Risk - Houston SMRP MaRS 2013
Leveraging Performance Standards to Reduce Risk - Houston SMRP MaRS 2013Leveraging Performance Standards to Reduce Risk - Houston SMRP MaRS 2013
Leveraging Performance Standards to Reduce Risk - Houston SMRP MaRS 2013
 
3 steps-to-ensuring-mechanical-asset-integrity-en-3293790
3 steps-to-ensuring-mechanical-asset-integrity-en-32937903 steps-to-ensuring-mechanical-asset-integrity-en-3293790
3 steps-to-ensuring-mechanical-asset-integrity-en-3293790
 
Plan for Success Strategies to Align Reimbursement and Commercialization - OM...
Plan for Success Strategies to Align Reimbursement and Commercialization - OM...Plan for Success Strategies to Align Reimbursement and Commercialization - OM...
Plan for Success Strategies to Align Reimbursement and Commercialization - OM...
 
genpact-white-paper-driving_hospital_performance_to_the_next_level
genpact-white-paper-driving_hospital_performance_to_the_next_levelgenpact-white-paper-driving_hospital_performance_to_the_next_level
genpact-white-paper-driving_hospital_performance_to_the_next_level
 
Regulatory Affairs Outsourcing Considerations and Models
Regulatory Affairs Outsourcing Considerations and ModelsRegulatory Affairs Outsourcing Considerations and Models
Regulatory Affairs Outsourcing Considerations and Models
 
Safety Score Card
Safety Score CardSafety Score Card
Safety Score Card
 
SDLC Control
SDLC ControlSDLC Control
SDLC Control
 
PPD Competitive Analysis
PPD Competitive AnalysisPPD Competitive Analysis
PPD Competitive Analysis
 
Applying Lean Six Sigma in Healthcare
Applying Lean Six Sigma in HealthcareApplying Lean Six Sigma in Healthcare
Applying Lean Six Sigma in Healthcare
 
Benefits of Collecting OEE Data with Production Tracking Software
Benefits of Collecting OEE Data with Production Tracking SoftwareBenefits of Collecting OEE Data with Production Tracking Software
Benefits of Collecting OEE Data with Production Tracking Software
 
The Coming Age of Continuous Auditing
The Coming Age of Continuous AuditingThe Coming Age of Continuous Auditing
The Coming Age of Continuous Auditing
 

Viewers also liked

Loucif Redha développement d'applications web - php - my sql
Loucif Redha  développement d'applications web - php - my sqlLoucif Redha  développement d'applications web - php - my sql
Loucif Redha développement d'applications web - php - my sqlRedha LOUCIF
 
Презентация 1.10 - Канадский эко-дом на берегу озера
Презентация 1.10 - Канадский эко-дом на берегу озераПрезентация 1.10 - Канадский эко-дом на берегу озера
Презентация 1.10 - Канадский эко-дом на берегу озераПавел Ефимов
 
Cultura y belleza de simitI
Cultura y belleza de simitICultura y belleza de simitI
Cultura y belleza de simitIluiskafu
 
Australian Driverless Vehicle Initiative
Australian Driverless Vehicle InitiativeAustralian Driverless Vehicle Initiative
Australian Driverless Vehicle InitiativeJumpingJaq
 
Bauer Radio CV application
Bauer Radio CV applicationBauer Radio CV application
Bauer Radio CV applicationJack Elliot
 
Unraveling urban traffic flows
Unraveling urban traffic flowsUnraveling urban traffic flows
Unraveling urban traffic flowsSerge Hoogendoorn
 
AEJMC Literary Journalism Presentation 2016
AEJMC Literary Journalism Presentation 2016AEJMC Literary Journalism Presentation 2016
AEJMC Literary Journalism Presentation 2016Mitzi Lewis
 
Indicadores segundo periodo tecnología
Indicadores segundo periodo tecnologíaIndicadores segundo periodo tecnología
Indicadores segundo periodo tecnologíamariazuluagaorozco
 
MICT presentation on Thailand’s Important Mission for Spectrum Re-farming
MICT presentation on Thailand’s Important Mission for Spectrum Re-farming MICT presentation on Thailand’s Important Mission for Spectrum Re-farming
MICT presentation on Thailand’s Important Mission for Spectrum Re-farming TelecomJournal
 
Презентация 1.16 - Новый оздоровительный эко-курорт Шри-Ланки
Презентация 1.16 - Новый оздоровительный эко-курорт Шри-ЛанкиПрезентация 1.16 - Новый оздоровительный эко-курорт Шри-Ланки
Презентация 1.16 - Новый оздоровительный эко-курорт Шри-ЛанкиПавел Ефимов
 
Interaction Design L03 - Color
Interaction Design L03 - ColorInteraction Design L03 - Color
Interaction Design L03 - ColorMohammad Shaker
 
Seguridad, privacidad y medidas de prevención
Seguridad, privacidad y medidas de prevenciónSeguridad, privacidad y medidas de prevención
Seguridad, privacidad y medidas de prevenciónAlejandra Chacón
 
How can the U.S. transition to personal public private social security saving...
How can the U.S. transition to personal public private social security saving...How can the U.S. transition to personal public private social security saving...
How can the U.S. transition to personal public private social security saving...Matias Zelikowicz
 
Quantitative Comparison of Artificial Honey Bee Colony Clustering and Enhance...
Quantitative Comparison of Artificial Honey Bee Colony Clustering and Enhance...Quantitative Comparison of Artificial Honey Bee Colony Clustering and Enhance...
Quantitative Comparison of Artificial Honey Bee Colony Clustering and Enhance...idescitation
 
Biz Dev for Women
Biz Dev for WomenBiz Dev for Women
Biz Dev for WomenMary Morgan
 

Viewers also liked (19)

Loucif Redha développement d'applications web - php - my sql
Loucif Redha  développement d'applications web - php - my sqlLoucif Redha  développement d'applications web - php - my sql
Loucif Redha développement d'applications web - php - my sql
 
Презентация 1.10 - Канадский эко-дом на берегу озера
Презентация 1.10 - Канадский эко-дом на берегу озераПрезентация 1.10 - Канадский эко-дом на берегу озера
Презентация 1.10 - Канадский эко-дом на берегу озера
 
Tigre animado
Tigre animadoTigre animado
Tigre animado
 
Steviose
StevioseSteviose
Steviose
 
Cultura y belleza de simitI
Cultura y belleza de simitICultura y belleza de simitI
Cultura y belleza de simitI
 
Australian Driverless Vehicle Initiative
Australian Driverless Vehicle InitiativeAustralian Driverless Vehicle Initiative
Australian Driverless Vehicle Initiative
 
Bauer Radio CV application
Bauer Radio CV applicationBauer Radio CV application
Bauer Radio CV application
 
Unraveling urban traffic flows
Unraveling urban traffic flowsUnraveling urban traffic flows
Unraveling urban traffic flows
 
AEJMC Literary Journalism Presentation 2016
AEJMC Literary Journalism Presentation 2016AEJMC Literary Journalism Presentation 2016
AEJMC Literary Journalism Presentation 2016
 
Indicadores segundo periodo tecnología
Indicadores segundo periodo tecnologíaIndicadores segundo periodo tecnología
Indicadores segundo periodo tecnología
 
Blogger
BloggerBlogger
Blogger
 
MICT presentation on Thailand’s Important Mission for Spectrum Re-farming
MICT presentation on Thailand’s Important Mission for Spectrum Re-farming MICT presentation on Thailand’s Important Mission for Spectrum Re-farming
MICT presentation on Thailand’s Important Mission for Spectrum Re-farming
 
Презентация 1.16 - Новый оздоровительный эко-курорт Шри-Ланки
Презентация 1.16 - Новый оздоровительный эко-курорт Шри-ЛанкиПрезентация 1.16 - Новый оздоровительный эко-курорт Шри-Ланки
Презентация 1.16 - Новый оздоровительный эко-курорт Шри-Ланки
 
Valuing Health at the End of Life
Valuing Health at the End of LifeValuing Health at the End of Life
Valuing Health at the End of Life
 
Interaction Design L03 - Color
Interaction Design L03 - ColorInteraction Design L03 - Color
Interaction Design L03 - Color
 
Seguridad, privacidad y medidas de prevención
Seguridad, privacidad y medidas de prevenciónSeguridad, privacidad y medidas de prevención
Seguridad, privacidad y medidas de prevención
 
How can the U.S. transition to personal public private social security saving...
How can the U.S. transition to personal public private social security saving...How can the U.S. transition to personal public private social security saving...
How can the U.S. transition to personal public private social security saving...
 
Quantitative Comparison of Artificial Honey Bee Colony Clustering and Enhance...
Quantitative Comparison of Artificial Honey Bee Colony Clustering and Enhance...Quantitative Comparison of Artificial Honey Bee Colony Clustering and Enhance...
Quantitative Comparison of Artificial Honey Bee Colony Clustering and Enhance...
 
Biz Dev for Women
Biz Dev for WomenBiz Dev for Women
Biz Dev for Women
 

Similar to Process Improvement - 10 Essential Ingredients

10 Things to Consider When Building a CTMS Business Case
10 Things to Consider When Building a CTMS Business Case10 Things to Consider When Building a CTMS Business Case
10 Things to Consider When Building a CTMS Business CasePerficient, Inc.
 
Week 5: Handout chris piccin lean - 040117 - day 2
Week 5: Handout   chris piccin   lean - 040117 - day 2Week 5: Handout   chris piccin   lean - 040117 - day 2
Week 5: Handout chris piccin lean - 040117 - day 2Talou Diallo
 
The Science of Predictive Maintenance: IBM's Predictive Analytics Solution
The Science of Predictive Maintenance: IBM's Predictive Analytics SolutionThe Science of Predictive Maintenance: IBM's Predictive Analytics Solution
The Science of Predictive Maintenance: IBM's Predictive Analytics SolutionSenturus
 
PharmTech QMS presentation
PharmTech QMS presentationPharmTech QMS presentation
PharmTech QMS presentationMichael Stewart
 
2014-10-15 Agility Solution DF Session Slides
2014-10-15 Agility Solution DF Session Slides2014-10-15 Agility Solution DF Session Slides
2014-10-15 Agility Solution DF Session SlidesGeoff Rothman
 
Executive PLM Consulting Overview
Executive PLM Consulting OverviewExecutive PLM Consulting Overview
Executive PLM Consulting OverviewDarrel Suderman
 
Introduction
IntroductionIntroduction
Introductionknksmart
 
Asset finance systems projects guide 101
Asset finance systems projects guide 101Asset finance systems projects guide 101
Asset finance systems projects guide 101David Pedreno
 
Equipment finance projects
Equipment finance projectsEquipment finance projects
Equipment finance projectsDavid Pedreno
 
Equipment finance system projects
Equipment finance system projectsEquipment finance system projects
Equipment finance system projectsDavid Pedreno
 
Equipment finance system projects
Equipment finance system projectsEquipment finance system projects
Equipment finance system projectsDavid Pedreno
 
Equipment Finance Projects
Equipment Finance ProjectsEquipment Finance Projects
Equipment Finance ProjectsDavid Pedreno
 
Equipment finance projects
Equipment finance projectsEquipment finance projects
Equipment finance projectsDavid Pedreno
 
Roundtable: Best Practices in First Call Resolution (FCR)
Roundtable:  Best Practices in First Call Resolution (FCR) Roundtable:  Best Practices in First Call Resolution (FCR)
Roundtable: Best Practices in First Call Resolution (FCR) Sheri Greenhaus
 
Harmonize your qms model to meet iso 13485 regulations april 2013
Harmonize your qms model to meet iso 13485 regulations april 2013Harmonize your qms model to meet iso 13485 regulations april 2013
Harmonize your qms model to meet iso 13485 regulations april 2013John Cachat
 
Operations: Top Reasons for Long Lead Times and What to Do About Them
Operations: Top Reasons for Long Lead Times and What to Do About ThemOperations: Top Reasons for Long Lead Times and What to Do About Them
Operations: Top Reasons for Long Lead Times and What to Do About ThemApril Bright
 

Similar to Process Improvement - 10 Essential Ingredients (20)

10 Things to Consider When Building a CTMS Business Case
10 Things to Consider When Building a CTMS Business Case10 Things to Consider When Building a CTMS Business Case
10 Things to Consider When Building a CTMS Business Case
 
Week 5: Handout chris piccin lean - 040117 - day 2
Week 5: Handout   chris piccin   lean - 040117 - day 2Week 5: Handout   chris piccin   lean - 040117 - day 2
Week 5: Handout chris piccin lean - 040117 - day 2
 
Week 05_Handout day 2
Week 05_Handout  day 2Week 05_Handout  day 2
Week 05_Handout day 2
 
The Science of Predictive Maintenance: IBM's Predictive Analytics Solution
The Science of Predictive Maintenance: IBM's Predictive Analytics SolutionThe Science of Predictive Maintenance: IBM's Predictive Analytics Solution
The Science of Predictive Maintenance: IBM's Predictive Analytics Solution
 
Lisa Burdick Resume 2016
Lisa Burdick Resume 2016Lisa Burdick Resume 2016
Lisa Burdick Resume 2016
 
PharmTech QMS presentation
PharmTech QMS presentationPharmTech QMS presentation
PharmTech QMS presentation
 
2014-10-15 Agility Solution DF Session Slides
2014-10-15 Agility Solution DF Session Slides2014-10-15 Agility Solution DF Session Slides
2014-10-15 Agility Solution DF Session Slides
 
Industrialization of testing
Industrialization of testing Industrialization of testing
Industrialization of testing
 
Executive PLM Consulting Overview
Executive PLM Consulting OverviewExecutive PLM Consulting Overview
Executive PLM Consulting Overview
 
Introduction
IntroductionIntroduction
Introduction
 
Andrew Ritchie Resume
Andrew Ritchie ResumeAndrew Ritchie Resume
Andrew Ritchie Resume
 
Asset finance systems projects guide 101
Asset finance systems projects guide 101Asset finance systems projects guide 101
Asset finance systems projects guide 101
 
Equipment finance projects
Equipment finance projectsEquipment finance projects
Equipment finance projects
 
Equipment finance system projects
Equipment finance system projectsEquipment finance system projects
Equipment finance system projects
 
Equipment finance system projects
Equipment finance system projectsEquipment finance system projects
Equipment finance system projects
 
Equipment Finance Projects
Equipment Finance ProjectsEquipment Finance Projects
Equipment Finance Projects
 
Equipment finance projects
Equipment finance projectsEquipment finance projects
Equipment finance projects
 
Roundtable: Best Practices in First Call Resolution (FCR)
Roundtable:  Best Practices in First Call Resolution (FCR) Roundtable:  Best Practices in First Call Resolution (FCR)
Roundtable: Best Practices in First Call Resolution (FCR)
 
Harmonize your qms model to meet iso 13485 regulations april 2013
Harmonize your qms model to meet iso 13485 regulations april 2013Harmonize your qms model to meet iso 13485 regulations april 2013
Harmonize your qms model to meet iso 13485 regulations april 2013
 
Operations: Top Reasons for Long Lead Times and What to Do About Them
Operations: Top Reasons for Long Lead Times and What to Do About ThemOperations: Top Reasons for Long Lead Times and What to Do About Them
Operations: Top Reasons for Long Lead Times and What to Do About Them
 

Recently uploaded

Rural SMEs, environmental action, and perceived opportunities - Kevin Mole
Rural SMEs, environmental action, and perceived opportunities - Kevin MoleRural SMEs, environmental action, and perceived opportunities - Kevin Mole
Rural SMEs, environmental action, and perceived opportunities - Kevin Moleenterpriseresearchcentre
 
Let’s get moving! Setting some goals Optimizing your workflow
Let’s get moving! Setting some goals Optimizing your workflowLet’s get moving! Setting some goals Optimizing your workflow
Let’s get moving! Setting some goals Optimizing your workflowngothuyanct
 
The Penta Model of Strategic Choices (summary)
The Penta Model of Strategic Choices (summary)The Penta Model of Strategic Choices (summary)
The Penta Model of Strategic Choices (summary)Mihai Ionescu
 
Bloomerang Scaling New Heights_ Tailored Strategies for Securing Your Next-Le...
Bloomerang Scaling New Heights_ Tailored Strategies for Securing Your Next-Le...Bloomerang Scaling New Heights_ Tailored Strategies for Securing Your Next-Le...
Bloomerang Scaling New Heights_ Tailored Strategies for Securing Your Next-Le...Bloomerang
 
Research Showcase 2024 final presentation slides
Research Showcase 2024 final presentation slidesResearch Showcase 2024 final presentation slides
Research Showcase 2024 final presentation slidesenterpriseresearchcentre
 
2024-02 Augusta Gold Corporate Presentation
2024-02 Augusta Gold Corporate Presentation2024-02 Augusta Gold Corporate Presentation
2024-02 Augusta Gold Corporate Presentationsimonecapitalcorp
 
Executive Summary - Example by Loopio.docx
Executive Summary - Example by Loopio.docxExecutive Summary - Example by Loopio.docx
Executive Summary - Example by Loopio.docxKatieFlood9
 
ERC Research Showcase Introduction Mark Hart
ERC Research Showcase Introduction Mark HartERC Research Showcase Introduction Mark Hart
ERC Research Showcase Introduction Mark Hartenterpriseresearchcentre
 
FICCI Monthly Bulletin February 2024.pdf
FICCI  Monthly Bulletin February 2024.pdfFICCI  Monthly Bulletin February 2024.pdf
FICCI Monthly Bulletin February 2024.pdfsubarnamostafa1
 
PUBLISHING AND LITERARY NETWORKS IN THE SOUTH WEST_EBOOK_WCOVER.pdf
PUBLISHING AND LITERARY NETWORKS IN THE SOUTH WEST_EBOOK_WCOVER.pdfPUBLISHING AND LITERARY NETWORKS IN THE SOUTH WEST_EBOOK_WCOVER.pdf
PUBLISHING AND LITERARY NETWORKS IN THE SOUTH WEST_EBOOK_WCOVER.pdfUniversity of Exeter MA Publishing
 
02.22.2024 Email Options in Bloomerang.pdf
02.22.2024 Email Options in Bloomerang.pdf02.22.2024 Email Options in Bloomerang.pdf
02.22.2024 Email Options in Bloomerang.pdfBloomerang
 
ZEOTAR EV Prince Team English Presentation
ZEOTAR EV Prince Team English PresentationZEOTAR EV Prince Team English Presentation
ZEOTAR EV Prince Team English PresentationKings Reddys
 
TriStar Gold Corporate Presentation Updated February 2024
TriStar Gold Corporate Presentation Updated February 2024TriStar Gold Corporate Presentation Updated February 2024
TriStar Gold Corporate Presentation Updated February 2024Adnet Communications
 
Osborn_Jordan_Sportsbroadcasting_PB1_6 (1).pdf
Osborn_Jordan_Sportsbroadcasting_PB1_6 (1).pdfOsborn_Jordan_Sportsbroadcasting_PB1_6 (1).pdf
Osborn_Jordan_Sportsbroadcasting_PB1_6 (1).pdffrannyosborn1
 
Digital Demo Day : Mastering High Volume Recruitment: Leveraging Language Ass...
Digital Demo Day : Mastering High Volume Recruitment: Leveraging Language Ass...Digital Demo Day : Mastering High Volume Recruitment: Leveraging Language Ass...
Digital Demo Day : Mastering High Volume Recruitment: Leveraging Language Ass...TalentView
 
Bloomerang Fundraising Week02.26.2024.pdf
Bloomerang Fundraising Week02.26.2024.pdfBloomerang Fundraising Week02.26.2024.pdf
Bloomerang Fundraising Week02.26.2024.pdfBloomerang
 
EAPJ Vol VIII February 2024.pdf
EAPJ Vol VIII February 2024.pdfEAPJ Vol VIII February 2024.pdf
EAPJ Vol VIII February 2024.pdfDarryl_Carr
 
flutter_bootcamp_MUGDSC_Presentation.pptx
flutter_bootcamp_MUGDSC_Presentation.pptxflutter_bootcamp_MUGDSC_Presentation.pptx
flutter_bootcamp_MUGDSC_Presentation.pptxRakshaAgrawal21
 
SARomics Biostructures 2024 Company Presentation
SARomics Biostructures 2024 Company PresentationSARomics Biostructures 2024 Company Presentation
SARomics Biostructures 2024 Company PresentationSalam Al-Karadaghi
 
Zero Budget Marketing Strategy with KPIs for a Cleaning Detergent Training ...
Zero Budget Marketing  Strategy with KPIs for a Cleaning Detergent  Training ...Zero Budget Marketing  Strategy with KPIs for a Cleaning Detergent  Training ...
Zero Budget Marketing Strategy with KPIs for a Cleaning Detergent Training ...Precious Mvulane CA (SA),RA
 

Recently uploaded (20)

Rural SMEs, environmental action, and perceived opportunities - Kevin Mole
Rural SMEs, environmental action, and perceived opportunities - Kevin MoleRural SMEs, environmental action, and perceived opportunities - Kevin Mole
Rural SMEs, environmental action, and perceived opportunities - Kevin Mole
 
Let’s get moving! Setting some goals Optimizing your workflow
Let’s get moving! Setting some goals Optimizing your workflowLet’s get moving! Setting some goals Optimizing your workflow
Let’s get moving! Setting some goals Optimizing your workflow
 
The Penta Model of Strategic Choices (summary)
The Penta Model of Strategic Choices (summary)The Penta Model of Strategic Choices (summary)
The Penta Model of Strategic Choices (summary)
 
Bloomerang Scaling New Heights_ Tailored Strategies for Securing Your Next-Le...
Bloomerang Scaling New Heights_ Tailored Strategies for Securing Your Next-Le...Bloomerang Scaling New Heights_ Tailored Strategies for Securing Your Next-Le...
Bloomerang Scaling New Heights_ Tailored Strategies for Securing Your Next-Le...
 
