MICHIGAN PATHOLOGY QUALITY SYSTEM (MPQS)
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1 MICHIGAN PATHOLOGY QUALITY SYSTEM (MPQS) Divisions of Anatomic Pathology & Clinical Informatics, Department of Pathology Administrative Forum December 15, 2008
2 Anatomic Pathology An Introduction 81 staff 24 trainees 42 faculty (8 emeritus)
3 surgical & medical pathology Anatomic Pathology An Introduction 5,881 8,275 6,361 72,280 cases in FY08 51,763 inside M-labs transfer consults
4 Anatomic Pathology MPQS Journey FY06 FY07 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 metric development
5 Jul-04 Jul-04 Jan-05 Jan-05 Jul-05 Jul-05 Jul-03 Jan-04 Jan-04 Jul UCL=6.04 UCL=6.04 Avg=4.86 Avg=4.86 LCL=3.67 LCL=3.67 Anatomic Pathology MPQS Journey UH UH "Room "Room 1" 1" (IF) (IF) TAT, TAT, JAN95-DEC05 JAN95-DEC05? Jul-97 Jul-97 Jan-98 Jan-98 Jul-98 Jul-98 Jan-99 Jan-99 Jul-99 Jul-99 Jan-00 Jan-00 Jul-00 Jul-00 Jan-01 Jan-01 Jul-01 Jul-01 Jan-02 Jan-02 Jul-02 Jul-02 Jan-03 Jan-03 Jan-97 Jan-97 Jul-96 Jul-95 Jul-95 Jan-96 Jan-96 Jul-96 Jan-95 Jan-95 mean mean TAT TAT (days) (days)
6 PLAN (identify, analyze)
7 Anatomic Pathology MPQS Journey FY06 FY07 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 metric development laboratory gemba walks
8 The Summer 2006 Understanding workflow in surgical pathology
9 Anatomic Pathology MPQS Journey Admin Coord (Craig Newman) FY06 FY07 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 metric development Director of Surg Path (Dan Visscher) laboratory gemba walks
10 The Problem Tuesday afternoon and Wednesday morning, Aug 15-16, 2006 specimens in Room 1, 7:00 am Wednesday morning not yet accessioned cassettes awaiting specimens in processing, Room 1, 7:00 7:00 am Wed am Wednesday morning morning accessioned but not grossed batch processing! GU cases signed out Tuesday (received Thursday & Friday)
11 Anatomic Pathology MPQS Journey Admin Coord (Craig Newman) FY06 FY07 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 metric development project launch Director of Surg Path (Dan Visscher) laboratory gemba walks
12 PLAN (identify, analyze) DO (design, implement) Cross-Functional Design Team Redesign process for gross examination of specimens to ensure continuous specimen flow, the right expertise for the right specimen at the right time, and support for tissue procurement.
13 Anatomic Pathology Cross-Functional Design Team histotechnologists gross small specimens partner PA and resident for all services
14 partner PA and resident for all services in project scope Grossing - AM (9 am - 2 pm) Grossing - PM (2 pm - 7 pm) Gross room Room 1 (IF/IS) PA resident Breast (BE) Derm (ID/MD) GI (GA) GU (GU) GYN (GS) resident PA PA PA resident resident PA resident resident resident PA Fri Wed Hour Mon
15 effective utilization of grossing stations ( benches ) ROOM 1 ROOM 2 Station 1 Room 1 histotechs Station 2 GI Breast GYN Station 3 GU Derm workload leveling M-Labs
16 effective utilization of signout rooms Room 1 Breast Derm GI GU Renal GYN AM signout (9 am-2 pm) Room 1 (UH 1) DP (3MSI) A (2UH) B (2UH) PM signout (2 pm-5 pm) Room 1 (UH 1) BE (5MSI) DP (3MSI) A (2UH) B (2UH) Gyn (5MSI) workload leveling
17 Accession cases to specific faculty improve accuracy/efficiency of case tracking minimize case hand-offs drive expectations for case turnaround Accession Day of Week Room 1 (IF/IS) Breast (BE - smalls) Breast (BE - bigs) Derm (MD) Derm (ID) GI (GA) GU (GU) GYN (GS - smalls) GYN (GS - bigs) MON WED TUE WED TUE WED WED WED TUE WED TUE THU WED THU WED THU THU THU WED THU WED FRI THU FRI THU FRI FRI FRI THU FRI THU MON FRI MON FRI MON MON MON FRI MON FRI TUE MON TUE MON TUE TUE TUE MON TUE
18 laboratory/transcription priorities aligned with service expectations Room 1 Breast Derm GI GU GYN M-Labs Gross transcription (completion) Slide/Case Delivery (completion) 2:00 PM 8:00 AM 3:00 PM 1:00 PM 2:00 PM 8:00 AM 8:00 AM 3:00 PM 9:00 AM 4:00 PM 2:00 PM 3:00 PM 9:00 AM 9:00 AM workload leveling
19 Anatomic Pathology Design Team Recommendations April 2007 histotechnologists gross small specimens partner PA and resident for all services stagger signouts for more effective utilization of grossing & signout space accession cases to specific faculty laboratory/transcription priorities aligned with service expectations
