Measuring Percent Outliers for Lab TAT in the ED. Judy Heng, BS MT, C(ASCP) AMT, MBA

Transcription

1 Measuring Percent Outliers for Lab TAT in the ED Judy Heng, BS MT, C(ASCP) AMT, MBA

2 Lab/ED TAT objectives: Define measurement indicator - Lab TAT % Outliers. % Outliers measurement v. AVG TAT in minutes. Lab % Outliers measurement process. Technologist performance management process. Benchmark opportunities among system hospitals. Lab - ED team - system hospitals: Performance management process. Tools and information to duplicate % Outliers TAT process improvement project. Q&A

3 Define measurement indicator - Lab TAT % Outliers.

4 Define % Outliers If lab s TAT expectation for a Troponin I on a patient in the ED is 60 minutes, then an outlier TAT is any TAT longer than 60 minutes. Example of % Outliers in 1 month: ED Trop I result volume 3,750 Trop I TATs > 60 min 635 Lab s Trop I % Outliers 16.9%

5 ED % Outliers are the lab TATs that: Exceed the lab s defined TAT expectation. Cause delays for the ED physician and staff. May delay patient treatment and/or patient disposition. Contribute to lengthy overall ED patient turnover time. TIP: Physicians and ED staff tolerate and accept lab TATs that meet defined expectations. They object to unnecessarily long lab TATs. Lab s focus should be on a reduction in the total number of unnecessarily long TATs the % Outliers.

6 Example of % Outliers in 1 month: ED Trop I result volume 3,750 Trop I TATs > 60 min 635 Lab s Trop I % Outliers 16.9% Using good measurement/benchmarking tools, it s not difficult to reduce the Trop I % Outliers in this example to < 5% monthly. It s possible to reduce your Trop I % Outliers to less than 2% monthly.* *Eliminating or reducing variance is the basis of Six Sigma process improvement.

7 Why measuring % Outliers beats AVG TAT measurements in the process improvement game.... It s more effective.

8 % Outliers v. Avg TAT measurement* % Outliers reduction: Avg TAT focus: Measurement and improvement effort focus on problem TATs a smaller subset than ALL TATs. Technologists can easily actualize the TAT expectation at the bench ED Trop I must be < 60 min. Easier to benchmark between hospital labs using different methods. Physician treatment decisions won t be delayed. Improvement of lab % Outliers improves ED patient turnover time. Average TAT can be good even with high lab % Outliers performance Technologists can t easily actualize an average TAT expectation at the bench too non-specific. Different methodologies often mean different average TATs. High lab TAT % Outliers will continue to delay physician treatment decisions even if lab Avg TAT is good. Improvements in lab Avg TAT don t easily correlate with improved ED patient turnover time. *Lab TAT is only one factor in the ED patient s care environment improving lab TAT won t compensate for or mitigate other patient care process problems the ED may have.

9 Lab % Outliers measurement process.

10 LIS TAT report 1 st step RUN DATE: 07/01/04 MIS **LIVE** PAGE 1 RUN TIME: 1341 TURN AROUND TIME REPORT xxxx xxxxxxx Medical Center PATIENT: ALL BEGIN DATE/TIME: 06/01/ END DATE/TIME: 06/30/ LOCATION:.ERS PRIORITY: STAT TEST: SODIUM (Basic Metabolic, Comprehensive Metabolic, Renal Panels) CALCULATION: RECEIVED TIME TO VERIFIED TIME RECEIVED VERIFIED TURN Name ACCOUNT# SPECIMEN# TEST DATE / TIME ID DATE / TIME ID AROUND TIME Z XXX 0601:C00075S SODIUM 06/01/04 00 HXH 06/01/ WGF 005 (mins) Z XXX 0601:C00076S SODIUM 06/01/04 05 WGF 06/01/ WGF 000 (mins) Z XXX 0601:C00082S SODIUM 06/01/04 56 WGF 06/01/04 17 WGF 001 (mins) Z XXX 0601:C00083S SODIUM 06/01/04 29 HXH 06/01/04 57 WGF 008 (mins) Z XXX 0601:C00090S SODIUM 06/01/ HXH 06/01/ WGF (mins) Z XXX 0601:C001S SODIUM 06/01/ BJM 06/01/ GXM (mins) Z XXX 0601:C00112S SODIUM 06/01/ VEH 06/01/ GXM (mins) This report came from MediTech format is.txt file

