Inventing the Mini-Lean Model To Achieve Fast, Lean, Efficient Results

Transcription

1 Inventing the Mini-Lean Model To Achieve Fast, Lean, Efficient Results Hannah Poczte, MPH, DLM (ASCP) Assistant Vice Pesident of Laboatoies Six Sigma Geen Belt Ed Giugliano, PhD Poject Diecto, Laboatoies Six Sigma Black Belt 1 New Jesey Manhattan Staten Island Rockland Westcheste Bonx Queens Booklyn Nassau Noth Shoe-LIJ Oveview Suffolk Key: Health System Hospital Competito Hospital 15 Hospitals* -3 Tetiay -10 Community -Childen -Psychiatic 16 Long Tem Cae Facilities* Home Cae (539,800 visits) Hospice Coe Lab Ambulance Tanspot Reseach Institute -200 Scientists -$36 Million in Gants * Includes affiliates 31% Maket Shae 5.5 M Population Seved 1.7 M Ambulatoy Visits 239,400 Dischages 473,100 Emegency Visits 1,216 Residents -99 Residency Pogams -5 Medical School Affiliations -1,300 Medical Students 7,500 Nuses 8,000 Physicians 1,380 Faculty $4.5 Billion in Revenue 3 d Lagest Secula Health System in U.S. 38,000 Employees -L.I. s Lagest Employe Ambulatoy Cae Netwok Physician Netwok Developing a Medical School in Patneship with 2 Hofsta Univesity 1

2 Geetings fom Long Island, New Yok NSLIJHS Laboatoies Coe Lab Business Lines Opeating Statistics $221 Million Annual Opeating Budget 17 Million Billable Tests 1400 FTEs 2 Fee Standing Cental Labs Coe Lab and SI 9 Hospital Based Labs 28 Patient Sevice Centes Business Line $$ Volume Hospital $42.6M 3.6M Refeence 3.0M 0.1M Physician Office 38.1M 2.9M Nusing Home 3.0M 0.3M Clinical Tials 2.0M 0.2M Total $88.7M 7.1M 3 Impoving NSLIJHS Laboatoies Opeational Pefomance The NSLIJHS Laboatoies has successfully adopted vaious Six Sigma, Lean and FTD methodologies to impove opeational pefomance, quality of Lab testing and incease custome satisfaction though the yeas. 4 2

3 Fom Theoy to Pactice Six Sigma Data diven, statistically validated methodology fo quality measuement and impovement based upon custome needs and eduction of vaiation and pocess defects. Implementation time is typically 4-6 months. LEAN Taking the Fat Out pocess impovement methodology focusing on value-added activities and emoval of those activities which undemine optimal pefomance. The Kaizen Event lasts 2-3 days and esults implemented in up to 3 months. FTD Fast Tack Decision making facilitates poblem solving activities with stakeholdes to identify solutions in a compessed time fame (GE Wokout). The FTD meeting equies only hous and esults ae attainable within a month. Mini Lean Combination of FTD and Lean tools in which much of the wok is done behind the scenes to steamline pocesses and identify solutions in a apid time fame. The event can occu within a day and impovements ae implemented within a few months. 5 Lean Pocess Developed a Chate and Contact Sensing Sessions Kaizen Event 2 to 3 days Value Steam Maps Ceated Bainstomed and Pioitized Causes of Waste T.I.M.W.O.O.D Bainstomed and Pioitized Solutions Assessed Solutions Developed Action Plans (WWW) Monitoed Results Repot out at 30, 60, 90 days and Final 6 3

4 When to Use LEAN When you need to - Addess chonic issue - Eliminate excessive waste (T.I.M.W.O.O.D) - Impove a multistep pocess with long cycle times - Incease flexibility and add capacity - Implement a solution quickly - Cut though excessive bueaucacy - Develop a long tem contol mechanism - Assess value added activities - Use eadily available data Don t use Lean fo - Technical poblems equiing complex analysis, igoous poblemsolving methodology o consideable data collection/analysis (Six Sigma) 7 Fast Tack Decision-Making Definition A pocess of concentated team-based decisionmaking and empowement used to esolve issues and impove pocesses A team of expeienced, knowledgeable people with a stake in the issue is chateed to develop solutions and action plans. The team is empoweed by key stakeholdes to poceed with implementation, given a clea eason fo not poceeding, o given a specific diection fo futhe study. The team is accountable fo implementation and follow-up of the action plans. 8 4