20 PLAN (identify, analyze) DO (design, implement) AP Laboratory Operations Group
21 Histotechnologists training, competency documentation incremental position PAs realigned reporting relationships new scheduling/staffing model policy development Anatomic Pathology Implementation Plan new functionality in LIS web-based calendars
22 project design team (Feb - Apr) AP Lab Operations Group Feb, Apr, May, Jun, Jul, Aug, Sep faculty meetings Jan, Feb, Apr, Jul, Sep AP Updates (weekly newsletter ) Jan, Feb, Mar, Apr, Jun, Jul, Aug, Sep residents luncheon Anatomic Pathology Pre-Launch Communication accessioning & histology breakfast
23 Anatomic Pathology MPQS Journey Admin Coord (Craig Newman) QA Coord (John Perrin) FY06 FY07 FY08 FY09 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 metric development project launch Director of Surg Path (Dan Visscher) laboratory gemba walks project implementation
24 GO LIVE! create positive environment to minimize negative backlash
25 Support from the TOP! create space to openly share ideas as problems emerged
26 PLAN (identify, analyze) DO (design, implement) CHECK (evaluate)
27 Room 1 NO, this isn t a weekend, this is 1:00 p.m. on a Wednesday afternoon and NO BATCHED SPECIMENS! You just can t make-up this kinda stuff first day out of the chute and it s working! document early successes, failures and solutions
28 PLAN (identify, analyze) ACT (adopt, standardize) DO (design, implement) CHECK (evaluate)
29 Anatomic Mean Turnaround Time (TAT) for AP Rotations Pathology Turnaround Time (TAT) for Affected Rotations 4.33 Turnaround Time (TAT) for Affected Rotations Lead ( Turnaround ) Time for All AP Patients Affected by August 2007 Project 3.73 UCL=3.73 Mean TAT (days) Avg= LCL= Aug 2.53 Jul-05 Oct-05 Jan-06 Apr-06 Jul-06 Oct-06 Jan-07 Apr-07 Jul-07 Oct-07 Jan-08 Apr-08 Jul-08 Oct-08
30 Anatomic Pathology Turnaround Time (TAT) for Affected Rotations Patient Volumes Mean Turnaround Time Monthly Patient Volumes Mean TAT (days) Jul-05 Oct-05 Jan-06 Apr-06 Jul-06 Oct-06 Jan-07 Apr Jul-07 Oct-07 Jan-08 Apr-08 Jul-08 Oct-08 Aug
31 Anatomic Pathology Turnaround Time (TAT) for Affected Rotations % -60% % SEP04-NOV05 SEP07-NOV % % CHANGE 5-40% Mean TAT (days) % -25.4% % Change -20% % 1-6.6% -2.3% 0 breast GI GYN GU derm (UMHS) derm (MLabs) UH ("bigs") UH ("smalls") 0%
32 Anatomic Pathology Anatomic Pathology Gross Examination of Specimens Gross Examination of Specimens % of Daily Volume Grossed by Group 80% 60% 40% Histotech PA Resident Linear (Resident) Linear (PA) Linear (Histotech) 20% 0% 8/1/2007 9/1/ /1/ /1/ /1/2007 1/1/2008 2/1/2008 3/1/2008 4/1/2008 5/1/2008 6/1/2008 7/1/2008 8/1/2008 9/1/ /1/ /1/2008 % of Daily Volume
33 Anatomic Pathology Performance In Core Laboratories Weekly Slide Delivery_Histology Lab_9-07 to % 95.0% 90.0% Avg=89.9% 85.0% % on time slide delivery 80.0% 75.0% 70.0% LCL=74.2% 65.0% 60.0% 55.0% 50.0% Sep. 3_07 Slide/Case Delivery (completion) Oct. 1 Oct. 29 Nov. 26 Dec. 24 Room 1 Breast Derm GI GU GYN M-Labs 3:00 PM Jan. 21 Feb. 18 Mar. 17 9:00 AM Apr. 14 May. 12 4:00 PM Jun. 9 Jul. 7 Aug. 4 2:00 PM Sep. 1 Sep. 29 Oct. 27 3:00 PM Nov. 24 9:00 AM 9:00 AM
34 Anatomic Pathology Staffing Efficiency AUG07
35 Anatomic Pathology MPQS Journey Admin Coord (Craig Newman) QA Coord (John Perrin) Blockbusters LARP FY06 FY07 FY08 FY09 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 metric development Director of Surg Path (Dan Visscher) project launch MPQS MQS Lean education Henry Ford site visit laboratory gemba walks project implementation
36 Anatomic Pathology MPQS Journey Admin Coord (Craig Newman) QA Coordinator Blockbusters LARP gemba walks 1 st employee recognition dinner FY06 FY07 FY08 FY09 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 metric development Director of Surg Path (Dan Visscher) project launch MPQS MQS Lean education Henry Ford site visit Suncoast laboratory gemba walks project implementation mandatory Lean training
37 Anatomic Pathology MPQS Journey cross-functional design & implementation teams continuous communication project launch (i.e. an experiment intended to allow us to discover what we could not otherwise have anticipated) share data in iterative process of discovery driven planning and implementation space a persistent strategic barrier
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