11 LIS TAT report 1 st step Suggested time frame: 30 days, 1 calendar month Required data: Profile or test method Received-in-lab TAT Verified TAT Verification tech ID TAT in minutes Patient name not needed if present, can be deleted in Excel. Patient ID number not needed except to validate that data is reliable. Potential measurements: Automated CBC If by test, use WBC or Hgb. Chem (Basmet+Compmet) If by test, use NA+ or CL Cardiac If by test, use Trop I UA macro If by test, use KETU UA macro+micro If by test, use UA WBC HCG Qual HCGQual Other PT/PTT, BNP, DOA, etc. Best to use 3 or 4 highest volume ED lab tests higher volume greater validity.

12 EXCEL format 2nd step Pt name ACCOUNT# SPECIMEN# TEST REC DATE REC TIME REC EMP ID VER DATE VER TIME VER EMP ID :WU:C005S SODIUM 6/28/ LF 6/28/ ACP :WU:C069S SODIUM 6/28/ SNH 6/28/ ACP :WU:C00184S SODIUM 6/29/ BBP 6/29/ ACP :WU:C017S SODIUM 6/10/ SlP 6/10/ ACP :WU:C9S SODIUM 6/28/ BJN 6/28/ ACP :WU:C063S SODIUM 6/28/ BJN 6/28/ ACP :WU:C071S SODIUM 6/28/ BJN 6/28/ ACP :WU:C0S SODIUM 6/28/ LF 6/28/ ACP :WU:C00151S SODIUM 6/8/ WFH 6/8/ ACP :WU:C051S SODIUM 6/28/ BBP 6/28/ ACP :WU:C005S SODIUM 6/29/ USU 6/29/ BJN :WU:C00182S SODIUM 6/27/ PSS 6/27/ BJN :WU:C00199S SODIUM 6/29/ USU 6/29/ BJN :WU:C00172S SODIUM 6/7/ SNH 6/7/ BJN :WU:C021S SODIUM 6/10/ UBP 6/10/ BJN :WU:C015S SODIUM 6/28/ BJN 6/28/ BJN :WU:C021S SODIUM 6/28/ BJN 6/28/ BJN :WU:C094S SODIUM 6/28/ BBP 6/28/ CH :WU:C00179S SODIUM 6/7/ WFH 6/7/ CH :WU:C072S SODIUM 6/28/ BJN 6/28/ CH :WU:C090S SODIUM 6/28/ LF 6/28/ CH :WU:C008S SODIUM 6/28/ BBP 6/28/ CH :WU:C001S SODIUM 6/10/ SDJ 6/10/ CH :WU:C00173S SODIUM 6/27/ BBP 6/27/ CH :WU:C054S SODIUM 6/28/ SNH 6/28/ CH :WU:C093S SODIUM 6/28/ LF 6/28/ CH :WU:C001S SODIUM 6/28/ LF 6/28/ CH :WU:C062S SODIUM 6/28/ BJN 6/28/ CH :WU:C00172S SODIUM 6/29/ BJN 6/29/ CH 36 TAT

13 EXCEL format 3rd step In Excel remove spurious TATs from data set... Case study parameters - remove 1) > 300 min TATs 2) 0 to 2 min TATs (CBC, UA) 3) 0 to 6 min TATs (Chem) 4) 0 to 10 min TATs (Cardiac) Repeated investigations showed that > 300 min TATs were add-ons or cancellations. Results that were received into LIS at the same time that results were verified also had to be removed from the data. What about min TATs? Repeated investigations within several different labs showed us that % of min TATs were legitimate TATs actual delays that lab or circumstances between lab and ED had caused. Periodic checks on these individual TATs consistently indicated that the majority were actual labcaused delays. Most of these TATs represented poor lab performance.

