Sutter Solano Laboratory
Lean Six Sigma Project
“Getting Our Ducks In A Row”
Joe Wells, MT, MA, Laboratory Supervisor
Progress as of July 22, 2008
Business Process ManagementKey Process Mapping
Clinical Laboratory Processes
Pre-Analytical Process
Analytical Process
Post Analytical Process
Labeling
Collection
Delivery
Receiving
Specimen Processing
Define: ProcessExpressSM Project Charter
Business Case: Expected laboratory turnaround times are not being met
for ER samples and early morning draws. This impacts laboratory customer satisfaction, patient care and finances.
Problem Statement Sutter Solano laboratory is not consistently meeting stated
turnaround times for ER samples and early morning draws. Variability in testing turnaround times is resulting in customer dissatisfaction.
Results for early morning draws should be on the charts by 7:30am for ICU and 8 am for Med/Surg.
Target= 95% 2007 Average= 85%
Organizational Pillars Service
TAT AM & ER Physician & Patient Satisfaction
Quality Reporting Timeliness Order entry errors Drawing Issues
Finance Workload Balance Variance Overtime
People Employee Satisfaction (EOW)
Growth Community
Define: Process Map Routine AMRoutine AM Run
Tests ordered
STAT?
Morning Run prints at 4:30
am
Sort by floor in blue bin
Sort by patientGet Cart
Is Cart Ready?
Stock Cart Go to Floor
Is there a Button on
Patient Name?
Nurse Collect
Draw
No
Yes
Yes
No
Transport to Laboratory
Sort Samples
Receive (Batch)
Is there additionalprocessing
necessary??
Deliver to Tech Workstations
Centrifuge
Has Specimen
been collected?
Yes
No Put 10:00 am on Collection
time
Fishbone & Brainstorming Notes
Root Causes Supported by data Phlebs start time does not allow
for completion by goal time Many ER calls for draw
throughout the day
Initial “Just do its”• List of patients with lines on floor• Pick up of specimens by morning CLSs• ER sample rack• Share patient satisfaction survey comments at staff meetings• Eliminate 2 sets of labels printing• Labels for UA sent to departments: 2-3 labels• STAT notification: Dynamic pending log• Quick reference on floors for order codes• Update physician phone directory• Back time (duplicate) IT fix• Provide charge nurse cell phone number for critical values
Process imperatives
• Communication of PIC line patients is key to decreasing time in early morning draws
• Batching in early morning rounds needs to be reduced
Measure: Phone Calls
Majority of phone calls deal with:Transfer, Information or Results
Improve: Brainstorming Results● Weekends should be staffed
as weekdays (7)● Autoverification (6)● If ER prints order just go (6)● Nurse education (6)● CLS help if phlebs are short
(5)● Schedule break times (5)● Use volunteers to run ER
samples to lab (5)● Monitor for pending draws (4)● Critical value call process (4)● Lab personnel in ER during
peak times (4)● Change phleb times (and
possibly techs) to start earlier (4)
Revise parameters for 8am TAT report
Buttons for line draws on floors Add ons added as a test Stat spin centrifuge for coag Have dedicated person to
receive labs in computer Second microscope set for AM
diffs Have techs drawing pre-AM
ask if can combine draws Scanners for quick entry Redesign of Heme and Chem
(in process) Slidemaker/Stainer Add call in phlebs
Dynamic Pending Monitor
Standardized Phlebotomy Carts
Improve: Solutions Implemented
Improve: Additional “Aha” Moments and
“Just Do It’s”
Fix lab intercomI-Stats in ER (Go-Live July 30, 2008)Phlebotomy carts standardized and ready
for use in AM2-way cell phone for ER communication
(Coming soon!)Regular pick up times on floors for early
morning draws and nurse drawsGetting current SRMF list of doctors
How We Track Our Success- Daily Report
Daily metrics tracking keeps everyone focused
Share Results & Celebrate!
Week Of July 20, 2008
71
98 99 98 93 92 100 92
020406080
100
Mon
TuesW
edThu
rFri
SatSun
Week
% of TestsCompletedon Time
95% Target
TAT target goal of 95% achieved, significant improvement from 2007
average of 85%
8am Turnaround Time Data Since Beginning of LSS Project (1/6/08)
91
83
89
9694
84
91
79
91
84 85
79
91
88
83
88
64
87
90
9496
98
93
98 97
9496 96
92
98
95
989695
60
65
70
75
80
85
90
95
100
1/6/
2008
1/20
/200
82/
3/200
82/
17/2
008
3/2/
2008
3/16
/200
83/
30/2
008
4/13
/200
84/
27/2
008
5/11
/200
85/
25/2
008
6/8/
2008
6/22
/200
87/
6/200
87/
20/2
008
8/3/
2008
8/17
/200
8
Week
% T
arg
et
Me
t
Between 1/6/2008 and 4/13/2008, the standard deviation was 5.4 and between 5/25/2008 and 8/17/2008 the standard deviation was 2.4.
This represents a 54% reduction in the process variation.
Patient Satisfaction Scores
2008 Inpatient Satisfaction Scores for Courtesy of Person that Took Blood Since
Start of Lean Six Sigma Project
020406080
100
Janu
ary
Februa
ry
Mar
chApr
ilM
ayJu
ne July
Augus
t
Septe
mbe
r
Octo
ber
Novem
ber
Decem
ber
Month
Per
cen
tile
Ran
k
Improved patient satisfaction percentile rank from 15 to >60 within
six months
Before After
Reducing Waste: 5 S Applied to Lab Closet
Kan-Ban in Lab Supply Closet
BeforeAfter
Lessons Learned
Keep employees informed-communicate the good, bad and the ugly along with the project goals
Make sure everyone knows their role and are included in the decision processes
Simple rewards and reminders keep everyone aware that the process is always active-never stops just because we hit the mark
Advertise to the facility-share the information and get other departments involved (IT, nursing, physicians, other hospital staff)
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