Using Observable Elements of Culture to Move Your Lab To Its Ideal State

Transcription

1 Using Observable Elements of Culture to Move Your Lab To Its Ideal State Icelyn Butler, Ph.D. Danaher Business System Leader Lab Quality Confab New Orleans, Louisiana October 21, 2014

2 The Evolution of Quality Joint Commission Introduction of Lean Concepts ISO Labs Accredited ISO 1950s 1960s 1970s 1980s 1990s 2000 TODAY Critical focus on quality metrics Introduction to DNV CAP regulations ISO Regulations (Manufacturing)

3 Laboratory Structures

4 Quality Management System QUALITY MANAGEMENT SYSTEM (CONTINUAL IMPROVEMENT) C U S T O M E R R E Q U I R E M E N T S Resource Management INPUTS Management Responsibility Product / Service Realization Measurement Analysis & Improvement OUTPUTS C U S T O M E R S A T I S F A C T I O N

5 Prioritizing Transformation Dysfunctional Operations Waste Decrease in Resources Increase in Healthcare Cost Variation in Care

6 Limited Impact

7 Importance has Escalated Unless providers can improve their efficiency to match adjustment, there will be a growing gap between provider costs and Medicare payments per service. Chart ref: Richard S. Foster Chief Actuary Centers for Medicare and Medicaid Services

8 Systematic Change is Imperative $1.2T Waste in US Healthcare Failure of Care Coordination $54b 2011 US Healthcare Spend $1.0T Failure of Care Delivery $154b Pricing Failures $178b Non-Waste Overtreatment $226b Waste $0.5T Fraud and Abuse $272b Administrative Complexity $389b 21-47% of Expenditures 2011 Estimated Impact of Waste to US Healthcare: $558 billion-$1.2 Trillion Ref. source JAMA April 11, 2012 Vol. 307, 2012

9 Challenges

10 Your Journey

11 Awakening Policies and Procedures Customer Focus Environment

12 Awakening

13 Awakening...Remember These Rooms

14 Awareness Policies and Procedures Customer Focus Environment

15 Laboratory Systemic Approach

16 Laboratory Structure Formulation Machine / Equipment Method Hematology RIE Turn Around Cause & Effect Method Table in main pathway Lack of Centrifuges Malfunction Of alarms on Track Lack of Barcode Wands Inappropriate Sorting of Specimens Screen Processing Machine to Non-hemo & Delete Processed Specimen in Extra tubes Sort all tubes Repeats Table >24 hr old Processing area 3 Label from Re-educate all Standardize 6 Need 5 Clerical, Phleb, Staff on labeling Labels through Dedicated Nursing, OP With diagram hospital Coag Fuge Mis-aligned Lack of 6S work area 8 Standard Shift Checklist Clarify alarm Workflow Standardize parameter Main/Oper/6S Workflow 9 Software Utilization- Overproduction LIS to revise Reflex testing Install Of HH & delta Deltas, Autoverification Barcode checks Autoverification 11 Deltas wands Maintenance Develop Responsibility Standard 8 unclear Work Process Lack of Create common Functional Alarm error fix Maintenance Visible for staff For line errors Educate for proper Bad specimen Fill levels Sent to testing Collection priority Diff keyboard LIS to add Alarm for Sound card Cell count keyboards 1 MT to enter Morph-keyboard LIS to fix Macros Change clerk job Description to Allow spec rejection Eliminate 2 nd Manual scan to LIS scanner Transfer specimens issue to stockyard Checking for To stockyard in white racks complete Overproduction LH makes LIS/Coulter to Un-needed slides asses Lack of Protocol Level workload Lack of Revisit Job Leveling For stocking Job Description Between shifts Supplies Description Of work Supplies & 2 Standard training When needed Responsibility Lack of Batching of Revise delta Excess motion Load Schedule Move or add Manpower/ Slides creates Parameters To transport Leveling Specialty refrigerator To eliminate Willingness backup Reagent to frig Of staff tests 7 slides To help Move supplies Supplies not To central Lack of both Run both Lack of Cross train Centrally location Coag instruments Coag Machines Crosstraining Staff & TSs located Running LNCD No batching 4 Protocol Not appropriate For Quantity supplies MT in hemo/coag Stocking No dedicated For workstation Dedicated role Supplies Staff for roles resposibilities Leveling of Demand and Personnel Material Man Power Not meeting TAT 90% < 30 min

17 Adoption and Beyond Policies and Procedures Customer Focus Environment

18 ADOPTION..observable evidence

19 ADOPTION observable evidence

20 Observable Elements of Impact High Performing Work Teams TAT Error Reduction Team Accountability Workflow Efficiencies Daily Management Workplace Standardization Performance Visibility

21 Continuum Step 2 Step 3 Step 1 *

22 2013 Beckman Coulter, Inc. Move your Lab forward with Beckman Coulter.