5 Fast Tack Decision-Making Pocess FTD FTD Planning Planning Identify FTD topic Assign FTD Lead Facilitato Chate the FTD and contact with Sponso Sensing Sessions to collect data, identify issues and efine the poblem / oppotunity statement Select / efine topic Collect backgound data and detemine topic questions Daw a pocess map, if necessay Design FTD meeting agenda and plan logistics Identify paticipants and communicate expectations Coach / pepae FTD Sponso / Owne FTD FTD Meeting Meeting Sponso sets challenge and expectations Team building Skill building Issue geneation Issue pioitization Facilitate poblemsolving teams Recommendation development Repot Out Teams epot out pesentations Evey idea gets a esponse Individual, team, Owne, and Sponso commitments to action items FTD FTD Follow-up Follow-up Put follow-up mechanisms in place Tack Activity and Results Ove Time Communicate - Headline - Newspapes - Meeting summay - Status epots Remove Baies Recognize and ewad implementation 9 When to Use FTD When you need to - Eliminate unnecessay wok - Impove pocesses involving the key ownes / stakeholdes - Build momentum - Make on the spot decisions - Empowe employees - Open up communication and dialogue - Impove intefaces and emove baies between depatments Don t use FTD fo - Issues ove which paticipants have no contol o do not feel stongly about - Technical poblems equiing complex analysis, igoous poblemsolving methodology o consideable data collection/analysis (Six Sigma) 10 5

6 When NSLIJHS Labs Use Mini-Lean Not Enough Time! Not Enough Money! Not Enough Staff! Not Enough Buy-In! 11 Mini-LEAN Multiple Sensing Sessions Much wok done behind the scenes 1 day Event Max Initial epot out Black Belts mento teams Geen Belts Actively Assist with poject Baseline metics established Monthly Pogess Updates to PI Committee Sustainability achieved by epoting metics monthly 12 6

7 When to Use Mini-Lean An FTD just won t wok Pocess is modeately complex Dealing with an ugent issue Need quick buy-in acoss the boad When a band-aid solution just isn t enough When woking within the constaints of a busy day in the Lab 13 Lean, Mini-Lean and FTD at NSLIJHS Labs Lean Methodology Has Been Used to Steamline Laboatoy Wokflow in RRLs and in the Coe Laboatoy To decease TAT of outine testing to 60min fom point of daw at RRLs To establish a wokflow between MTs and a newly poposed position of Laboatoy Technical Assistant (LTA) at the Coe Laboatoy Mini-Lean and FTD Pocesses Have Been Adopted to Addess Issues Which Aise in the Coe Laboatoy Outpatient Requisition Image Availability Mini-Lean Tacking of Specimens to Micobiology and Molecula Biology - FTD Influenza Sample Tacking Mini-Lean In Pogess 14 7

8 Medical Technologist Lean The Poblem Thee is a citical shotage of MTs. Recuitment is extemely difficult. Ovetime is high as is the System-wide vacancy ate. This tanslates to loweed moal, lack of poductivity and the inability to get wok done quickly. The Goal To emove non-value added, non-technical tasks fom the job desciption of the MT. To ceate a new job categoy which will inteact closely with MTs pefoming tasks histoically eseved fo technologists. MTs will then be able to focus on those tasks which they ae now pofessionally licensed to pefom. The Scope In -Hematology, Coagulation, Chemisty, Special Chem, Seology Out Micobiology, Molecula Biology, Anatomic Pathology 15 Medical Technologist Lean CAP Elevato Speech A team met last month to educe the amount of nontechnical tasks that techs pefom. Ou goal is to enhance ou wokfoce with the newly ceated position of LTA (Lab Technical Associate). The tasks and esponsibilities of this new position ae being addessed. This position should be a benefit to all of the technical staff, allowing us to opeate moe fully as lab pofessionals. You suppot fo this poject will enable the lab to both gow and to continue to delive quality lab sevices now and in the futue. 16 8

