Staffing to Workload in Central Receiving

Transcription

1 Staffing to Workload in Central Receiving Lonnie D. Stallcup, Jr. Manager, Continuous Process Improvement Objectives Evaluate data collection processes which will best help to staff to workload. Combine process frequencies with other key measures to determine hourly staffing needs. Produce a visual aid to determine if staffing needs are being met. 1

2 About Us Once three separate hospital laboratories. In 1998, the 3 hospitals, having divested of their labs (staff & equipment), formed a LLC that consolidated lab services under the company name: Laboratory Alliance of Central New York, LLC. The company provides all inpatient and outpatient testing (clinical & anatomic pathology) for the 3 owner hospitals and for the community at-large through its Outreach services. Each hospital continues to operate a Rapid Response Lab (RRL). The Operations Center is our primary laboratory. We have 11 patient service centers (PSCs) throughout Central New York. Our corporate offices are located in Syracuse, N.Y. Corporate Offices 2

3 Owner Hospitals Crouse Hospital Upstate University Hospital Community Campus St. Joseph s Hospital Health Center The Operations Center 3

4 Patient Service Centers Laboratory Alliance of Central New York, LLC Central New York s largest state-licensed laboratory. Provide clinical and anatomic pathology testing to a 16-county region in Central New York. More than 10 million tests are performed annually at our four laboratories in Syracuse, New York. 4

5 Introduction of Lean In 2010, we began to implement Lean into the culture of our network, starting with the Operations Center General Lab. Since then, we have implemented it into our RRLs and into our Microbiology Department. Each of these labs has been transformed from a static design to one that allows us to easily change our labs to meet the demands of new technology and still operate efficiently Lean Workstation with Movable Benches 5

6 Moveable Lab Benches and Strategically Placed Instrumentation Help to Make This Lab Lean Lean Workstation 6

7 Implementation of Lean We have eliminated waste and organized our work areas to have exactly what is needed to accomplish various tasks. We have also introduced Standards of Work to ensure that we standardize work practices among our employees, reduce errors, and improve patient care. One of the most challenging endeavors has been to ensure that our staffing levels meet the demands of our workload. It s not as simple as counting requisitions. The Challenge 7

8 Central Receiving 8

9 Establishing the Standard We video recorded our staff accomplishing various processes to gain a better understanding of how they complete these processes. This helped us to establish better work standards, but it also helped us to understand how much time each of these processes requires. Determining the Frequency Once we knew what the processes are and how much time is required for them, we set out to determine the frequency of the various processes. It s not as simple as counting requisitions. 9

10 Types of Work Requisitions requiring registration AND order entry. Requisitions requiring manual ordering of tests. Requisitions whose tests have been pre-ordered and need their lab receive time documented. Microbiology, Blood Banking. Review of the Reqs We went through a stack of requisitions (2.5 feet tall) to try to identify the frequencies for the various data input processes. VERY TIME CONSUMING ( reqs/day) Subject to human error (miscount, misjudge) 10

11 The Tally Sheet The Manual Tally Staff would process a requisition and its accompanying specimens. Then, staff would mark a tally next to the appropriate processing method on a tally sheet. PROBLEM Staff might forget to mark. PROBLEM Staff might miscount, either because of lack of understanding or accident. EDUCATE! This method requires one person to sort through all of the collected data and translate it. 11

12 Mother Necessity We needed a way to pull the data from our LIS. No method existed for pulling from the LIS the data we needed to understand workload processes for Central Receiving. We had to create a method. The New Process We created a process tally that operated within Central Receiving s workflow and did not interrupt it. Staff are already using the LIS. Instead of interrupting their flow and having them tally, we had them scan or key in a code which represented the accomplished work. 12

13 Tally Orders Function Code Same accession as tests or different? Order under Function Same RE Same RE Gen Lab Module Tests: Same Micro or BB Tests: Different Gen Lab: OER Micro or BB: RE The Electronic Tally After staff complete their test order, they are prompted to enter a result. The LIS defaults to 1. Example: FREMAN:1 If staff actually had to order tests under two different accession numbers, they change the default to 2. 13

14 The Crystal Report So What do I do with this data? 14

15 Manual Manipulation Manual manipulation with Microsoft Excel. Sometimes people put the wrong entry in and go back and correct it. Both the original result and the correct result were printed in the Crystal Report. We had to sift out the bad data before interpreting the good data. We Built a Template! Equipped with formulas to convert the Crystal Report into useful information. Although the Crystal Report may still have bad data, the template ignores it, but it also helps to establish hourly time periods. Numbers are in a text format. Template puts them into numerical format. 15

16 The Converted Report Hourly Tabulation 16

17 Process Timing Time Required for Each Hour 17

18 Employees Needed for Each Hour How do we know how many employees we need? e = t w e = required number of employees for a given hour t = time required to complete a given process w = minutes of work accomplished by 1 employee in 1 hour 18

