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  • September , 2009September , 2009

    Slashing Pap Smear Turnaround Time with Lean to Gain Competitive

    Market Advantage

    Slashing Pap Smear Turnaround Time with Lean to Gain Competitive

    Market Advantage

    Presenters:Ginny Blake, Quality Coordinator, Baystate Reference Laboratories (BRL)

    Jason Newmark, Director, Baystate Reference Laboratories (BRL)

    AgendaAgenda

    I. IntroductionII. BaystateHealth(BH)OverviewIII. BHCaseStudy:CytologyPAPTATIV. LessonsLearnedV. NextSteps

  • Thekeytosuccessistoquittalkingandbegindoing.

    WaltDisney

    Whydowedowhatwedo thewaywedo?Whydowedowhatwedo thewaywedo?

  • Number #5

    SHRUG

    Number #4

    NO TIME

  • Number #3

    NOT MY JOB

    Number #2

    BLANK STARE

  • Number #1

    WEVE ALWAYSDONE IT THIS WAY

    DatadrivenandMeasurableContinuousandProactiveTeamworkandAccountabilityPatienceandPersistenceTrialandErrorImaginationSeeing andAccepting theopportunities

    Makeidentifyingopportunitiesforimprovementapriorityandrememberthatatthemostbasiclevel,performanceimprovementis:

    Makeidentifyingopportunitiesforimprovementapriorityandrememberthatatthemostbasiclevel,performanceimprovementis:

    Startdoing

  • II.BaystateHealth(BH)Overview

    BaystateHealth(BH):3HospitalIntegratedDeliveryNetworkMaryLaneHospital/FranklinMedicalCenter/BaystateMedical Center800 950Beds

    BaystateMedicalCenter(BMC):AcademicMainCampusWesternCampusofTuftsUniversitySchoolofMedicineOnlyLevelITraumaCenterinregion~250300residents&fellows

    BaystateReferenceLaboratories(BRL)/LaboratoryNetwork:>4.5MillionBillableTests/Yr65%ofvolumeexternaltohospital480FTEs,>600+people23Pathologists2,300ProvidersServiced26+PatientServiceCenters

    II.BaystateHealthOverview

  • BaystateReferenceLaboratoriestookaleadroleinLEANInitiatedfirstformalLEANprojectsHeldShowcaseofExcellence topromote/presentprocessesandresultsacrossdepartmentandorganizations

    Momentum CommittedTimeandResourcesEngagedconsultanttofacilitateonsitetrainthetrainerLEAN/PIprogram(participantshadlittletonoexperiencewithLean)4projectsidentifiedwithassociatedleadstaffKICKOFFNOV8,2008

    II.BaystateHealthOverview(cont.)

    EmbracingLean ConceptsEmbracingLean Concepts

    III.BHCaseStudy:CytologyPAPTAT

  • FullServiceCytopathologyLabPerformsapprox62,000paps/year21FTEs

    Average10+yearsofexperienceHighlevelofsatisfactionandprideinqualityLowturnoverrates

    7CytopathologistsNationallyrecognizedMedicalDirectorResidents/Fellows

    III.BHCaseStudy

    CytopathologyDepartmentOverviewCytopathologyDepartmentOverview

    PrimaryPlayersBRLNEPA(PathologyGroup);affiliatedwithlocalhospitalQuest

    Providersarefiercely loyaltolocalhospitals;however,thereissomeopportunitytowin referralsthrough:

    ServiceQualityConsistencyAccess

    III.BHCaseStudy(cont.)