9 Med Tech Tasks High Level Pocess Map Pe-Analytic Tasks Analytic Tasks Post-Analytic Tasks Othe Tasks Reagent Inventoy Instumentation statup Pevent Maintenance - Documentation Quality Contol pocess - Toubleshooting - Calibation Find missing samples - Remsta, SSR, Shaed Sample handing - Uine Pou-offs - Timed uine testing Repint Labels Relabel samples Place sample on instument Set up Sed Rates Make slides manually Read diffeentials Make dilutions Check tests odeed Manually pogam tests Review/elease esults Call Citical values Consult with Diecto Pefom calculations Stoe specimens Repint BARC esults Send slide to Path MD Veify elease of esult Retun shaed samples Re-stock woking eagent supplies Communication - Answe phones - Client Sevices Education - Tain students - new analyzes 17 Pioity Payoff Matix Pe Analytical - Heme Payoff/ High Benefit Low Pint ovedue Pou off uines Load consumables Attend to alams Defost mateial Deliveing misdiected samples Sot samples Load instuments Cancel tests Pint labels Remsta Temp. check Centifuge samples Empty stoage acks Stoe eagents in walk in Match slides Make slides fo uines, fluids and Wight stains Hand delive Find specimens duplicate odes Aliquoting Check LASC Inventoy Low Effot High 18 9

10 MT-LTA Wokflow Timeline - Heme 19 The LTA Job Desciption Assists medical technologist/technician with peand post-analytical tasks including pinting pending woksheets, gatheing and pepaing specimens fo analysis and fo pope stoage of specimens upon completion. Assists in the pepaation of eagents, aids technologist/technician in the pefomance of limited peventative maintenance accoding to established pocedues and loads specimens on instumentation

11 The Hematology Plan / Pilot Maximize Poductivity of MTs and Opeational Pefomance Focus on CBC testing and Diffeential pefomance Right-size the numbe of Slide Reades on Day Shift Woking smate by impoving MT/LTA Team Inteactions and wok flow Impove Hematology Sevice Levels to RRLs Pilot LTA is a FT position in the Main Lab The tasks and esponsibilities as outlined peviously Tained and Competency Assessed Adjust wokflow Pilot Metics Ave numbe of diffs ead by technical staff Pecent CBC outlies > than 180 min TAT and % Yield Pecent CBC outlies IP only > 240 min TAT and % Yield Labo cost pe test in Hematology 21 Good Impovement in Ave Diffs/h and TAT Yield! Hematology Metics Day Shift Ave Diffs/h Heme 3 H TAT % Yield CBC Labo Cost/test Baseline Ma $1.39 $1.37 Baseline Ave cost/test = $1.39 Ap $1.30 May $1.46 Jun $1.37 Jul-09 Aug $1.10 $1.18 Cuent Ave cost/test = $ FTE Savings 22 11

12 Chemisty Plan / Pilot Maximize Poductivity of MTs and Opeational Pefomance Focus on Automated and Immuno Chemisty Testing and Lead Testing Wok smate by impoving MT/LTA Team Inteactions and wok flow Impove Chemisty Sevice Levels to RRLs Pilot LTA is a FT Position in the Main Lab Hied Tasks included samples handling, building woklists, pending eview, pou-offs, PM, etc. Initial Taining and competence of LTA was completed 2 weeks late Go-Live date was last month Adjust Wokflow Evaluated and adjusted as necessay Pilot Metics Automated Chemisty 3 hou TAT- pecent outlies geate than 180 min Automated Chemisty 4 hou TAT - IP only % outlies > 240min Immunochemisty 4 hou TAT - the pecent outlies >240 min Blood Lead TAT in hous 23 Chemisty Metics Good Chem Testing TAT Impovement! AutoChem 3 h TAT % Yield ImmunoChem 4 h TAT % Yield Lead Testing TAT In H Baseline Aug Sept Geat Lead Testing TAT Impovement! 24 12