19 Further Manipulation We factored in a 10% absentee rate. If the raw need was more than a whole number, we used the following formula: If the decimal is 0.49 or less. Do not round up. Carry the 0.49 forward. At 07:00 am, if my raw number is 1.49, I set my final need for this time period as 1, and added the 0.49 to the 08:00 am hour. If the decimal is 0.5 or greater, round up. If my raw number is 2.63 for a given hour, I automatically round the need up to 3. Comparing the Calculated Need to Actual Staffing 19

20 Method of Comparison Central Receiving Supervisor feeds into the spreadsheet the actual staffing levels for the day, factoring in lunches, dinners, and breaks. The actual level is compared to the needed level and a difference is calculated. If overstaffed, the cell conditionally formats to red. Understaffed = green Graphical Comparison Green=Understaffed; Red= Overstaffed; Brown=Balanced 20

21 How Do We Know if the Data is Good? We compare the amount of requisitions received in one day to the amount of entries for one day. Entries should exceed the requisitions. When this does not occur, the supervisor reminds staff. Potentially, we could build in more control measures. Keep it simple! Short Term vs. Long Term We were going to introduce this as a temporary measure. We did not want to make a decision for a year based on data from one or two weeks. We helped staff to understand that collecting this data would help us to ensure that we were adequately staffed. We threw out the first week of data as we wanted to monitor staff and assure that they understood and were collecting data accurately. 21

22 A Word of Caution to This Tale Information Systems (IS) Department had to exclude these non-test order codes from our daily workload. Otherwise, workload would be falsely increased. IS had to ensure that these codes were not crossing over interfaces. The information is for internal use only. Considering the Data Over Time 22

23 Predicting the Staffing Levels Comparing the Days 23

24 Mean, Median, Mode I look at the Frequency of employees needed for each hour. I am also looking at Mean, Median and Mode. These should help us to make good decisions when we are ready to establish staffing levels. Limitations This data is only capturing data entry on the pipeline and not Tech Support or TPAs. In future models, we will build in other areas of Central Receiving. 24

25 The Road to Lean is Paved with Good Intentions Lean is a continuous journey to excellence. Some ideas look wonderful on paper, but reality paints a different picture. Lean operates on One-Piece-Flow (or OPF). Our Lab Office Assistants process one patient s lab request at a time. In theory, with OPF, specimens will be processed not long after their arrival in the lab so we stopped time stamping the received time. A Bump in the Road Staffing levels in Central Receiving can be quite intricate. High turnover rate Staffing levels for a given time period might not be appropriate for the incoming work. We needed to know when the work was coming in and compare that information to when the work was completed. Fortunately, our couriers document the time that specimens are delivered to our labs. Additionally, the numbers of specimens are documented. 25

26 Specimen Arrival (number of requisitions) Specimen Arrivals (# of requisitions) 7:00 7:00 8:00 8:00 9:00 9:00 10:00 10:00 11:00 11:00 12:00 12:00 13:00 13:00 14:00 14:00 15:00 15:00 16:00 16:00 17:00 17:00 18:00 18:00 19:00 19:00 20:00 20:00 21:00 21:00 22:00 22:00 23:00 23:00 0:00 0:00 1:00 1:00 2:00 2:00 3:00 3:00 4:00 4:00 5:00 5:00 6:00 6:00 Number of Employees Order Entries (number of requisitions) 3/6/2015 Time of Arrival vs. Time of Order Entry Blue= Arrivals are Greater Than Entries Specimen Arrival vs. Scheduled Employees

27 Specimen Arrival (number of requisitions) 7:00 8:00 9:00 10:00 11:00 12:00 13:00 14:00 15:00 16:00 17:00 18:00 19:00 20:00 21:00 22:00 23:00 0:00 1:00 2:00 3:00 4:00 5:00 6:00 Number of Employees 3/6/2015 Specimen Arrival vs. Ideal Schedule The New Data Suggests Preliminary data suggests that there may be some time periods where our staffing can be adjusted to meet the work flow. We are still in the process of collecting data. We want to ensure that the initial suggestions hold true over a time period. 27

28 Ideal Staffing vs. Actual TIME ARRIVAL ORDER IDEAL ACTUAL 7: : : : : : : : : : : : : : : : : : : : : : : : SUMS: Requisitions/Employee/Hour: 25 Problems With the Data The latter charts are based on employee performance. On average, 25 requisitions per hour. Employee Performance will vary: Experience Type of Requisition At the current average, some parts of the schedule would be difficult to complete. This may compel us to look at the courier schedule to adjust drop off times. 28

29 Lessons Learned Collecting data electronically can be far more valuable than manual data collection. Experience with Excel can help to minimize time required to manipulate data. Data can help to staff according to workload. Data may also validate the need for more or less staff. Although our Rapid Response Labs have similar processes, we are also taking into account their unique processes in order to staff appropriately. Point of Contact Lonnie Stallcup 1304 Buckley Road Syracuse, NY Cell: