Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Process Improvement - 10 Essential Ingredients

1,820 views

Published on

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

Published in: Business, Technology
  • Be the first to comment

Process Improvement - 10 Essential Ingredients

  1. 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. 2. PresentationPresentation OutlineOutline AvailableAvailable OnlineOnline Copyright© 1999-2010 Management Decision Systems, Inc. 2http://mandecsys.com/labconfab/SPI10Ingredients.pdf
  3. 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. 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. 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. 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. 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. 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. 9. Hospital Department SiloHospital Department Silo Copyright© 1999-2010 Management Decision Systems, Inc. 9
  10. 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. 11. #2 Understand The Customer House of Quality Copyright© 1999-2010 Management Decision Systems, Inc. 11 “Must understand customer’s needs & priorities!”
  12. 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. 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. 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. 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. 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. 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. 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. 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. 20. Grocery Store Vs. LaboratoryGrocery Store Vs. Laboratory Copyright© 1999-2010 Management Decision Systems, Inc. 20 #5 Design Space to Optimize Production continued
  21. 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. 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. 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. 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. 25. Copyright© 1999-2010 Management Decision Systems, Inc. 25 Chemistry Chemistry Hematology Coagulation Urine Pediatric Laboratory – Core FocusPediatric Laboratory – Core Focus
  26. 26. Pediatric Laboratory – Core FocusPediatric Laboratory – Core Focus Copyright© 1999-2010 Management Decision Systems, Inc. 26
  27. 27. A Black Belt Examines a SiloA Black Belt Examines a Silo Copyright© 1999-2010 Management Decision Systems, Inc. 27
  28. 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. 29. #6 Instrumentation Copyright© 1999-2010 Management Decision Systems, Inc. 29 “Optimal test throughput & required staffing is usually established by the manufacturer”
  30. 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. 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. 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. 33. #7 Eliminate Process Bottlenecks Copyright© 1999-2010 Management Decision Systems, Inc. 33 “Swim Lane Process Diagraming”
  34. 34. Copyright© 1999-2010 Management Decision Systems, Inc. 34 “Ishikawa Diagram” #7 Eliminate Process Bottlenecks
  35. 35. #7 Eliminate Process Bottlenecks Copyright© 1999-2010 Management Decision Systems, Inc. 35 “Value Stream Mapping”
  36. 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. 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. 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. 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. 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. 41. #8 Establish Performance Metrics Copyright© 1999-2010 Management Decision Systems, Inc. 41
  42. 42. #8 Establish Performance Metrics Copyright© 1999-2010 Management Decision Systems, Inc. 42
  43. 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. 44. #9 Reduce Error & Variation Copyright© 1999-2010 Management Decision Systems, Inc. 44
  45. 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. 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. 47. #9 Reduce Error & Variation Copyright© 1999-2010 Management Decision Systems, Inc. 47 Cadence - balanced, rhythmic flow
  48. 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. 49. #10 Performance Visualization Copyright© 1999-2010 Management Decision Systems, Inc. 49 “Quickening through visualization”
  50. 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. 51. #10 Performance Visualization Copyright© 1999-2010 Management Decision Systems, Inc. 51 “Pediatric Laboratory” 1 Hr. 30 Min. Difference
  52. 52. #10 Performance Visualization Copyright© 1999-2010 Management Decision Systems, Inc. 52 “Pediatric Laboratory”
  53. 53. #10 Performance Visualization Copyright© 1999-2010 Management Decision Systems, Inc. 53 “Pediatric Laboratory”
  54. 54. Silo Process ImprovementSilo Process Improvement Copyright© 1999-2010 Management Decision Systems, Inc. 54 No such thing as "Just A Lab Project"
  55. 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. 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. 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. 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.

×