13 MT Lean Outcomes Impovements in TAT Decease Cost/Test and Incease in Capacity Optimized Staffing and Woking Smate Inceased Employee Moale Eliminated Non-Value Added Tasks fom MTs Ceated a Caee Ladde fo Lab Suppot Staff Impoved Oveall Sevice Levels Establish A Best Pactice Model Lessons Leaned to be adopted at othe RRLs 25 Mini-Lean Outpatient Requisition Availability The Poblem A lage numbe of outpatient client equisitions wee not eadily available fo electonic viewing by staff equiing such infomation The Goal 100% of Requisitions Available fo Viewing by 9:00am the following day The Scope Outpatient Requisitions 26 13

14 The OP Requisition Mini-Lean Pocess Sensing Sessions Defined High Level Pocess Map Established the multi-disciplinay team of stakeholdes Identified Geen Belt Collected Baseline Data and Established Metics Set the Agenda Mini-Lean Event Held Half day Event Value Steam Mapping Bainstomed, categoized, pioitized poblems & solutions Assessed Potential Solutions (Pioity Payoff Matix) Moe Fully Developed Metics Action Plan 27 High Level Pocess Map Map Accessioning Req is accessioned then eq checked Poblems to bin and ae addessed late. Completed equisitions ae then filed. Pickup Staff picks up filed equisitions and bings waehouse fo scanning once a day Scanning Pep Reqs soted into piles (single, with attach-ments, etc.), staples emoved, scipts and insuance cads taped on lage pape. Scanning Requisitions ae scanned into imaging softwae. Post Scanning Re-staple and Re-file. Exceptions ae fixed. Bacode issues. Lookup file issues. Manual enty. Repint labels. Rescan. Billing Successfully scanned eqs sent to Billing fo Data Enty Stoage Reqs picked up fom Billing, esoted and boxed fo offsite stoage. Boxes labeled. Stoage vendo ed fo pickup. Speadsheet geneated fo vendo. Sent to Client Sevices Reqs looked up to answe questions. If image missing, call, o fax equest fom to Billing. Night and W/E CS must pull eq themselves. Backup 2hs/week and images unavailable 28 14

15 Pioity Payoff Matix One Pick up Payoff High Benefit Low File equisitions as they ae checked Multiple pick ups fom accessioning Change shift times Lab aid Site visit Reevaluate equipment Investigate softwae Scanne in Accessioning Multiple file extacts Add a scanne Low Effot High 29 Mini-Lean OP Requisition Availability Issues Identified and Resolved Tanspotation Issues Multiple eq pickups fom accessioning File eqs as they ae checked Staffing Issues Change shift times to match eq availability Stat shift ealie to meet am cutoff Assign someone to handle poblem eqs Coss-taining Scan equisitions ove the weekends 30 15

16 Mini-Lean OP Requisition Availability Issues Identified and Resolved Pocess Impovement Decease numbe of fields to be indexed to Pt Name Accession Numbe Multiple File Extacts Scipts & insuance cad copied on 1 page Standadize Requisitions long tem 31 Mini-Lean OP Requisition Availability Outcomes Numbe of Exceptions has Deceased 10-fold Deceasing the indexing citeia fom 5 fields to 2 Fom 1000 s pe day to appox 100 s pe day Pecent of Requisitions Available fo Electonic Lookup by 9:00am has Inceased Substantially Within 1 week impoved fom 0% to aveage of 30% Cuently aveaging of 85% equisition availability Attaining 100% peiodically depending on staffing 32 16

17 FTD - Reduction of Missing Molecula and Micobiology Specimens The Poblem Coe Lab has had an inceased numbe of missing specimens ove the last seveal months many of which wee shaed The Goal Impove tacking of specimens and educe the numbe these missing samples Minimize time spent seaching fo missing specimens The Scope Accessioning, Micobiology and Molecula Depatments 33 FTD - Reduction of Missing Molecula and Micobiology Specimens Sensing Session Identified Depatmental Issues and global issues Quick fixes wee identified and addessed pio to the Meeting Established an agenda fo the FTD Meeting Held FTD Meeting Bainstomed, categoized, pioitized poblems & solutions Examined Accessioning, Mico and Molecula depatments pocess flow Developed an Action Plan based on Pioity Payoff Matix 34 17

