Sutter Solano Laboratory

Lean Six Sigma Project

“Getting Our Ducks In A Row”

Joe Wells, MT, MA, Laboratory Supervisor

Progress as of July 22, 2008

Business Process ManagementKey Process Mapping

Clinical Laboratory Processes

Pre-Analytical Process

Analytical Process

Post Analytical Process

Labeling

Collection

Delivery

Receiving

Specimen Processing

Define: ProcessExpressSM Project Charter

Business Case: Expected laboratory turnaround times are not being met

for ER samples and early morning draws. This impacts laboratory customer satisfaction, patient care and finances.

Problem Statement Sutter Solano laboratory is not consistently meeting stated

turnaround times for ER samples and early morning draws. Variability in testing turnaround times is resulting in customer dissatisfaction. 

Results for early morning draws should be on the charts by 7:30am for ICU and 8 am for Med/Surg.

Target= 95% 2007 Average= 85%

Organizational Pillars Service

TAT AM & ER Physician & Patient Satisfaction

Quality Reporting Timeliness Order entry errors Drawing Issues

Finance Workload Balance Variance Overtime

People Employee Satisfaction (EOW)

Growth Community

Define: Process Map Routine AMRoutine AM Run

Tests ordered

STAT?

Morning Run prints at 4:30

am

Sort by floor in blue bin

Sort by patientGet Cart

Is Cart Ready?

Stock Cart Go to Floor

Is there a Button on

Patient Name?

Nurse Collect

Draw

No

Yes

Yes

No

Transport to Laboratory

Sort Samples

Receive (Batch)

Is there additionalprocessing

necessary??

Deliver to Tech Workstations

Centrifuge

Has Specimen

been collected?

Yes

No Put 10:00 am on Collection

time

Fishbone & Brainstorming Notes

Root Causes Supported by data Phlebs start time does not allow

for completion by goal time Many ER calls for draw

throughout the day

Initial “Just do its”• List of patients with lines on floor• Pick up of specimens by morning CLSs• ER sample rack• Share patient satisfaction survey comments at staff meetings• Eliminate 2 sets of labels printing• Labels for UA sent to departments: 2-3 labels• STAT notification: Dynamic pending log• Quick reference on floors for order codes• Update physician phone directory• Back time (duplicate) IT fix• Provide charge nurse cell phone number for critical values

Process imperatives

• Communication of PIC line patients is key to decreasing time in early morning draws

• Batching in early morning rounds needs to be reduced

Measure: Phone Calls

Majority of phone calls deal with:Transfer, Information or Results

Improve: Brainstorming Results● Weekends should be staffed

as weekdays (7)● Autoverification (6)● If ER prints order just go (6)● Nurse education (6)● CLS help if phlebs are short

(5)● Schedule break times (5)● Use volunteers to run ER

samples to lab (5)● Monitor for pending draws (4)● Critical value call process (4)● Lab personnel in ER during

peak times (4)● Change phleb times (and

possibly techs) to start earlier (4)

Revise parameters for 8am TAT report

Buttons for line draws on floors Add ons added as a test Stat spin centrifuge for coag Have dedicated person to

receive labs in computer Second microscope set for AM

diffs Have techs drawing pre-AM

ask if can combine draws Scanners for quick entry Redesign of Heme and Chem

(in process) Slidemaker/Stainer Add call in phlebs

Dynamic Pending Monitor

Standardized Phlebotomy Carts

Improve: Solutions Implemented

Improve: Additional “Aha” Moments and

“Just Do It’s”

Fix lab intercomI-Stats in ER (Go-Live July 30, 2008)Phlebotomy carts standardized and ready

for use in AM2-way cell phone for ER communication

(Coming soon!)Regular pick up times on floors for early

morning draws and nurse drawsGetting current SRMF list of doctors

How We Track Our Success- Daily Report

Daily metrics tracking keeps everyone focused

Share Results & Celebrate!

Week Of July 20, 2008

71

98 99 98 93 92 100 92

020406080

100

Mon

TuesW

edThu

rFri

SatSun

Week

% of TestsCompletedon Time

95% Target

TAT target goal of 95% achieved, significant improvement from 2007

average of 85%

8am Turnaround Time Data Since Beginning of LSS Project (1/6/08)

91

83

89

9694

84

91

79

91

84 85

79

91

88

83

88

64

87

90

9496

98

93

98 97

9496 96

92

98

95

989695

60

65

70

75

80

85

90

95

100

1/6/

2008

1/20

/200

82/

3/200

82/

17/2

008

3/2/

2008

3/16

/200

83/

30/2

008

4/13

/200

84/

27/2

008

5/11

/200

85/

25/2

008

6/8/

2008

6/22

/200

87/

6/200

87/

20/2

008

8/3/

2008

8/17

/200

8

Week

% T

arg

et

Me

t

Between 1/6/2008 and 4/13/2008, the standard deviation was 5.4 and between 5/25/2008 and 8/17/2008 the standard deviation was 2.4.

This represents a 54% reduction in the process variation.

Patient Satisfaction Scores

2008 Inpatient Satisfaction Scores for Courtesy of Person that Took Blood Since

Start of Lean Six Sigma Project

020406080

100

Janu

ary

Februa

ry

Mar

chApr

ilM

ayJu

ne July

Augus

t

Septe

mbe

r

Octo

ber

Novem

ber

Decem

ber

Month

Per

cen

tile

Ran

k

Improved patient satisfaction percentile rank from 15 to >60 within

six months

Before After

Reducing Waste: 5 S Applied to Lab Closet

Kan-Ban in Lab Supply Closet

BeforeAfter

Lessons Learned

Keep employees informed-communicate the good, bad and the ugly along with the project goals

Make sure everyone knows their role and are included in the decision processes

Simple rewards and reminders keep everyone aware that the process is always active-never stops just because we hit the mark

Advertise to the facility-share the information and get other departments involved (IT, nursing, physicians, other hospital staff)