Research Showcase 2024 final presentation slides
Research Showcase 2024 final presentation slidesResearch Showcase 2024 final presentation slides
Research Showcase 2024 final presentation slides
 
2024-02 Augusta Gold Corporate Presentation
2024-02 Augusta Gold Corporate Presentation2024-02 Augusta Gold Corporate Presentation
2024-02 Augusta Gold Corporate Presentation
 
Executive Summary - Example by Loopio.docx
Executive Summary - Example by Loopio.docxExecutive Summary - Example by Loopio.docx
Executive Summary - Example by Loopio.docx
 
ERC Research Showcase Introduction Mark Hart
ERC Research Showcase Introduction Mark HartERC Research Showcase Introduction Mark Hart
ERC Research Showcase Introduction Mark Hart
 
FICCI Monthly Bulletin February 2024.pdf
FICCI  Monthly Bulletin February 2024.pdfFICCI  Monthly Bulletin February 2024.pdf
FICCI Monthly Bulletin February 2024.pdf
 
PUBLISHING AND LITERARY NETWORKS IN THE SOUTH WEST_EBOOK_WCOVER.pdf
PUBLISHING AND LITERARY NETWORKS IN THE SOUTH WEST_EBOOK_WCOVER.pdfPUBLISHING AND LITERARY NETWORKS IN THE SOUTH WEST_EBOOK_WCOVER.pdf
PUBLISHING AND LITERARY NETWORKS IN THE SOUTH WEST_EBOOK_WCOVER.pdf
 
02.22.2024 Email Options in Bloomerang.pdf
02.22.2024 Email Options in Bloomerang.pdf02.22.2024 Email Options in Bloomerang.pdf
02.22.2024 Email Options in Bloomerang.pdf
 
ZEOTAR EV Prince Team English Presentation
ZEOTAR EV Prince Team English PresentationZEOTAR EV Prince Team English Presentation
ZEOTAR EV Prince Team English Presentation
 
TriStar Gold Corporate Presentation Updated February 2024
TriStar Gold Corporate Presentation Updated February 2024TriStar Gold Corporate Presentation Updated February 2024
TriStar Gold Corporate Presentation Updated February 2024
 
Osborn_Jordan_Sportsbroadcasting_PB1_6 (1).pdf
Osborn_Jordan_Sportsbroadcasting_PB1_6 (1).pdfOsborn_Jordan_Sportsbroadcasting_PB1_6 (1).pdf
Osborn_Jordan_Sportsbroadcasting_PB1_6 (1).pdf
 
Digital Demo Day : Mastering High Volume Recruitment: Leveraging Language Ass...
Digital Demo Day : Mastering High Volume Recruitment: Leveraging Language Ass...Digital Demo Day : Mastering High Volume Recruitment: Leveraging Language Ass...
Digital Demo Day : Mastering High Volume Recruitment: Leveraging Language Ass...
 
Bloomerang Fundraising Week02.26.2024.pdf
Bloomerang Fundraising Week02.26.2024.pdfBloomerang Fundraising Week02.26.2024.pdf
Bloomerang Fundraising Week02.26.2024.pdf
 
EAPJ Vol VIII February 2024.pdf
EAPJ Vol VIII February 2024.pdfEAPJ Vol VIII February 2024.pdf
EAPJ Vol VIII February 2024.pdf
 
flutter_bootcamp_MUGDSC_Presentation.pptx
flutter_bootcamp_MUGDSC_Presentation.pptxflutter_bootcamp_MUGDSC_Presentation.pptx
flutter_bootcamp_MUGDSC_Presentation.pptx
 
SARomics Biostructures 2024 Company Presentation
SARomics Biostructures 2024 Company PresentationSARomics Biostructures 2024 Company Presentation
SARomics Biostructures 2024 Company Presentation
 
Zero Budget Marketing Strategy with KPIs for a Cleaning Detergent Training ...
Zero Budget Marketing  Strategy with KPIs for a Cleaning Detergent  Training ...Zero Budget Marketing  Strategy with KPIs for a Cleaning Detergent  Training ...
Zero Budget Marketing Strategy with KPIs for a Cleaning Detergent Training ...
 