14 Import Excel data into ACCESS ACCESS report page 4 th step Feedback for Departmental Improvement of Chemistry - ER-TAT - December 20 Emp ID Avg TAT %Variance From # of Outliers % of Outliers Number % Total Volume Comments Tech AVG TAT Performed Performed Tech % % % Tech % % % Tech % % % Tech % % % Tech % % % Tech % % % Tech % % % Tech % % % Tech % % % Tech % % % Tech % % % Tech % % % Tech % % % Tech % % % Tech % 10 3.% % Tech % % % Tech % % % Average Turn Around Time: 22 mins Average % Outliers: 5.1 % Total Test Performed: 1690

15 ACCESS report in Excel 5 th step (optional) Emp ID Avg TAT in Minutes % Variance From Tech AVG TAT # of Outliers % of Outliers Chems > 40 min Number Performed % Total Volume Performed by Tech Tech # % % % Tech # % % % Tech # % % % Tech # % % % Tech # % % % Tech # % % % Tech # % % % Tech # % % % Tech # % % % Tech # % % % Tech # % % % Tech # % % % Tech # % % % Tech # % % % Tech # % 10 3.% % Tech # % % % Tech # % % % Tech AVG % % Performance Feedback Comments

16 Technologist performance management process.

17 Individual technologist focus on reduce % outliers significant improvement! Emp ID May 20 % Outliers CBCs > 30 min Performance Feedback Comments Tech % Improve TAT, Improve % Outliers Tech % GOOD! Tech % Improve % Outliers Tech % GOOD! Tech % GOOD! Tech % Improve TAT, Improve % Outliers Tech % Improve % Outliers Tech % VERY GOOD! Tech % Improve TAT, Improve % Outliers Tech % VERY GOOD! Tech % Improve % Outliers Tech % Improve TAT, Improve % Outliers Tech % BEST PRACTICE! Tech % VERY GOOD! Tech % FAIR! Tech % Improve TAT, Improve % Outliers Tech % Improve % Outliers Average 9.6% Lab team --> Improve % Outliers Green = Productive Red = Less or Not Productive Emp ID OCT 20 % Outliers CBCs > 20 min Performance Feedback Comments Tech % VERY GOOD! Tech % VERY GOOD! Tech % EXCELLENT! Tech % EXCELLENT! Tech % VERY GOOD! Tech % EXCELLENT! Tech % EXCELLENT! Tech % VERY GOOD! Tech % BEST PRACTICE! Tech % VERY GOOD! Tech % VERY GOOD! Tech % BEST PRACTICE! Tech % VERY GOOD! Tech % VERY GOOD! Tech % EXCELLENT! Tech % EXCELLENT! Tech % EXCELLENT! Average 0.6% EXCELLENT! Green = Productive Red = Less or Not Productive

18 Individual technologist focus on reduce % outliers significant improvement! Emp ID May 20 % Outliers Chems > 40 min Performance Feedback Comments Tech % Improve TAT Tech % Improve TAT, Improve % Outliers Tech % Improve TAT, Improve % Outliers Tech % Improve TAT, Improve % Outliers Tech % GOOD! Tech % Improve TAT, Improve % Outliers Tech % GOOD! Tech % VERY GOOD! Tech % Improve TAT, Improve % Outliers Tech % Improve TAT Tech % BEST PRACTICE! Tech % Improve TAT, Improve % Outliers Tech % BEST PRACTICE! Tech % Improve TAT, Improve % Outliers Tech % VERY GOOD! Tech % FAIR! Average 13.6% Lab team --> Improve % Outliers Green = Productive Red = Less or Not Productive Emp ID OCT 20 % Outliers Chems > 35 min Performance Feedback Comments Tech % FAIR! Tech % EXCELLENT! Tech % VERY GOOD! Tech % EXCELLENT! Tech % BEST PRACTICE! Tech % EXCELLENT! Tech % VERY GOOD! Tech % FAIR! Tech % EXCELLENT! Tech % GOOD! Tech % VERY GOOD! Tech % EXCELLENT! Tech % BEST PRACTICE! Tech % FAIR! Tech % VERY GOOD! Tech % BEST PRACTICE! Tech % VERY GOOD! Average 3.4% VERY GOOD! Green = Productive Red = Less or Not Productive