    WesternMACytopathMarketWesternMACytopathMarket

  • Changeinleadership=operationsviewedfromanewperspective

    BRLInterimDirector consultant(Leanexpert)BRLNewDirector hiredfromoutsideBaystateNewAnatomicPathologySeniorManager

    Provider/Clientperceptions=extensivelylongPAPTATvs.competitors TAT< 3days=threateningtoleave!Truth!=95%PAPscompleted

  • LackofawarenessofcustomerperceptionOurturnaroundtimesaregood,wecantgetanybetterStaffcantworkanyharderItsallbeendonebefore youwontfindanythingnewthatwillimproveTATDisbelief/denialthatcompetitorscouldachieveshorterTATs

    CytologyandBRLstaffperceptionsCytologyandBRLstaffperceptions

    III.BHCaseStudy(cont.)

    Ifthecompetitioncandoit,Ifthecompetitioncandoit,

    wewe candoitcandoit

  • StartHere

    III.BHCaseStudy(cont.) ProcessImprovement:LeanKaizenEventRoadmap

    BusinessCase

    ClarifyProblem

    Identify&MaptheProcesses IdentifyPain

    Points/Causes

    Brainstorm&PrioritizeSolutions

    SelectSolutions&DevelopShouldBe map

    IdentifyMeasure(s)toTrackSuccess

    ActionPlan/NextSteps

    Inputs Outputs

    ListentothevoiceofthecustomerCustomerperceivedTATfromdateofcollection

    OurAHA! Moment(SIPOCActivities)

    OurAHA! Moment(SIPOCActivities)

    III.BHCaseStudy(cont.)

    Supplier Input Process Output Customer NeedsRequire-

    mentsMeasure-

    ments

    Physician PAP Results Physician ResultsAccurate Results TAT

    Patient Specimen Fast Results

  • Realizationofall processesinvolvedinturnaroundtimeFrontEnd processesimpactonPapTATBottlenecksatregistration,accessioning,andtransferofslidestocytotechnologistsHighlightedtimespentwaitingformypart oftheprocess

    Whyareweoperatingthisway?

    MappingtheProcessMappingtheProcess

    III.BHCaseStudy(cont.)

    III.BHCaseStudy(cont.) CauseandEffect

  • 1. Resolvingproblemsownedbyanotherdepartment(e.g.,duplicatemedicalrecordnumbers)

    2. Maintainingapapertrailoffinalreports3. Limitedcrosstraining4. Lackofcommunicationbetweenworkareas:workinginsilos5. Registrationprocesslongandcumbersome6. Haltingtheprocesstoinvestigate/resolveproblemsatfrontend7. Greater#ofQCsperformedthanrequired8. PerformanceofQCsdesignatedto2positions9. Papsregisteredafterprocessingmissingslidesdifficulttotrack10. Absenceofpersonalproductivitygoalsandoractivemonthly

    monitoring

    III.BHCaseStudy(cont.)

    Top10List(IdentifiedIssues)Top10List(IdentifiedIssues)

    III.BHCaseStudy(cont.)SOLUTIONS

    III.BHCaseStudy(cont.)SOLUTIONS

    Solution Criteria MatrixSolution Criteria Matrix

    Complexity vs. TimeComplexity vs. TimeImpact to outcome Impact to outcome Actions implementable within 60Actions implementable within 60--90 day?90 day?

  • TrialedChangesWeekly not onaMondayorFridayCommunicatedchangesEncouragedstaffinput/tweakingRemainedflexible

    III.BHCaseStudy(cont.)

    BrainstormingsolutionsandenactingchangesBrainstormingsolutionsandenactingchanges

    COMMUNICATIONCOMMUNICATIONCOMMUNICATION

  • TeammemberswithcoworkersInputChanges

    FacilitatorwithprocessOwnerProgressupdateSupport/Recognition

    TeamwithChampion/SponsorRoadblocksResources

    III.BHCaseStudy(cont.)

    andmorecommunication! andmorecommunication!

    Reducedbottlenecks:Sentrequisitionswithproblems(missingorincompleteinfo,illegible)toonepersonforfollowuptoeliminatebackups/batchingReorganizedstaffing adjustedhours toregisterbulkofpapsonD.O.C.(2nd shift)Eliminatedinvestigationofduplicatemedicalrecordnumbers sendtoMedRecforfollowupCrosstrainedRegistration/PrepStaffReducedtheQC%volumeby7%

    StrategiesInActionStrategiesInAction

    III.BHCaseStudy(cont.)