Process Improvement - 10 Essential Ingredients

  • 1. Copyright© 1999-2010 Management Decision Systems, Inc. 1 Streamlining Process Improvement 10 Essential Ingredients Richard Ouellette, FACHE CLSSMBB MT(ASCP)H San Antonio, Texas November 2, 2010 Management Decision Systems, Inc.
  • 2. PresentationPresentation OutlineOutline AvailableAvailable OnlineOnline Copyright© 1999-2010 Management Decision Systems, Inc. 2http://mandecsys.com/labconfab/SPI10Ingredients.pdf
  • 3. Process Improvement JourneyProcess Improvement Journey Copyright© 1999-2010 Management Decision Systems, Inc. 3 1. Organization & Leadership 2. Understand The Customer 3. Rigorous Implementation Methodology 4. Understand Testing Demands 5. Design Space to Optimize Production 6. Instrumentation 7. Eliminate Process Bottlenecks 8. Establish Performance Metrics 9. Variation Reduction 10.Performance Visualization
  • 4. A portion of this presentation based on…A portion of this presentation based on…  Major Academic Pediatric Medical Center  1.5 Million tests annually  STAT TAT - 4 to 11 Hrs. 20% <= 1 Hr.  60% of all testing ordered STAT  High variability for routine TAT > 24 Hrs.  Misplaced specimens  High physician dissatisfaction  Staffing vacancies (core lab ~ 35%)  70% testing drawn by nursing  New Cerner Millennium install  Major laboratory reorganization Copyright© 1999-2010 Management Decision Systems, Inc. 4 Referred to as… Pediatric LaboratoryReferred to as… Pediatric Laboratory
  • 5. Fusion Management: Harnessing the Power of Six Sigma, Lean, ISO, 9001:2000, Malcom Baldrige, TQM, and Other Quality Breakthroughs of the Past Century by Stanley A. Marash 2004 Copyright© 1999-2010 Management Decision Systems, Inc. 5 #1 Organization & Leadership Chapter 1 Management by Fad (or Confusion Management) Majors Reasons For Failure: 1.Lack of Executive Leadership – “commitment by deeds”, “lead by mid-level managers with little if any involvement by executives” 2.Failure to Deploy – “management fails to support” 3.Seeking Shortcuts – “management adopts superficial aspects of a program” 4.Inadequate Measurement – “management does not measure success properly”, “measurements detached from business results”
  • 6. #1 Organization & Leadership  No such thing as "Just A Lab Project"  Silos & Matrix Management  Money & Budget  Executive Sponsorship  Project Leadership  Role of Lab Management & Staff  Goal Congruency Copyright© 1999-2010 Management Decision Systems, Inc. 6 “Understand dynamics, priorities, urgency & politics!”
  • 7. #1 Organization & Leadership Copyright© 1999-2010 Management Decision Systems, Inc. 7 “Understand dynamics, priorities, urgency & politics!” Executive Management Process Leader Staff Organization Participants Resources Managers
  • 8. #1 Organization & Leadership Copyright© 1999-2010 Management Decision Systems, Inc. 8 “Goal Congruency, Communication & Coordination” Resources Staff Organization Participants Executive Management Managers Process Leader
  • 9. Hospital Department SiloHospital Department Silo Copyright© 1999-2010 Management Decision Systems, Inc. 9
  • 10. #2 Understand The Customer SIPOC  Clarify High Level Process Structure  Ties to Value Stream  Understanding & Awareness Copyright© 1999-2010 Management Decision Systems, Inc. 10
  • 11. #2 Understand The Customer House of Quality Copyright© 1999-2010 Management Decision Systems, Inc. 11 “Must understand customer’s needs & priorities!”
  • 12. #2 Understand The Customer House of Quality – Critical To Quality Copyright© 1999-2010 Management Decision Systems, Inc. 12 CTQ – Typically in Define or Measure phase of DMAIC project Identify customer Identify customer's need Identify initial set of basic customer requirements Progress further with more levels as required Validate requirements with customers
  • 13. #2 Understand The Customer House of Quality – Critical To Quality Copyright© 1999-2010 Management Decision Systems, Inc. 13 CTQ Issues leading to failure • Not understanding the customer requirements • Not having infrastructure to support the process • Not having qualified human resources • Absence of following established standards “If your customer simply wants to go from point A to Point B don’t give them a Mercedes when all they really need is a Hyundai .”
  • 14. #3 Rigorous Implementation Methodology Copyright© 1999-2010 Management Decision Systems, Inc. 14 “Unfortunately control & sustain are often forgotten” DMAIC (Six Sigma)  Define  Measure  Analyze  Improve  Control PCDA (Deming)  Plan  Check  Do  Act
  • 15. #3 Rigorous Implementation Methodology Copyright© 1999-2010 Management Decision Systems, Inc. 15 “Project management” Process improvement requires project management. It is very important to track majors phases, tasks, responsibilities, dates and deliverables, i.e. the details. Suggested Resources: •PMBOK – A Guide to the Project Management Body of Knowledge, 3rd Edition by Project Management Institute •Microsoft Office Project
  • 16. #4 Understand Testing Demand  3 Years of Trend  Test Flows - Inpatient, Outpatient, Outreach  Priority - Note if STAT > 25% = Service Issues  30 Days Billable Test Detail  Day of Week (DOW)  Hour of Day (HOD)  Priority, Times, Location, Who  Pareto - 40 of 700 = 85% Total Test Volume Copyright© 1999-2010 Management Decision Systems, Inc. 16 “Critical to have LIS support and that the data is validated!”
  • 17. #4 Understand Testing Demand Copyright© 1999-2010 Management Decision Systems, Inc. 17 “Critical to have LIS support and that the data is validated!”
  • 18. #5 Design Space to Optimize Production  Core Concept  Benefits  2nd , 3rd & Weekend Shifts  Outreach Testing  Efficiency  Costs  Cross Training  Job Enrichment  Ratio - Flexibility vs. Training & Competencies Copyright© 1999-2010 Management Decision Systems, Inc. 18 “Can have significant cost ramifications…”
  • 19. #5 Design Space to Optimize Production continued  Pareto - 40 of 700 = 85% Total Testing Volume  Queuing - Grocery Store  Bar Coding  Cashier  Waiting Lines  5S - Sort, Straighten, Sweep, Standardize, and Sustain Copyright© 1999-2010 Management Decision Systems, Inc. 19 “Can have significant cost ramifications…”
  • 20. Grocery Store Vs. LaboratoryGrocery Store Vs. Laboratory Copyright© 1999-2010 Management Decision Systems, Inc. 20 #5 Design Space to Optimize Production continued
  • 21.  Proximity  Specimen Type  Instrument Location  LIS – Printers & Terminals  Staff Travel – Pre & Analytic  Automation Lines  Specimen Drop Off – Visible  STAT Monitors - Visible Copyright© 1999-2010 Management Decision Systems, Inc. 21 “Can have significant cost ramifications…” #5 Design Space to Optimize Production continued
  • 22. Pediatric Laboratory - Initial DesignPediatric Laboratory - Initial Design Copyright© 1999-2010 Management Decision Systems, Inc. 22 SpecimenProcessing Chemistry Chemistry Chemistry Special Chemistry Hematology Coagulation Urine Tube System & Drop Off
  • 23. Pediatric Laboratory - SpaghettiPediatric Laboratory - Spaghetti DiagramsDiagrams 2.25 miles per shift 4.14 miles per shift Copyright© 1999-2010 Management Decision Systems, Inc. 23
  • 24. Copyright© 1999-2010 Management Decision Systems, Inc. 24 SpecimenProcessing Chemistry Chemistry Chemistry Special Chemistry Hematology Coagulation Urine Tube System & Drop Off Pediatric Laboratory – Focus AreaPediatric Laboratory – Focus Area
  • 25. Copyright© 1999-2010 Management Decision Systems, Inc. 25 Chemistry Chemistry Hematology Coagulation Urine Pediatric Laboratory – Core FocusPediatric Laboratory – Core Focus
  • 26. Pediatric Laboratory – Core FocusPediatric Laboratory – Core Focus Copyright© 1999-2010 Management Decision Systems, Inc. 26