19 Individual technologist focus on reduce % outliers significant improvement! Emp ID May 20 % Outliers Cardiacs > 60 min Performance Feedback Comments Tech % Improve TAT, Improve % Outliers Tech % Improve TAT, Improve % Outliers Tech % Improve TAT, Improve % Outliers Tech % Improve TAT, Improve % Outliers Tech % Improve TAT, Improve % Outliers Tech % Improve TAT, Improve % Outliers Tech % Improve % Outliers Tech % Tech % Improve TAT, Improve % Outliers Tech % Improve % Outliers Tech % BEST PRACTICE! Tech % Improve TAT, Improve % Outliers Tech % BEST PRACTICE! Tech % Improve TAT, Improve % Outliers Tech % Improve % Outliers Tech % Improve TAT, Improve % Outliers AVG 36.6% Green = Productive Red = Less or Not Productive Lab team --> Improve % Outliers Emp ID OCT 20 % Outliers Cardiacs > 50 min Performance Feedback Comments Tech % TAT NEEDS IMPROVEMENT! Tech % EXCELLENT! Tech % EXCELLENT! Tech % EXCELLENT! Tech % VERY GOOD! Tech % Tech % FAIR! Tech % FAIR! Tech % EXCELLENT! Tech % EXCELLENT! Tech 11 3.% VERY GOOD! Tech % EXCELLENT! Tech % BEST PRACTICE! Tech % Tech % Tech % EXCELLENT! Tech % VERY GOOD! AVG 2.2% EXCELLENT! Green = Productive Red = Less or Not Productive

20 Individual technologist focus on reduce % outliers significant improvement! Emp ID May 20 % Outliers UAs > 30 min Performance Feedback Comments Tech % Improve TAT, Improve % Outliers Tech % GOOD! Tech % EXCELLENT! Tech % GOOD! Tech % FAIR! Tech % EXCELLENT! Tech % Improve TAT, Improve % Outliers Tech % Improve TAT, Improve % Outliers Tech % Improve TAT Tech % GOOD! Tech % EXCELLENT! Tech % Improve % Outliers Tech % BEST PRACTICE! Tech % EXCELLENT! Tech % GOOD! Tech % Tech % FAIR! AVG 4.4% Lab team --> Improve % Outliers Green = Productive Red = Less or Not Productive Emp ID OCT 20 % Outliers UAs > 20 min Performance Feedback Comments Tech % FAIR! Tech % VERY GOOD! Tech % FAIR! Tech % EXCELLENT! Tech % EXCELLENT! Tech % VERY GOOD! Tech % VERY GOOD! Tech % VERY GOOD! Tech % EXCELLENT! Tech % FAIR! Tech % FAIR! Tech % VERY GOOD! Tech % BEST PRACTICE! Tech % EXCELLENT! Tech % EXCELLENT! Tech % VERY GOOD! Tech % EXCELLENT! Tech % VERY GOOD! AVG 1.2% EXCELLENT! Green = Productive Red = Less or Not Productive

21 18% 16% 14% 16.2% Lab ER TAT % Outliers - Department Performance Outliers are Looooong TATs that delay ER doctors and patients. (CBCs > 30 min; Chems > 40 min; Cardiacs > 60 min; UA's > 30 min) 13.4% 14.3% ER TAT % Outliers - Total Lab Performance Goal ER TAT % Outliers - New Targets 12% 11.2% 10.8% 10% 10.5% 10% 10% 10% 10% 9.7% 8% 9.1% 6% 4% 6% 6% 6% 6% 6% 6% 6% 3% 3% 3% 3.2% 3% 3.6% 3% 3% 3% 3% 3% 2% 0% Jan- Feb- Mar- Apr- May- Jun- Jul- Aug- 3.5% 3% 3.0% 2.9%2.7% 2.4% 2.5% 2.1% Sep- Oct- Nov- Dec- Jan- Feb- Mar- Apr- 3% May- In May, 20, lab techs verified 4,846 ER CBCs, chemistries, cardiacs, and UAs. 649 or 13.4 % of the total were outliers (TATs that failed established criteria). 2.4% 2.8% 1.9% 1.4% 1.9% Jun- Jul- Aug- Sep- Oct-