18 Pioity Payoff Matix Payoff High Benefit Low Tanspot Cat Divides Gabage Tops on all waste cans Table lip on Mico eceiving table Reoganize stoage and signage New scanning SOP Add Millennium to new site designations Designate two new eceiving locations equipment Tain uses in Millennium Scanning Pull cables to new pot designations Add scannes Low Effot High 35 FTD Reduction of Missing Micobiology and Molecula Specimens - Issues Identified Specimen Pocessing Issues Shaed specimen soting not clealy defined as to final destination Multiple odes fo single samples sent Missing specimens wee falling to floo o into tash Tanspot Issues Multiple means of specimen tanspot to Micobiology Samples not segegated in tanspot cat Stoage aea in Molecula not identified 36 18

19 FTD Reduction of Missing Micobiology and Molecula Specimens - Impovements Quick Fixes Table lip on eceiving aea in Micobiology Micobiology specimen tanspot cat divides Gabage can tops fo all waste cans Reoganize stoage acks in feeze/efigeatos in Molecula Diect accessioning tanspot of specimens to Mico & Molecula 37 FTD Reduction of Missing Micobiology and Molecula Specimens - Impovements Othe Solutions Positive Specimen Tacking Veify hadwae in Mico and Molecula» Wokstation with scanne Ode necessay hadwae Place scanning (Millennium) pogam on computes Run cabling whee necessay Define uses Validate scanning pogam SOPs witten fo all elated pocesses 38 19

20 FTD Reduction of Missing Micobiology and Molecula Specimens - Accomplishments NO MISSING SPECIMENS! Utilized intenal specimen tacking in othe depatments Minimize time spent looking fo specimens Impove staff moale He said, She said Inceased client and management satisfaction Influenza A H1N1 in NY The 2009 Novel Influenza A H1N1 outbeak in the NY geate metopolitan aea in Apil 2009 led to immediate incease in the volume of espiatoy vius testing. Duing the nomal influenza season, on aveage/month: NS-LIJ labs pefoms Rapid Influenza/month Coe Lab Viology lab pefoms 1,955 tests Apil 24-June 2009: 11,624 patients wee tested 34,082 tests wee pefomed (volume equal to a yea s testing) 8,766 Rapid Influenza A+B 8,856 DFA 5,786 vial cultue 4,853 RVP 40 20

21 2009 Influenza A H1N1 in NY What did we accomplished: Built-out of the physical plant Conveted testing paadigms fom outine sceening tests and vial cultue to a high-capacity molecula assay fo espiatoy viuses Built Laboatoy Infomation System Intefaces Inceased Wokfoce (Client Sevice, Logistics, Accessioning, technical) Built same-day epidemiologic epots Established Rapid epoting (ECLRS) to NYSDOH and local DOH of tests esults including influenza A subtyping Enhanced communication 41 Mini-Lean Flu Specimen Tacking The Poblem Coe Lab, which was at the epicente of the swine flu pandemic, had an inceased numbe of missing flu specimens duing the initial swine flu suge beginning Sping of 09 which contibuted to the delay in TAT and incomplete testing The Goal Impove tacking of specimens in the lab and educe the numbe of missing flu specimens Expedite specimen flow and handling within the laboatoy Minimize time spent looking fo specimens The Scope Flu specimens handled by Logistics, Accessioning, and pocessed in the Main Lab, Viology and Molecula Depatments Flu Testing including apid EIA testing, DFA analysis and vial cultue, molecula RVP and swine flu confimation testing 42 21

