workflow consulting for the histology lab, perspectives on safety and efficiency
DESCRIPTION
make better, more informed decisions, workflow consulting for the histology lab, perspectives on safety and efficiency, In this sixty minute lecture with an extended question and answer session you will learn from a leading exert in single piece flow and lean six sigma techniques, participants will learn how a lean practitioner views the histology laboratory workflow with valuable before and after comparisons, you will hear about no cost techniques that could improve the turn around time in your laboratory immediately, start improving the safety quality and efficiency of your histology laboratory todayTRANSCRIPT
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Make Better, More Informed Decisions
One lab can change a patient’s life forever
J. Hylton Surrett, MBA, MHA, LSSMBB
Workflow Consulting Solutions
Ventana Medical Systems, Inc.
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Objectives
Workshop objectives:
1. Review some of the ever evolving challenges in Histology operations and safety
2. Review several examples of typical operational issues as seen through a lean perspective
3. Review a few basic tools and how they impact patient safety, chain of custody and case integrity
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Agenda
• AP industry challenges • See the AP lab through the eyes of a lean
practitioner • What can you start focusing on today• Closing remarks • Open Q&A discussion
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Key challenges for AP labs
• Histology is still a very manual process and therefore hard to scale without adding staff
• Productive plateaus will exist throughout the process since human ability will set both the pace for production but also are the error prevention safety net
• Reducing the number of manual steps and interventions in the histology process is critical to greater efficiency and safety
• Determining the balance between the aspects of histology that are and should be “art” and what should be “automated”
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The AP lab is challenging
One data point from a 2-week study in histology 1
– Close to 30% of cases had manual rework totaling 159 hours or 1.3 FTEs
– 89% of defects were made in the analytic phase
– Approx. 1.5% misidentification rate, 67% of those in slide labeling
– All misidentifications would have been addressed by an integrated identification system
Typical savings found in service businesses 2
– 30–60% reductions in cost (over time)– Cycle time improvements of up to 50%– Capacity recapture of 20% (with no additional
staff)
1 Am J Clin Pathol 2007; 128 p423
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George Group results, Lean Six Sigma for Service
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NEJM Study shows cost of medical error is greater than $500,000
– 1,452 closed claims– 73% that involved medical error received compensation– Average compensation: $521,560– Administrative costs: $52,521-$112,968
Source: New England Journal of Medicine: http://www.nejm.org/doi/full/10.1056/NEJMsa054479#t=articleBackground
A medical error averages >$500,000
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Why are lean approaches necessary?
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Patient case integrityOne study showed that the average AP lab helps 93 patients per day
If One patient becomes 8 Artifacts…thats 744 discrete items every day and 186,000 A
YEAR!
How do we ensure every case’s integrity?
– How many times is each item handled by the lab staff?
– How do we know where all the items are?
– How do we know who did the work and when?
– How do you know when something is lost?Plan A market research study
2,100 lab study, average of 24,000 cases per year, 152M to 330M H&E per year
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Labs battle human error because of the consequences for patients
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Who are we as lean practitioners?
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Lean workflow
•Quality
–Error Reduction
–Consistent results
–Continuous improvement
•Productivity
–Faster turnaround times
–Higher testing capacity
–Streamlined workflow
•Cost Reduction
–Reduce wasteful activities
–Balance workload demands
–Integration and adoption of technology
•Lab Design/Redesign
–Integrate Lean workflow principles
–Increase efficiency by design
–Automate good workflow practices
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Ventana workflow locations
North America
Well over +250 different engagement types ranging from Full Laboratory Workflow assessments to
Targeted Solutions Internationally12
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Increase efficiency
Seamless alignment of automated solutions improves safety and reduces costs.
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See the lab through the eyes of a
Lean practitioner…
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What a lean practitioner sees…..
Many people moving work along in non-linear patterns
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What a lean practitioner sees...
Batch Accessioning where errors may not be caught…
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What a lean practitioner sees...
Batch Cassette Marking and Verification where same tissue types follow
each other
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What a lean practitioner sees...
Batching results with potential for mix-ups
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What a lean practitioner sees...
Manual documentation reduces efficiency
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What a lean practitioner sees...
Illegible Identifiers …Smudged cassettes
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What a lean practitioner sees...
Excessive & Illegible handwriting
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What a lean practitioner sees...
Mismatched specimen and cassettes
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What a lean practitioner sees...
Mislabeled slides lead to errors and rework
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What a lean practitioner sees...
Interruptions may cause mismatching
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Sorting Through MaterialsWhat a lean practitioner sees...