22 18% 16% 14% 16.2% Lab ER TAT % Outliers - Department Performance Outliers are Looooong TATs that delay ER doctors and patients. (CBCs > 20 min; Chems > 35 min; Cardiacs > 50 min; UA's > 20 min) 13.4% 14.3% ER TAT % Outliers - Total Lab Performance Goal ER TAT % Outliers - New Targets 12% 11.2% 10.8% 10% 10.5% 10% 8% 10% 10% 10% 9.7% 9.1% 6% 4% 6% 6% 6% 6% 6% 6% 6% 3% 3% 3% 3.2% 3% 3.6% 3% 3% 3% 3% 3% 2% 0% Jan- Feb- Mar- Apr- May- Jun- Jul- Aug- 3.5% 3.0% 2.9%2.7% 2.4% 2.1% Sep- Oct- Nov- 3% 2.5% 3% 2.4% 1.4% In October, 20, lab techs verified 5,523 ER CBCs, chemistries, cardiacs, and UAs. Only 1 or 1.9 % of the total were outliers (TATs that failed established criteria - new targets). Dec- Jan- Feb- Mar- Apr- May- Jun- Jul- 1.9% Aug- 2.8% Sep- 1.9% Oct-

23 : ( : ) : ) : ( : ( : ( : ( : ) : ( : ( : ( : ) : ( : ) : ( Tech ED TAT value to the Lab Team 30 day time period - overall: JULY # 12 CBC Chem Card UA TOTALS % Outliers Red if > 3 % EVAL Vol % of Total Rank = Highest Vol % minus Outlier % JUL "Value to Lab" ER TAT Performance Rank Tech / 3, % % -3.9% # 5 8.8% Tech / 3,256 BEST 2.3% 1.6% Practice! % # 9 7.6% Tech / 3, % % Tech / 3, % % Tech / 3, % # 1 8.8% Tech / 3, % % 4.2% 6.2% 8.8% -12.4% # 17 # 4 # 3 # % 6.2% 4.2% 2.8% Tech / 3, % # 2 7.6% # 2 1.6% 9.0% Tech / 3, % % Tech / 3, % % Tech / 3, % % Tech / 3, % % Tech / 3, % % Tech / 3, % % Tech / 3, % % Tech / 3, % # 3 7.2% Tech / 3, % % Tech / 3, % % Tech / 3, % % -12.9% 2.8% 0.9% -3.2% 0.8% -0.2% 1.0% 7.2% -13.3% 0.5% 1.3% # 20 # 16 # 12 # 14 # 19 # 15 # 13 # 1 # 7 # 10 # % 1.0% 0.9% 0.8% 0.5% -0.2% -3.2% -3.9% -12.4% -12.9% -13.3% Compare volumes and % outliers by Individual tech. Some techs verify high test volumes with very low % outlier TATs. Distinct variations in performance. Feedback report alerts techs to improve % outliers.

24 : ) : ) : ) : ) : ) : ) : ( : ) : ) : ) : ) : ) : ) : ) With a performance management system in place, with consistent feedback over time, technologists will improve their performance: JUL CBC Chem Card UA TOTALS % Outliers RED if > 3 % Vol % of Total Tech / 2, % 7.1% Tech / 2, % 3.2% Tech / 2, % # % Tech / 2, % 6.4% Tech / 2, % 0.0% Tech / 2, % 5.2% Tech / 2, % # % Tech / 2, % 9.5% Tech / 2, % 1.5% Tech / 2, % 12.3% Tech / 2, % 1.4% Tech / 2, % # % Tech / 2, % 1.5% Tech / 2, % 1.4% Tech / 2, % 8.0% Tech / 2, % 8.6% Tech / 2, % 0.1% Rank = Highest Vol % minus Outlier % 6.2% 2.2% 9.8% 4.3% 0.0% 3.3% 9.6% 9.2% -3.1% 9.5% -1.0% 10.9% 1.5% -1.1% 5.9% 0.1% JUL # 12 BEST Practice! # 3 # 7 Rank = Highest Vol % minus Outlier % 10.9% 9.8% 9.6% # % # 8 9.2% # 16 # 1 # 15 # 4 # 6 # 2 # 13 # 17 # 5 # % # 14 # 9 8.2% 6.2% 5.9% 4.3% 3.3% 2.2% 1.5% 0.1% 0.0% -1.0% -1.1% -3.1%

