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Evaluation of Newborn Screening Production Processes
Andy Rohrwasser, PhD, MBA (for all of Utah Newborn Screening)
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How does the system perform?
How can we improve? Can we grow and if so, how?
How can we advance – technology perspective?
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Why is this important?
• On-time testing is critically important • High scrutiny as a public service provider • Competition • Scientific advancement is the basis for new service
offerings • New testing mandates emerge constantly (SCID, CCHD,
LSDs, XALD)
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NBS Processes – (typical) incomplete perspective
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Incomplete perspective – continued
Sample Collection & Logistics Sample Receiving Sample Testing Follow-up
care coordination
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Beyond Silos: A customer centric system approach Who is really the customer? What exact value do we
provide?
Sample Collection & Logistics
Sample Receiving Sample Testing
Follow-up care coordination
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1. Eliminate Silo-Perspective, adopt system view
2. Assess all steps and their respective utility in the overall process together with all parties involved (sample receiving, lab, follow-up, IT, finance)
3. Redesign Processes across silos
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4 Sub-Processes
Sample Collection & Logistics Sample Receiving Sample Testing Reporting/Follow-up
coordination
TAT: 0.1 – 1.25 days
TAT: 0.8 – 6 days
TAT: 0.8 – 1.3 days
TAT: > 1day
Bottleneck Bottleneck No bottleneck
Close to capacity limit Mondays
Overall process: outside CDC recommendations for >40% customers
No bottleneck Close to capacity limit
Mondays
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Process Improvements & Focus on the Biggest Problem
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Logistics: Where and Why so long?
• Tabulate TATs • Convert zip codes into relative distances • Convert corporate status into variable
• Multiple regression analysis/ANOVA
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High pay-off solution: FedEx Partnership Courier Service for Hospitals with > 3days TAT
TAT: from 4.14 days to 2.9 days; costs $19,832
Transport time t = f(distance, corporate status); p < 0.005
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0
0.5
1
1.5
2
2.5
3
3.5
low medium high Utahaverage
Tran
sit T
ime
[day
s]
Hospital Category by Birth Volume
2014
2013