  • 27. A Black Belt Examines a SiloA Black Belt Examines a Silo Copyright© 1999-2010 Management Decision Systems, Inc. 27
  • 28. #6 Instrumentation  Throughput - Manufacturer Specification  Staffing/Input Requirements  Bar Coding  Importance of LIS/HIS  Location & Support Space Copyright© 1999-2010 Management Decision Systems, Inc. 28 “Optimal test throughput & required staffing is usually established by the manufacturer”
  • 29. #6 Instrumentation Copyright© 1999-2010 Management Decision Systems, Inc. 29 “Optimal test throughput & required staffing is usually established by the manufacturer”
  • 30. #7 Eliminate Process Bottlenecks Process Diagramming & Value Stream Mapping Modeling - KISS Takt Time - Customer Demand Process Breakdown - Pre-Analytic, Analytic Workload Balancing Staff Involvement - Stakesmanship Copyright© 1999-2010 Management Decision Systems, Inc. 30 “Need involvement of staff performing the work”
  • 31. Total Testing Process – 3 Phases/13 Steps Copyright© 1999-2010 Management Decision Systems, Inc. 31 Clinical Question Test Selection Test Order Patient Specimen Identification Specimen Collection Specimen Preparation Specimen Processin g Analysis Results Reporting Report Review Results Interpretation Action Transportation Post Analytic (Care Provider) Analytic (Laboratory) Pre Analytic (Care Provider) #7 Eliminate Process Bottlenecks Source: Adapted from Boone, J. Presentation at the 2007 Institute on Critical Issues in Health Laboratory Practice: Managing for Better Health, Atlanta, September 23 – 26, 2007
  • 32. Copyright© 1999-2010 Management Decision Systems, Inc. 32Source: Adapted from Boone, J. Presentation at the 2007 Institute on Critical Issues in Health Laboratory Practice: Managing for Better Health, Atlanta, September 23 – 26, 2007 8 Key Steps #7 Eliminate Process Bottlenecks Total Testing Process – 3 Phases/13 Steps Clinical Question Test Selection Test Order Patient Specimen Identification Specimen Collection Specimen Preparation Specimen Processing Analysis Results Reporting Report Review Results Interpretation Action Transportatio n Post Analytic (Care Provider) Analytic (Laboratory) Pre Analytic (Care Provider)
  • 33. #7 Eliminate Process Bottlenecks Copyright© 1999-2010 Management Decision Systems, Inc. 33 “Swim Lane Process Diagraming”
  • 34. Copyright© 1999-2010 Management Decision Systems, Inc. 34 “Ishikawa Diagram” #7 Eliminate Process Bottlenecks
  • 35. #7 Eliminate Process Bottlenecks Copyright© 1999-2010 Management Decision Systems, Inc. 35 “Value Stream Mapping”
  • 36. #7 Eliminate Process Bottlenecks Copyright© 1999-2010 Management Decision Systems, Inc. 36 Lead Time = 122 Minutes VA/T = 11.2 Minutes Lead Time = 66 Minutes ∆ of 46% VA/T = 9.3 Minutes ∆ of 17%
  • 37. #8 Establish Performance Metrics  #7 Institute leadership  #8 Drive out fear  #9 Break down department barriers Copyright© 1999-2010 Management Decision Systems, Inc. 37 “Deming offered fourteen key principles for management for transforming business effectiveness; 3 key principles are…” Being measured is not bad… it is good!
  • 38. #8 Establish Performance Metrics  Ownership - Lab's... Like it or not  Communication - Customer & Staff  Measurement  Frequency  Actual Performance - Sharing & Follow-up Copyright© 1999-2010 Management Decision Systems, Inc. 38 “Metrics provide focus & direction, otherwise you are a ship without a rudder”
  • 39. #8 Establish Performance Metrics Copyright© 1999-2010 Management Decision Systems, Inc. 39 Few have been bitten by an elephant… but almost everyone… has been bitten by a mosquito.
  • 40.  Use tests on STAT list for major metrics  Commit to a reasonable TATs Better to under commit and over deliver! –STAT - 1 hour from order to report –Routine - 4 hour from order to report –AM - Report by 6 AM/7 AM  Send-Out – Published SO Lab’s TAT  Outreach – Sales, Customer Service Copyright© 1999-2010 Management Decision Systems, Inc. 40 #8 Establish Performance Metrics
  • 41. #8 Establish Performance Metrics Copyright© 1999-2010 Management Decision Systems, Inc. 41
  • 42. #8 Establish Performance Metrics Copyright© 1999-2010 Management Decision Systems, Inc. 42
  • 43. #9 Reduce Error & Variation  Accelerate Discovery  Measurement - Metric & Frequency  Daily Monitoring - Dashboard & Scorecards  Drive Performance - With a passion! Copyright© 1999-2010 Management Decision Systems, Inc. 43
  • 44. #9 Reduce Error & Variation Copyright© 1999-2010 Management Decision Systems, Inc. 44
  • 45. #9 Reduce Error & Variation Copyright© 1999-2010 Management Decision Systems, Inc. 45 “Don’t assume everyone knows how to interpret” Pre-Analytic Analytic Expected TATs Exceptions
  • 46. Copyright© 1999-2010 Management Decision Systems, Inc. 46 “Customer demand vs. laboratory supply” 2 PM Customer Demand 2 PM Laboratory Supply #9 Reduce Error & Variation
  • 47. #9 Reduce Error & Variation Copyright© 1999-2010 Management Decision Systems, Inc. 47 Cadence - balanced, rhythmic flow
  • 48. Copyright© 1999-2010 Management Decision Systems, Inc. 48 #9 Reduce Error & Variation “People will do what you ask… if you watch what they do.”
  • 49. #10 Performance Visualization Copyright© 1999-2010 Management Decision Systems, Inc. 49 “Quickening through visualization”
  • 50. #10 Performance Visualization  Leadership … BIG picture & results  Your staff want to succeed  Train, train, train  Communication... Feedback  Share successes & failures with customers Copyright© 1999-2010 Management Decision Systems, Inc. 50 “Quickening through visualization”
  • 51. #10 Performance Visualization Copyright© 1999-2010 Management Decision Systems, Inc. 51 “Pediatric Laboratory” 1 Hr. 30 Min. Difference
  • 52. #10 Performance Visualization Copyright© 1999-2010 Management Decision Systems, Inc. 52 “Pediatric Laboratory”
  • 53. #10 Performance Visualization Copyright© 1999-2010 Management Decision Systems, Inc. 53 “Pediatric Laboratory”
  • 54. Silo Process ImprovementSilo Process Improvement Copyright© 1999-2010 Management Decision Systems, Inc. 54 No such thing as "Just A Lab Project"
  • 55. Process Improvement Journey SuccessProcess Improvement Journey Success Copyright© 1999-2010 Management Decision Systems, Inc. 55 1. Organization & Leadership 2. Understand The Customer 3. Rigorous Implementation Methodology 4. Understand Testing Demands 5. Design Space to Optimize Production 6. Instrumentation 7. Eliminate Process Bottlenecks 8. Establish Performance Metrics 9. Variation Reduction 10.Performance Visualization
  • 56. Summary RemarksSummary Remarks  Complex process improvement is dynamic, involves the entire organization and leadership  Process improvement is a team effort  Fair, or unfair you have full responsibility for a test from the time of ordered for until it is complete  Improving costs & service is an ongoing effort  The laboratory is a detailed oriented business Copyright© 1999-2010 Management Decision Systems, Inc. 56
  • 57. Thank you!Thank you! Richard Ouellette, FACHE CLSSMBBRichard Ouellette, FACHE CLSSMBB Management Decision Systems, Inc.Management Decision Systems, Inc. 101 Main Street101 Main Street Holden, Massachusetts 01520Holden, Massachusetts 01520 Website:Website: http://www.mandecsys.comhttp://www.mandecsys.com Phone: 508-829-7813Phone: 508-829-7813 Email:Email: rouellette@mandecsys.comrouellette@mandecsys.com Copyright© 1999-2010 Management Decision Systems, Inc. 57
  • 58. #8 Establish Performance Metrics Copyright© 1999-2010 Management Decision Systems, Inc. 58 Few have been bitten by an elephant… but almost everyone… has been bitten by a mosquito.