25 Tech ED TAT value to the Lab Team 1 year time period - overall: % ER TAT Outliers 20 AVG Jan-04 Feb-04 Mar-04 Apr-04 May-04 Jun-04 Jul-04 Aug-04 Sep-04 Oct-04 Nov-04 Dec AVG % ER TAT Outliers Tech % 4.3% 0.0% 0.0% 6.1% 0.0% 1.9% 5.6% 2.6% Tech % Tech 2 8.2% 3.2% 3.6% 0.0% 3.8% 4.6% 1.6% 2.3% 2.7% Tech % Tech % 11.3% 12.9% 6.9% 8.7% 2.6% 4.5% 2.0% 7.0% Tech % Tech % 15.0% 1.4% 2.1% 3.6% 2.2% 4.9% 4.2% 4.8% Tech % Tech 5 9.2% 6.0% 8.9% 3.8% 0.8% 1.0% 0.7% 0.0% 3.0% Tech 1 2.6% Tech % 0.0% 7.7% 8.1% 5.7% 0.0% 4.3% Tech 2 2.7% Tech % 22.4% 24.1% 10.0% 5.7% 37.8% 11.2% 18.0% 18.5% GOAL 3.0% Tech % 13.9% 5.6% 12.6% 4.6% 4.9% 10.7% 8.7% Tech 5 3.0% Tech 9 7.1% 7.6% 4.1% 4.7% 6.7% 1.4% 0.9% 1.4% 3.8% Tech 9 3.8% Tech % 26.0% 20.5% 13.4% 14.7% 17.6% 26.8% 16.9% 19.4% Tech 6 4.3% Tech % 23.4% 20.3% 9.9% 1.5% 12.5% 7.0% 4.8% 11.3% Tech 4 4.8% Tech % 0.5% 3.1% 0.5% 1.0% 3.3% 1.8% 0.0% 1.5% AVG 4.9% Tech % 9.8% 5.1% 8.7% 1.8% 3.2% 4.3% 5.5% 5.5% Tech % Tech % 7.8% 9.9% 6.9% 3.9% 5.7% 7.7% 3.1% 6.4% Tech % Tech % 5.0% 8.8% 4.5% 1.0% 3.0% 12.7% 7.7% 6.1% Tech % Tech % 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% Tech 3 7.0% Tech % 0.7% 0.0% 0.0% 0.0% 2.0% 0.5% 0.0% 0.5% Tech % Tech % 9.0% 11.7% 13.0% 5.3% 12.3% 9.1% 16.1% 10.9% Tech 8 8.7% Tech % 0.0% Tech % Tech % 6.0% 12.9% 8.5% 11.2% 4.8% 3.8% 7.2% 7.8% Tech % AVG 12.3% 10.9% 9.5% 6.6% 4.5% 5.0% 6.3% 4.9% 6.8% Tech % GOAL 10.0% 10.0% 5.0% 5.0% 5.0% 3.0% 3.0% 3.0% 3.0% 3.0% 3.0% 3.0% 3.0% 4.1% Tech % AVG YTD

