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Transcript of 1 Process Improvement. Process Improvement-Module 152 Learning Objectives At the end of this module,...
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Process Improvement
Process Improvement-Module 15 2
Learning ObjectivesAt the end of this module, participants
should be able to: Relate the historical perspective of
process improvement. Describe the importance of process
improvement in maintaining quality. Explain the need for tools to monitor
laboratory processes.
Process Improvement-Module 15 3
Scenario
You have implemented CD4 testing in the
laboratory. Staff are trained and
comfortable using it. It has been
validated, test results are being reported
and it “seems” to be working well.
How do you know that the test is
working well and will continue to work
well in the future?
Process Improvement-Module 15 4
The Quality Management System
Organization Personnel Equipment
Purchasing &
Inventory
Process Control
Information Management
Documents&
Records
Occurrence Management Assessment
Process Improvement
Customer Service
Facilities &
Safety
Process Improvement-Module 15 5
W. Edwards Deming14 Points for Quality
create constancy of purpose for improvement
improve constantly and forever
Two points address continual improvement:
Process Improvement-Module 15 6
The Deming Cycle
Act
Plan
Do
Check
Process Improvement-Module 15 7
Continual Improvement(ISO 15189:2007)
develop plan for
improvementidentify potential sources of error
implement
review the effectiveness
of action
adjust the action plan
and modify the
system
Process Improvement-Module 15 8
Conventional Improvement Tools
internal audits external quality assessment external audit and accreditation management review opportunities for improvement quality indicators
Process Improvement-Module 15 9
Monitoring Quality
Quality Plan
Internal Audit
External Audit
Quality Control
Quality Goal
Opportunities for improvement
QualityAssessment
Monitoring Monitoring Monitoring
Process Improvement-Module 15 10
Optimizing space, time, and activity to improve the physical paths of workflow.
Lean
New Trends-Improvement Tools
Process Improvement-Module 15 11
Path of workflow and maintenance by blood culture technologist
Pre Lean Post Lean
Process Improvement-Module 15 12
New Trends-Improvement Tools
Six Sigma A formal structure of project planning to implement change
and improvement.
Process Improvement-Module 15 13
Structure in Six Sigma Organized processes to assist in decision
making for continual improvement:
control define measure analyze improve
Process Improvement-Module 15 14
What is Quality?
“Quality is defined asconformance to requirements, not as 'goodness' or 'elegance'.”
Philip CrosbyFour Absolutes of Quality Management 1979
Process Improvement-Module 15 15
Quality Indicators Definition
Established measures used to determine how well an organization meets needs and operational and performance expectations.
ISO 9001:2000 (5.4.1; 8.4)ISO 15189:2007 (4.12.4)
Process Improvement-Module 15 16
So…Quality Indicators
indicate performance determine quality highlight concerns identify areas needing further study track changes over time
Process Improvement-Module 15 17
Measuring Performance fewer quality indicators are better link to factors needed for success based on customer and stakeholder
needs start at the top flow down change with changing environment
and strategy have targets or goals based on
research rather than arbitrary values Mark Graham Brown
Process Improvement-Module 15 18
Eight Steps to DevelopingSuccessful Indicators
1. objective2. methodology3. limits4. interpretation5. limitations6. presentation7. action plan8. exit plan
Process Improvement-Module 15 19
The BIG SECRET for Quality Indicator Team
Engage the folks who do the work,
because they know what
they do!
Process Improvement-Module 15 20
Characteristics
Timedshort and long term
Timedshort and long term
Engagingall levels
Engagingall levels
Balancedfull cycle
Balancedfull cycle Actionable
action orientedActionableaction oriented
Interpretablespecific
Interpretablespecific
Achievablecontained
Achievablecontained
Measurableobjective
Measurableobjective
GoodQuality
Indicators
GoodQuality
Indicators
Process Improvement-Module 15 21
Keeping Score
“Many organizations spend thousands of hours collecting and interpreting data. However many of these hours are nothing more than wasted time because they analyze the wrong measurements, leading to inaccurate decision making.”
Mark Graham BrownUsing the Right Metrics to Drive World Class Performance
1996
Process Improvement-Module 15 22
Computer Nonsense Indicators
[urine culture] * [glucose] * [INR]
[NUPA hr] * [Telephone minutes] X100
Just because a computer can
calculate a value, doesn’t mean that it should.
Process Improvement-Module 15 23
Quality Indicators ExamplesSystem Preexam -Examination- Postexam
test order accuracy and appropriateness
patient identification adequacy
accuracy of point-of-care testing
critical values reporting
turnaround time
clinician satisfaction
accuracy of sample information
cervical cytology/biopsy correlation
clinician satisfaction
clinician follow-up
clinician follow-up
diabetes monitoring
hyperlipidemia screening
blood culture contamination
Process Improvement-Module 15 24
40 60 80 100
Proficiencytesting
Qualitycontrol
Competencypersonnel
Result turnaround time
Patient ID
Most common indicators tracked (%) 2005
Reference: Hilborne L. Developing a core set of laboratory based quality indicators. IQLM Conference; 2005 Apr 29.
Process Improvement-Module 15 25
Caution Theoretically, patient outcome indicators
best assess quality, but are the
most difficult to measure. too many variables require large amounts of data need extended collection periods
David HsiaMedicare Quality Improvement Bad Apples or Bad Systems? JAMA. 2003;289:354-356.
Process Improvement-Module 15 26
Essentials for Implementation
Continual Improvement
CommitmentPlanningStructureLeadership Participation and Engagement
Process Improvement-Module 15 27
Planning
Consider: root causes of error
risk management
failures and potential
failures and near-misses
costs, benefits, and
priorities
costs of inaction
Errors?
Failures?Benefits?
Priorities?
Process Improvement-Module 15 28
Leadership
Fosters the culture for improvement: openness that others
have good ideas commitment that
improvement will occur opportunity that staff
can participate
Process Improvement-Module 15 29
Participation management does
not always know what workers know and do
continual improvement requires leadershipand team participation
Process Improvement-Module 15 30
Quality Improvement Activities
One project every 6 months.
Set a timeline.
Process Improvement-Module 15 31
Quality Improvement Activities
Use a team approach.
Involve bench-level staff.
Process Improvement-Module 15 32
Quality Improvement Activities
Use Quality Tools
audits reviews EQA OFI indicators Six Sigma lean
Process Improvement-Module 15 33
Quality Improvement Activities
Correct or prevent poor practices
Report progress to management and laboratory staff
Process Improvement-Module 15 34
Quality Improvement Activities
Use available information to study: customer’s suggestions or complaints identified errors from occurrence
management program problems identified
in internal audits
Process Improvement-Module 15 35
Quality Improvement Activities
If possible, design a study so that results can be statistically measured.
Pre lean state for final positive blood culture reports
Post lean state for final positive blood culture reports
Process Improvement-Module 15 36
Quality Indicators and Timing
Use an indicator only as long as it provides
useful information.
Don’t get tied to your indicators.
Process Improvement-Module 15 37
Summary
Plan
DoAct
CHECK
Each step is essential to keep the quality cycle
cycling.
Each step is essential to keep the quality cycle
cycling.
Process Improvement-Module 15 38
Key Messages quality counts
continual improvement is the core of quality management
Process Improvement-Module 15 39
Questions?
Comments?
Organization Personnel Equipment
Purchasing &
Inventory
Process Control
Information Management
Documents&
Records
Occurrence Management Assessment
Process Improvement
Customer Service
Facilities &
Safety
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