Editor's Notes

  1. Hello my name is Richard Ouellette and I will be talking today on process improvement. In this presentation I have identified 10 key ingredients that are required in order to be successful in a “complex” process improvement undertaking. What sort of circumstances warrant this approach toward process improvement: A combination of several of the following Complex improvement that may exceed any one individual’s capabilities A crisis may exist High level Analytical &amp; group dynamic &amp; project management skills required Need to draw upon multi-disciplinary expertise from several departments A requirement to obtain resources that may not be budgeted The need for an executive sponsor that can garner consensus among disparate interest The process improvement approach that I will be discussing does not replace ongoing process improvement s that managers make on a daily basis, it simply provides a recommended methodology for complex problem solving and implementation within a complex organization.
  2. This presentation outline is available on line at the address found at the bottom of this slide.
  3. Think of each of the 10 ingredients as individual climbers. Similar to the climbers in these pictures each “ingredient” is tied to one another. Success is for all climbers to start at the mountain base together and to successfully reach the summit together, as a team.
  4. A portion of this presentation is based on a case study. Specific highlights are in red: Pediatric hospital 70% of the testing drawn by nursing Significant service related issues
  5. The 1st ingredient is Organization and Leadership 1st point to be stressed is there is no such thing as a “Just a lab project”. If you want to move an instrument it involved engineering, solving a supply storage problem involves purchasing, introduce a new collection tube requires nursing, implement a new test involves finance… and the list goes on. Healthcare, especially in a hospital is a collection of disciplines operating in silos of expertise. In order to benefit patients these silos must work together and barriers must be bridged. Improvements are generally implemented through project teams. This means that the “Improved department” may need to implement the improvements and they most certainly will have to own and sustain them as well. Very early into the process the “Project Leader” must explain, where we are currently, where we want to be in the future, what &amp; how &amp; when we will get there. People need to see the “Big Picture
  6. There are a number of key roles with any process improvement effort. Staff, the individuals that do the work need to be involved, managers need to be committed, resources need to be allocated, support needs to be provided by organization leaders and there needs to be a process leader to coordinate implementation and communication.
  7. As with all complex undertaking there is a need to align these dynamic entities so that there is good communication, coordination and goal congruency as depicted by the overlapping circle entities.
  8. I think humor is an important tool in opening up dialog. How often does a lab employee have direct contact with a patient, a nursing unit or a physician. How many nurses or physicians have actually visited the laboratory. The nature of our work puts us in silos but we must fight the negative impact this can have on patient care.
  9. Understanding the customer is ingredient #2 There are 2 six sigma tools that may be helpful, SIPOC &amp; House of Quality It is important that everyone understand the big picture and the relationships of how things fit together to meet the needs of the customer. SIPOC shows a High-level picture of how the given process is servicing the customer. It promotes understanding and awareness.
  10. The House of Quality tool is used for defining the relationship between customer desires and the laboratory’s capabilities. It is a part of the quality function deployment (QFD) and it utilizes a planning matrix to relate what the customer wants to how the laboratory is going to meet those wants. This tool provides a rigorous approach to getting at what the customer wants and how you are going to make that happen.
  11. What are critical components to quality? Identify who is the customer, e.g., doctor, physician, nurse, family etc. What does the customer need What are their requirements And… how do you validate requirements with the customer?
  12. What are some of the issues that can lead to failure in meeting customer need? 4 are identified on this slide… but the most prevalent is not understanding the customers requirements.
  13. Important Ingredient # 3 is Rigorous implementation Methodology Deming started us off with Plan Check Do &amp; Act and the six sigma folks are developed the DMAIC approach (Define, Measure, Improve, Control). Regardless of which one you use, similar to a recipe either serves as an ordered &amp; structured approach that can be cycled depending on the complexity of the improvements involved.
  14. I have never been involved with a process improvement effort where “project management” skills were not required. There is a tremendous amount of information and detail with tracking project phases, tasks, due dates and deliverable. They say the devil is in the detail so here are 2 recommended resources. PMBOK Microsoft Project
  15. Important Ingredient #4 is Understand Testing Demand Given that the laboratory is the largest producer of clinical information in healthcare it is important that you understand the demand flows and ordering priorities on an inpatient, outpatient and outreach basis. I will typically look at 3 or more years of testing trends as well as 30 days worth of billed test detail analyzing DOW, HOD testing patterns. I’ll also take a close look at roughly the 40 top tests (out of 700) that tend to generate 85% of the total testing volume. I will go into more detail on this later in the presentation.
  16. This slide shows some of the day of week and within day testing pattern analysis.
  17. Ingredient #5 is Design Space to Optimize Production… we are at the half way point An entire presentation can be done on this subject alone so let me touch on the key points quickly. The core concept is based on the Pareto concept that I touch upon in Ingredient #4 Under Testing Demand; roughly 40 of you 700 orderable tests constitute 85% of you testing volume. Given this, focus this high volume testing in a centralized, well designed area with unidirectional testing flows that are in close proximity to the specimen receipt area. Design the space to minimize travel. Lay out the equipment so that single operators can operate multiple instruments. Configure your LIS to expedite testing, i.e., bar coding, delta checking, auto verification and STAT monitors. Cross train you technical staff to work in multiple departments. The result is greater efficiencies, quicker testing throughput, enhanced workflows on 2nd, 3rd &amp; weekend shifts and generally… a much more satisfied technical staff.
  18. Cleanliness is next to godliness and unfortunately some laboratories do not understand this concept and the end result is a fraternity house environment. If you walk into the managers or supervisors office and the you find that it is disorganized and messy as well, you need to rethink your 5S implementation… perhaps with a root cause analysis. Lets talk about grocery stores…
  19. A grocery store with it’s check outs, waiting lines (queues) , bar coding, supply chain management and customer frustration &amp; anxiety serves as a great way to explain how a laboratory functions to a non-labatorian. I would go so far to say that queuing in particular is not given enough emphasis in lean/six sigma methodology… it does however play a more predominate role in TOC Theory of constraints. Take a look at these picture and please retain the image especially the bar code reader upper right and the queue that is held up on the lower left picture by the customer that decided to write her check only after all her groceries were wrung up and bagged… and then she forgot her pin and needed to make a call. I always seem to be behind these individuals… see that’s me.
  20. I have already touched upon many of these items on this slide… key take aways are proximity and unrestricted flow.
  21. This is a diagram of the pediatric medical center’s core laboratory. It is not ideal space but it does have potential. Remember one of the 1st slides in the presentation with the table full of specimens. That table is here and you should be aware that it was quickly determined that specimen processing space was inadequate and had congested traffic flow.
  22. Spaghetti diagramming was done and it was determined that an day shift laboratory assistant traveled 2 ¼ miles within this space per day and the evening shift assistant traveled a little over 4 miles. This travel is a great way to keep the staff lean, but it is not what Taiichi Ohno at Toyota had in mind.
  23. The focus of the improvements was in this area: Locating high production equipment in close proximity to support specimen share and reduced travel distance Breaking down a non-load bearing wall and turning the new space into automated chemistry. Eliminating a non-load bearing wall that created a blind alley bottleneck. Completely re-designing specimen processing work area and standardizing work activities
  24. Here is the new space… actual construction costs were $45,000 Note the new processing space and automated chemistry and the workflow pattern indicated by the green arrows. This space is also configured for outreach should this client wish to venture into this
  25. Here are some pictures of the improvements STAT monitors that provide real-time performance feedback, also referred to later in this presentation as “performance visualization”. Upper left slide – expanded work space as opposed to the slide shown earlier in this presentation. Processing area has been centralized with defined workstations in individual responsibilities assigned, aka “work standardization” Petition wall removed for better workflow in chemistry area
  26. Once again… looking into a healthcare silo can be difficult as this picture indicates. Stanley Marash author of Fusion Management may have used this slide as an example of leadership in some organizations and why process improvement did not work.
  27. Important ingredient #6 is instrumentation Every manufacturer of testing equipment will provide you with it’s throughput capabilities as well of, operational instructions and expected staffing. So for example, if you have a hematology instrument that can produce 60 tests per hour and you have certain hours of the day that exceed this throughput, e.g., 80 test/hour 7 – 10 AM, you know you have a bottleneck that you can resolve in 1 of 3 ways Buy an additional analyze to double throughput Divert testing demand… start the morning earlier Do nothing