Slides labeled up to 3 times prior to reaching the MD
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So what can I focus on today to address these issues in our lab?
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• Single Piece Flow
• Reducing Touches
• 5s & Visual Controls
• Poka yoke
• Barcoding
AP lab improvement via basic lean principles & enabling technologies
Eliminate Waste
– Errors
– Overproduction
– Wait Time
– Transportation
– Rework
– Inventory
– Motion
– Unrealized Talents
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Single piece flow error rate prevention & technology
An integrated software
solution can help to
prevent & help
eliminate these errors.
Single Piece Flow
Accessioning reduced
slide labeling errors by
<75%
QP094 – Mislabeling Rate of Specimens, Blocks, and Slides in Surgical Pathology 28
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Single piece flowConfidence at each step means free to move forward faster• Improve throughput and turn over time
- 10 to 30% increase
• Create capacity to grow the business by uncovering more productivity
• Less need for scheduled or unexpected over-time
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VANTAGE rework reductionProcess safeguards reduce mistakes and any rework they create
Total annual savings of $298,195
$174,613Data
capture
savings
26%Turnaround
time
$51,090Overtime
savings
$63,492Bar coding
savings
Workflow Consulting Case Study = Reference Lab
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Primary staining without automation
Place basket
into oven
Load basket
on
coverslipper
& start
Unload
basket from
coverslipper
Move
slides to
archive
drawer
Retrieve
& label
slide
Unload
basket from
stainer
Confidential and Proprietary Information
Move slide
to warmer
Place slide
into basket
Travel to
oven
Remove
basket from
oven
Load basket
on stainer &
start
Slide is stained
Slide drying
Move slides
from basket
to folder
Travel to
bench
Travel to
oven
Travel to
stainer
Travel to
bench
Travel to
stainer
Travel to
coverslipper
Travel to
bench
Slide is
coverslipped
Travel to
coverslipper
Travel to
slide sorting
area
Mount tissue
on slide
Dry
Is load
position
occupied?
No
Place basket
next to
stainer
Travel to
bench
Yes
Is basket
in unload
position?
Travel to
benchContinue
other work
Continue
other work
No
Stain
Type of
coverslipping
Automated
Manual Travel to
manual
station
Wait for
cover-
slipper to
complete
run
Is coverslipper
run complete?
Yes
No
Remove slide
from basket
Apply
coverslip
Place slide in
basket
Place label
on slide
Slide is reviewed
by pathologist
Folder
delivered to
pathologist
Order recut?
Yes
NoFolder is
returned to
lab
Recoverslip
necessary?
No
Yes
Retrieve slide
folder
Move slides
from folder to
tray
Travel to
oven
Place tray in
oven
Slides dry
overnight
Travel to
bench
Travel to
oven
Remove tray
from oven
Yes
Coverslip
Review &
Archive
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Automated primary stainingIncreased Consistency & Throughput
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0Mislabeled
slides since
go-live
140Eliminated
manual steps
per day
Increased
productivity
Reduce error, improve productivity
Case study: community hospital
& eliminated handwriting while reducing
dependency on paper
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The 5s system/process
•to separate the needed items from the un-needed items
Sort
•to arrange in a way for how the remaining items will be
usedSet In Order
•to maintain the work area in a clean and orderly fashion
supporting the sorted and set-in-order itemsShine
•to replicate and ensure consistency across all users
Standardize
•to maintain and improve
Sustain
Make errors difficult to create, easy to detect and eliminate the
non-value added activities
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Examples of 5s (before)
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Example of 5s (after)
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LabelerWater Bath
Lamp
Blocks
Slide Holder
Slides Tray
ScannerIce
Materials:
Blades,
Cotton, etc.
Microtome
Tray
Microtome
Vantage
5s improves throughput at the cutting station
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5s improves throughput at
case assembly
Identification & tracking via barcodingBarcodes give you a connection to each sample, cassette and slide
• Real – time visibility at key points in your process
• Provides historical audit trail for every block, slide, and sample
• Supports process reporting for CAP, JCAHO or other agency goals
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The Case for VANTAGE Histology Challenges
Manual & paper processes
The Case for VANTAGE Histology Challenges
Manual & paper processes
Limited or no process data
The Case for VANTAGE Histology Challenges
Manual & paper processes
Limited or no process data
Limited or no system integration
Manual & paper processes
Limited or no process data
Limited or no system integration
Opportunity for error
The Case for VANTAGE
Histology Challenges
The Case for VANTAGE Histology Challenges
VANTAGE Workflow Solution
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Case studies: Create a safer, effective,
efficient lab environment
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• Tandem microtomists sit in mirror image of each other
• Single case flow improves case-specific TAT, quality
Improve throughput
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• Save time and reduce errors associated with stopping and starting work at Embedding and Microtomy workstations
Organize Accessories
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• Reduce case set-up and preparation by 2 hours per day
Improve visual controls
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• Visual slide marker marks spot where slide was removed; facilitates faster, accurate slide replacement
Reduce lost slides in archiving
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• Create linear histology workflow to increase TAT
36/15
PathologyLab
Symphony Symphony
Buy SmartDraw!- purchased copies print this document without a watermark .