22 Mini-Lean Flu Specimen Tacking Seveal Sensing Sessions Held Geneal Meeting Identified goals, objectives and scope Key Stakeholdes attended Additional Sessions wee held Identified specimen aival into lab, odeing issues, delivey to depatments Discussed majo additional issues in each depatment Consideed communication with clients» Who needs to know» What they need to know» How to communicate High Level Pocess Mapping Meeting» Black Belt assisted by Geen Belt» Pocess ownes wee invited individually LIS, Accessioning, Viology and Molecula Biology» Daft of High Level Pocess Map Geneated 43 Mini-Lean Flu Specimen Tacking Held Mini-Lean Event Requied two half day meetings Coss sectional team of stakeholdes Team Mentoed by a Black Belt Assisted by a Geen Belt Event 1» Posted the High Level Pocess Map» Developed the Value Steam Map» Identified souces of waste and bottlenecks» Developed Peliminay Action Plan - WWW Event 2» Bainstomed solutions on highest anking bottlenecks» Assessed solutions using the pioity payoff matix» Developed an Action Plan - WWW» Developed a new steamlined pocess 44 22

23 Value Steam Map 45 Pioity Payoff Matix Payoff High Benefit Low Identify stoage pocedue flu specimen Refigeato Bins fo specimen stoage in Viology Development of new Respiatoy Vius Test wokflow New test algoithm fo odeing espiatoy vius tests Send technical update fo influenza and RSV testing to clients LIS Positive Tacking. Locations built in Millennium Viology Lean Request LIS build of new Flu tests and eflex panels Maketing to in-sevice clients Staffing issues Molecula, Viology, Main Lab and Logistics Ceate New Flu equisition Low Effot High 46 23

24 Mini-Lean Flu Specimen Tacking Issues Identified Confusion Regading Test Odeing Excess Motion of Techs and Samples Lack of Positive Tacking of Specimens Solutions Implemented New Flu Tests and Reflex Rules Built in LIS New Testing Algoithm Developed New Flu Test Requisition Ceated fo Outeach Specimens Flow In Lab Was Steamlined Specimen Stoage In Viology Scanning Station Established In Seology Fo Tacking of Samples Fo Rapid Flu Testing Tacking Of Flu Specimen Delivey Into Viology (Pio FTD) Recuitment of Additional Staff 47 Mini-Lean Flu Specimen Tacking Solutions Test Algoithms 48 24

25 Mini-Lean Flu Specimen Tacking Solutions - New Specimen Flow Pocess 49 Mini-Lean Flu Specimen Tacking Metics Metics developed to be compaed against baseline data collected duing the Sping Outbeak Numbe of officially documented missing flu specimens - 4 Manhasset Hospital RVP TAT Aveage TAT 36hs 98.8% compliance with Mon Fi 48hs and Weekends 72 hs Coe Lab TAT Respiatoy Vius Panel Testing Aveage TAT - 55 hous 50 25

26 Mini-Lean Flu Specimens Tacking The Big Test Is Yet To Come Will the new obust pocess stand up to the anticipate flu suge this fall? Will newly developed flu panels and the Out Patient equisition esult in steamlined specimen pocessing and testing? Will positive tacking of flu specimens actually esult in less time spent looking fo missing specimens? Will we be able to impove espiatoy testing TAT? 51 Compaison of Lean, Mini-Lean and FTD Pocess LEAN Complex MINI- LEAN Modeate FTD Othe Sensing Sessions The Event Implementation YES 2-3 days Up to 90 days YES As Much Wok Done Behind the Scenes As Possible ½ to 1 day Customized to Poject Needs and Staff Availability days YES ½ day Up to 1 month 52 26

27 Othe Advantages of Lean, Mini-Lean and FTD Ceate a Cultue of Change Pomote Employee Buy-in Establish Consensus Motivate Staff Incease Intedepatmental Knowledge Empowe Employees Encouage Teamwok 53 THANK YOU! 54 27

28 Fast Tack Decision-Making Meeting Kick-Off Mission Gound Rules, Intoductions, Roles, Teambuilding, etc Define the Poblem Pocess map, if needed Bainstom Poblems / Baies Categoize Poblems / Baies Define Heades fo Categoies votes Pioitize Categoies Bainstom/Categoize Potential Solutions Assess Potential Solutions Develop Repot Out Issue: Recommendation: Shae Repot Outs within Goup Repot Out Decisions and Action Plans Pay-off Benefit: Ease Implementation Resouces Requied To Implement: Recommendation Owne: 55 28