26 : ( : ) : ) : ( : ) : ) : ) Lab TAT Best Practice *STARs* and the techs who are trying to be *STARs* What are they doing consistently that co-workers % Outliers JULY CBC Chem Card UA TOTALS Red if > 3 Vol % of EVAL Total # 12 are % not? JUL % ER TAT Outliers Rank = Highest Vol % minus Outlier % 20 AVG Jan-04 Feb-04 Mar-04 Apr-04 May-04 Jun-04 Jul-04 Aug-04 Sep-04 Oct-04 Nov-04 Dec AVG % ER TAT Outliers "Value to Lab" ER TAT Performance Rank Tech / 3, % % -3.9% # 5 Tech / 3, % 1.6% BEST Practice! % # 9 Tech / 3, % % Tech / 3, % % Tech / 3, % # 1 8.8% Tech / 3, % # 2 9.0% Tech / 3, % % 4.2% 6.2% 8.8% 7.6% 0.9% # 17 # 4 # 3 # 2 # % 4.2% 1.6% 1.0% Tech / 3, % % 1.0% # % Tech / 3, % # 3 7.2% Tech / 3, % % 7.2% 0.5% # 1-3.9% 8.8% 7.6% 7.2% Tech % 4.3% 0.0% 0.0% 6.1% 0.0% 1.9% 5.6% 2.6% Tech % Tech 2 8.2% 3.2% 3.6% 0.0% 3.8% 4.6% 1.6% 2.3% 2.7% Tech % Tech % 11.3% 12.9% 6.9% 8.7% 2.6% 4.5% 2.0% 7.0% Tech % Tech % 15.0% 1.4% 2.1% 3.6% 2.2% 4.9% 4.2% 4.8% Tech 1 2.6% Tech 5 9.2% 6.0% 8.9% 3.8% 0.8% 1.0% 0.7% 0.0% 3.0% Tech 2 2.7% Tech 9 7.1% 7.6% 4.1% 4.7% 6.7% 1.4% 0.9% 1.4% 3.8% Goal 3.0% Tech % 0.5% 3.1% 0.5% 1.0% 3.3% 1.8% 0.0% 1.5% Tech 5 3.0% Tech % 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% Tech 9 3.8% Tech % 0.7% 0.0% 0.0% 0.0% 2.0% 0.5% 0.0% 0.5% Tech 4 4.8% AVG 12.3% 10.9% 9.5% 6.6% 4.5% 5.0% 6.3% 4.9% 6.8% AVG 4.9% GOAL 10.0% 10.0% 5.0% 5.0% 5.0% 3.0% 3.0% 3.0% 3.0% 3.0% 3.0% 3.0% 3.0% 4.1% Tech 3 7.0% AVG YTD

27 Regarding the posting of results Your best practice techs or *star* performers will like it!!! Techs who want to perform well and can use objective data to self-adjust will give it a chance most likely make rapid improvements. Less productive techs will challenge the data usually for a short time. After 2 or 3 months, the improvements that occur will make it difficult for them to challenge it. Just the act of posting results will stimulate significant improvement in the entire team. In fact, the best results occur when you altogether avoid using the data punitively. Represents defining the outcomes (from First, Break All the Rules). Manager also serves as a mirror, reflects performance information back toward the employee. Based on concepts from Gallup management principles in First, Break All the Rules

28 Benchmark opportunities among system hospitals.

29 2.9% 3.2% 2.8% 3.0% 2.3% 1.4% 3.2% 2.2% 8.3% 6.5% 5.4% 9.8% 8.7% 6.6% 7.3% 5.8% 5.7% 5.5% 5.4% 6.3% 6.3% 4.5% 5.7% 4.5% 4.9% 7.0% 6.2% 9.3% 8.0% 8.7% 6.8% 5.0% 11.6% 9.8% 8.8% 14.4% 17.7% 19.1% 23.7% Benchmark lab TAT % outliers between labs: Lab ED TAT % Outliers Performance - 12 hospital system 25% 20% Nov ' % Outlier TATs Apr '04 % Outlier TATs Jul '04 % Outlier TATs 15% 10% 5% 0% Hospital Lab # 1 Hospital Lab # 2 Hospital Lab # 3 Hospital Lab # 4 Hospital Lab # 5 Hospital Lab # 6 Hospital Lab # 7 Hospital Lab # 8 Hospital Lab # 9 Hospital Lab # 10 Hospital Lab # 11 Best Practice: #7, # 9 ; Most Improved: #11, # 8, # 12; Division Overall: Reduced Lab TAT % Outliers from 8.7% to 5% Hospital Lab # 12 Division AVG % Outliers

30 Benchmark ED patient turnover time and lab % outliers: July 2004? Is there a relationship between Lab % Outliers and ER Patient Turnover in hours? 10% 4.0 9% 8.7% 8% 7% 6% 7.8% % 7.1% % % 6.8% 5.9% % 4% 4.9% 5.0% 3.0 3% GC Lab % Outliers - Div AVG (12 Labs) ER Patient Turnover in Hours - Div AVG (12 EDs) 2% Oct- Nov- Dec- Jan-04 Feb-04 Mar-04 Apr-04 May-04 Jun-04 Jul

31 Correlation between lab % outliers and ED patient turnover time? Maybe... Hospital # 12 Relationship between Lab % Outliers v. ED Patient Turnover Time in Hours 16% 14% 12% 10% 8% 14.4% % % 9.5% # 12 Lab ER TAT % Outliers ER Patient Avg TAT in Hours % 6.6% 6.3% % 4.5% 5.0% 4.9% % Nov- Dec- Jan-04 Feb-04 Mar-04 Apr-04 May-04 Jun-04 Jul

32 Maybe... Hospital # 4 Relationship between Lab % Outliers v. ED Patient Turnover Time in Hours 10% Hospital # 4 Lab ER TAT % Outliers 5.0 9% 8% 7% 6% 5% 4% 3% 2% 1% 7.3% 3.66 ER Patient Avg TAT in Hours % 5.3% % % % % % % % Nov- Dec- Jan-04 Feb-04 Mar-04 Apr-04 May-04 Jun-04 Jul

33 Maybe not... needs further study and more data. 10% 8% Hospital # 10 Relationship between Lab % Outliers v. ED Patient Turnover Time in Hours Hospital 10 Lab ER TAT % Outliers ER Patient Avg TAT in Hours 7.2% 7.1% % 6.3% 5.6% 5.2% 5.7% % 4.5% 4.3% 3.5 4% 2% % Nov- Dec- Jan-04 Feb-04 Mar-04 Apr-04 May-04 Jun-04 Jul

34 Benchmark technologist performance: System's 'BEST Practice' ER TAT medical technologists Cumulative for February, March, April, May, June, July 2004 (Tech's total volume of ER tests verified in one month must be > 150 to be included here.) DIV Rank # Hospital - Tech Tech's ER Test Volume Total Tech's Number of Outliers Tech's % Outliers Tech's ER TAT Value to Home Lab TAT in % 1 # 7 - XT 1, % 9.4% 2 # 6 - KCX % 5.8% 3 # 12 - VXH 1, % 5.3% 4 # 1 - XGP 1, % 3.3% 5 # 1 - SPX 2, % 5.6% 6 # 6 - EXE 1, % 13.3% 7 # 5 - XSK 1, % 12.1% 8 # 7 - XXX 1, % 5.6% 9 # 12 - DXT 1, % 7.5% 10 # 8 - SX % 16.2% 11 # 5 - XCB 1, % 7.5% 12 # 7 - EXT 1, % 8.5% 13 # 6 - VXS % 5.4% 14 # 1 - XAX 2, % 6.2% 15 # 7 - RXG 1, % 7.5% 16 # 12 - HXH % 7.6% 17 # 7 - XXA 1, % 8.8% 18 # 5 - MXX 1, % 7.5% 19 # 4 - LXM 1, % 6.5% 20 # 7 - CXX % 5.5% Top 20 Tech AVG (Best Practice) 1, % 7.8% System tech average overall 1, % 0.3% Bottom 20 tech AVG (Poor performance) % -11.2%

35 Laboratory Best Practices: Specimen label color different for ED. ED specimens are prioritized. Utilized increased POC testing. Utilized YELLOW/RED BAGS (biohazard bags) for ED specimens. Lab has access to ED tracking system. Proactive ED draws rainbow with barcode label MD notification of test results; paperless access to results. Announcing to the techs that there is a specimen from EC. January 2006: Emergency Department Benchmarks and Best Practices: A Report of the Premier ED Survey Findings

36 Lab ED team System hospitals: Performance management process.

37 Performance management across system: Involves lab directors/managers, ED nurse directors, ED staff, and ED physicians. Requires standardized measurement processes data collection and analysis must be consistent. Requires standardized reporting system. Suggest monthly reporting. Can be automated into dashboard format. Can be used to share best practice processes and ideas between facilities and across system. Can be used to recognize performance excellence.

38 Lab TAT % Outliers Process Improvement Questions?