  • TrainedalleligiblecytotechstoperformQCIncreasedto2timesdailytheavailableQCslidesputupforreviewUtilizedpostitsforreqswithillegiblehistoryUtilizedtechnology:eliminatedprintingandfilingofhardcopiesofthefinalreportImplementedpersonalproductivitymonitorsPostweeklyturnaroundtimes

    StrategiesInAction(cont.)StrategiesInAction(cont.)

    III.BHCaseStudy(cont.)

    PAP TAT - Percent Completion From Accession in Lab to Result Available

    0

    20

    40

    60

    80

    100

    Q1 08 Q2 08 Q3 08 Q4 08 Q1 09 Q2 09*

    Jun15-30

    Jul 1-15

    Jul15-22P

    erce

    nt o

    f Cas

    es C

    ompl

    eted

    1 DAY TAT2 DAY TAT3 DAY TAT5 DAY TAT

    III.BHCaseStudy(cont.)

    ResultsResults

  • 3DayTAT:67%to100%PAPscompletedin3Days33%Improvement

    2DayTAT:39%to98%ofPAPScompletedin2Days59%improvement

    1DayTAT:16%to85%ofPAPScompletedin1Day69%improvement

    III.BHCaseStudy(cont.)

    Results(cont.)Results(cont.)

    AncillaryResultsImprovedHPVTATImprovedTrackingExpenseSavings

    Soft ResultsTeamworkAcrossDept(inclPathologists)CelebrationandPride(improvedemployeemorale)RecognitionBRLandSystemLeaderDirectClientFeedbackLearnedastructuredapproachtosolvingproblems

    III.BHCaseStudy(cont.)

    Results(cont.)Results(cont.)

  • RECOGNITIONRECOGNITION

    LEANSHOWCASEJAN2009LEANSHOWCASEJAN2009

    VI.LessonsLearned

  • ItsKindofFuntodotheImpossible

    WaltDisney

    Employeeswerereally engaged(andledproject)ResourceswereallottedforprojectChangesweretrialedbeforeimplementingCommunicationboardpostedforALLstafftoreviewandprovideinputthroughoutprojectSponsor/championswereengagedandsupportiveCelebratedsuccess/evenbabysteps

    IV. LessonsLearned

    WhatWeDidWellWhatWeDidWell

  • Lotsofsmallpotatoes canreallyimpacttheoutcomeKeepintunewiththevoiceofthecustomerJustbecausewealwaysdiditthatway doesntmeanwehavetocontinueRelinquishingcontrolandallowingstafftobeengagedbenefitseveryone!Findingthetime formeetingsactuallyresultsinsavedtimeLimitScopeandsetrealisticgoalsHavefun!

    IV. LessonsLearned(cont.)

    KeystoSuccessKeystoSuccess

    V. NextSteps

  • 1. ContinuetomonitorperformanceReportCard2. Implementenhancedtechnologies3. IncorporateLeaninCytoLabrelocation(Winter2009)4. Encourage/stressteamworkandinvolvement5. Ensureconsistencyofprocessesandpractices

    V.NextSteps Cytology

    1. MakeLeanpartofculture2. KeepLeanAlive FacilitatorSkillsTraining3. Befrontrunner fororganization4. CreateadditionalPerformanceImprovementTeam

    positions5. Gainadditionaleducation/trainingANDattendnational

    conferences(alaLabConFab!)

    V.NextSteps Lean

  • Bringonthenextchallenge!Bringonthenextchallenge!

    Questions

    Jason NewmarkJason.newmark@bhs.org

    (413) 794-1731

    Ginny BlakeVirginia.blake@bhs.org

    (413) 794-1838