Visit www.smartdraw.com or call 1-800-768-3729.
Improve specimen flow
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Improve reflex testing and consult flowAdvanced Staining Bench
• Advanced Stain orders are printed
• HT picks up the order(s) & pulls as required
• Block(s)
• Unstained slide(s)
• Controls (if not TMA appropriate)
• Consult cases
• HT places in empty slide tray for case integrity
• Order is QC’ed and any additional slides required (negatives) are
ordered and staged for pick-up by HT
Consult Cases
LIS Terminal (QC)
Block &
Unstained
Slide
Staging
Control
Pull
Station
PrinterConsult
Cases
To Microtomy
Advanced Stain Cases
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• Lab runner, water spider establishes continuous flow
• Reduces 356 ft/case or 38% of total distance traveled
Microt
omy
Microt
omy
Microtomy
Microtomy
Embe
dding
Speci
al Stain
ers
Gross
ingGr
ossing
Grossing
TPTPTPTP
TP
TPTP
Microt
omy
Case
Assem
bly
H&E S
taining
Recut
s and
Speci
als
XTXT
XT
XT
XTUL
TRA
SS
SS
SSSS
SS
SS
Reduce bottlenecks, increase TAT
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Open Q&A Discussion
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Closing Remarks
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I need to reduce errors and risk...
I need to increase my quality tracking documentation…
I need to increase my staff’s efficiency…
What reason resonates with you?
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99.7%Reduction in
mislabeled
slides since
VANTAGE go-
live
& improved staining quality and consistency
1,100Eliminated
manual steps
saving 5
hrs/day
25%Reduction in
duplicate
slides resulting
in rework
Reduce errors, streamline operations
Case Study: Reference Lab
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& annual savings of $298,195
$174,613Data capture
savings
26%Turnaround
time
$51,090Overtime
savings
$63,492Bar coding
savings
Reduce costs with VANTAGE
Case study: reference lab
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Business
Non Value- Added 30%
Non-Value Added 65%
Value- Added 5%
A typical workflow process
Before Leaning a process, most activities are NVA
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Primary staining without automationTypical H & E Stainer Supported Process
Place basketinto oven
Load basketon
coverslipper& start
Unloadbasket fromcoverslipper
Moveslides toarchivedrawer
Retrieve& label
slide
H&E Workflow with Symphony Steps
Unloadbasket from
stainer
Confidential and Proprietary Information
Move slideto warmer
Place slideinto basket
Travel tooven
Removebasket from
oven
Load basketon stainer &
startSlide is stained
Slide drying
Move slidesfrom basket
to folder
Travel tobench
Travel tooven
Travel tostainer
Travel tobench
Travel tostainer
Travel tocoverslipper
Travel tobench
Slide iscoverslipped
Travel tocoverslipper
Travel toslide sorting
area
Mount tissueon slide
Drying
Is loadposition
occupied?
No
Place basketnext tostainer
Travel tobench
Yes
Is basketin unloadposition?
Travel tobench
Continueother work
Continueother work
No
Staining
Type ofcoverslipping
Automated
Manual Travel tomanualstation
Wait forcover-
slipper tocomplete
run
Is coverslipperrun complete?
Yes
No
Remove slidefrom basket
Applycoverslip
Place slide inbasket
Place labelon slide
Slide is reviewedby pathologist
Folderdelivered topathologist
Order recut?
Yes
NoFolder isreturned to
lab
Recoverslipnecessary?
No
Yes
Retrieve slidefolder
Move slidesfrom folder to
tray
Travel tooven
Place tray inoven
Slides dryovernight
Travel tobench
Travel tooven
Remove trayfrom oven
Yes
Coverslipping
Review & Archiving
Hylton Surrett, MBA, MHA, MBBSenior Manager, Advanced WorkflowMobile: (520) 306 - 0589Fax: (520) 299 - [email protected]
Contact information