  28. With todays instrumentation automation, testing bottle necks are not typically occurring in the analytical phase of testing. I’ll touch upon this when discussing the next key ingredient.
  29. We are in the home stretch. Ingredient #7 is Eliminate Process bottlenecks When looking at any complex process it is important to break it down to it’s individual pieces and study them in detail. There are several tools that can be used to accomplish this including process, swim-lane and value stream mapping. It is OK for the process leader to develop initial drafts of these maps but it is important that the project team actively participate and reach consensus on the final documents. Customer demand could be accessions/day or accessions/1st shift or tests/day or hematology tests/day. Takt time takes the minutes of work /unit produced, e.g., if there were 200 CBCs on 1 shift (assume 8 X 60 = 480 Minutes) the Takt time would be 480/200 = 4.8 minutes per CBC to keep up within 1st shift demand. The mix and coordination of resources (phlebotomy, transportation, information systems &amp; instrumentation) constituents the “supplies you will allocate to meet this “demand”. Some key points… You may not have perfect data to apply to these mapping tools; it can run the gamut from obtain near perfect real time information from the list to time studies and counting test tubes and accession arrivals. It is important to understand the limitations of the data you are using and that it ties out to you measures ,e.g., physician expectations are tied to completed tests, phlebotomy &amp; speciment receipt is tied to accessions… 2 very different denominators These are powerful tools and they can be as complex or simple as you want them to be… keep it simple. 3 relatively simple value stream maps may be more effective than 1 complex one that no one can understand other than the black belt that put it together. These are visual tools. If any member of you process improvement teams does not understand their output they offer little to no value to your improvement effort.
  30. This diagram depicts the Pre-analytic, Analytic &amp; post-analytic phases of producing a laboratory result and the individual steps involved in the process. Results reporting – quality aspect of this step that we are looking at related to delta checking and auto-verification
  31. The laboratory is responsible for 8 of these steps in both the Pre-analytic and analytic phases. When examining the testing continuum it is important to look in detail at each for these steps and carefully examine the resource you are deploying. Let me stress, it is important that the laboratory take responsibility for all 8 steps identified in this diagram, even, for example, if they are not be collecting the specimen. I’ll talk more about this in establishing performance metrics.
  32. This is a swim lane process diagram and it is useful in showing process steps by area of responsibility.
  33. This is a swim lane process diagram and it is useful in showing process steps by area of responsibility.
  34. This is a value stream map and it can be closely tied to the SIPOC diagram that I mentioned earlier. Each box on the bottom depicts a process step going from left to right. The yellow triangles typically represent inventory, however they can also be used to reflect patients or tests in a queue between process steps. The objective in using value stream mapping is to optimize the supplied resources to closely match customer demand; supply vs. demand.
  35. OK lets look at the pediatric core laboratory and the issues identified in this simplified value stream map looking at the various steps of draw, transport receive, process test verify and report. The tube system was not trusted and we also leaned that there were tube container shortages Nursing was manually tracking test orders and collections; the lab was printing collection floor lists at defined times. As a result, add-on orders created multiple accessions on the same specimen and there were a number of instances of inadequate specimen. This was a problem for nursing and it was a big problem for the lab when these specimens were received and needed to be reconciled. Poor &amp; inadequate space in specimen receipt &amp; processing Delta checking &amp; auto-verification were not being used There were significant backups of specimens throughout each step creating a significant lead-time of roughly 2 hours Future State Tube system was validated and new transport containers purchased Epic EMR installation delayed in order to give nursing ability to pull own collection list Processing area reengineered LIS functionality was expanded to include delta checking, auto-verification, specimen tracking and STAT monitors Lead-time was cut roughly in half and value added time was reduced by roughly 2 minutes
  36. Fair or unfair, like it or not, the lab is held responsible to all 8 of the pre-analytic and analytic steps, even if they do not directly control all of the steps, e.g., in the pediatric medical center 70% of the tests were collected by nursing, not the laboratory. You must establish performance goals as a department and for implementing process improvements. Otherwise, how do you, your customers and your executive sponsor know you are performing at acceptable levels. Your performance goals need to be measurable, timely and made available to your staff and customers
  37. There is an old saying that I heard early in my laboratory career…. Few have been bitten by an elephant but almost everyone has been bitten by a mosquito. Basically what this means is that it is the most frequently ordered tests that will bite you if they are delayed, not the big expensive esoteric send-outs.
  38. Here is a recommended approach that I have successfully used for a number of years. …. Read from slide You also need to be very specific on your metric, e.g., 1 hour from ordered for to report result. I have not run into a medical staff that opposed this approach, most were estotic especially when the laboratory started delivering on the TATs.
  39. Here is an example of what I mean by Pareto. I took a months worth of performed tests and ordered them in ascending order. The top 15 tests constitutes 54% of the test volume and all of these tests are in this clients STAT test list.
  40. Therefore including the high volume STAT tests list in your metric will include 57% of all of your tests, 48% of all of your routine tests and 76% of all of your STAT tests
  41. Reduce Error and variation is item # 9. Once you understand you testing demands, have identified your bottlenecks and established targeted performance metrics, you are now ready to roll up your sleeves and make improvements. The goal is to move performance from what is shown on the left to the graph shown on the right. Note that the red line id the performance goal.
  42. Daily dashboards with individual drill down exception reports for each metric is an effective “visual” tool in accelerating change especially when you share it daily with your staff, nursing and key physicians. Regardless of stumbles, everyone knows you are committed to these improvements.
  43. Important point
  44. Important point… do not assume that everyone knows how to read and interpret a dashboard or drill down report. Go over them in detail at staff meetings and do one-on-ones with key nurses and physicians.
  45. Reduce Error and variation is item # 9. Once you understand you testing demands, have identified your bottlenecks and established targeted performance metrics, you are now ready to roll up your sleeves and make improvements. The goal is to move performance from what is shown on the left to the graph shown on the right. Note that the red line id the performance goal.
  46. Important point… do not assume that everyone knows how to read and interpret a dashboard or drill down report. Go over them in detail at staff meetings and do one-on-ones with key nurses and physicians.
  47. The last important ingredient is Performance Visualization. Keep in mind that we want to make significant improvements, so you need to understand human nature. As this graph shows people retain visual information to a much greater degree than what they hear or see. We have all heard that a picture is worth a 1,000 words. And let me add I am not talking just about graphs and dashboards. You gain significant credibility in you process improvement efforts when you meet in person with 2nd shift staff during the evening, 3rd shift in the early AM or the weekend crew on Saturday. Having executive management, physicians and your pathologist visibly present, engaged and participating in process improvement efforts is very important.
  48. Did you ever wonder why religions plays such a big role in many of our lives? Here is my take… religion shows you the big picture from start to finish, what you need to do right and what you should not be doing. Furthermore, if you do everything right it tells you how you will be rewarded. So, if my assessment is correct, most people due to their upbringing have a predisposition for wanting to see the big picture, do what is right and participate in the rewards. NEED TO REMOVE TIE TO RELIGION
  49. We are at the end with a few wrap up slides…. This compares March vs July’s cumulative testing completed. Note that in July 6 AM work was completed whereas the same work in march was being completed at 7:30 AM.
  50. This slide shows the 3 major performance metric trend with major initiatives depicted below on the March – June time table. The implementation cycle was rigorous and the improvements were as well.
  51. This was the ER’s laboratory performance graph with improvements starting in March - August
  52. This brings this presentation to a close
  53. Think of each of the 10 ingredients as individual climbers. Similar to the climbers in these pictures each “ingredient” is tied to one another. Success is for all climbers to start at the mountain base together and to successfully reach the summit together, as a team.
  54. Let me leave you with a few summary thoughts. I would like to thank you for your time and interest.
  55. There is an old saying that I heard early in my laboratory career…. Few have been bitten by an elephant but almost everyone has been bitten by a mosquito. Basically what this means is that it is the most frequently ordered tests that will bite you if they are delayed, not the big expensive esoteric send-outs.