Harvest, Copia, & One Lab s Journey Towards Becoming Lean J U N E 2 2, 2 0 1 6 L I S A S E L I S K A R, P. H. M. Thoughts expressed by me do not necessarily reflect those of my employer, the County of Tulare.
Outline Lean- a quick overview Choosing Orchard Harvest LIS and Orchard Copia Lean Project: Test Ordering Lean Project: Specimen Accessioning Lean Project: Reporting Lean Project: Data Mining
Lean Isn t an acronym, prescription, or short-term costreducing project Is a way of thinking, a culture, the way a unit operates
How to think Lean Maximize Customer Value -Find out exactly what is valuable to the end user While minimizing waste -Using resources only in areas that maximize value to the customer The challenge is not in the concept, it s in the DOING
Before Lean Incorrect Assumptions Waste and Ineffective Service Always done it this way. This is the way I was told to do it. I didn t know we could change it. They might not listen to my ideas. I thought this is what was required. I didn t know that s what they needed. I didn t know that s when they actually needed it. I don t know if we can provide that. I don t think we have enough resources for that. Infamous: It is what it is.
The Customer Voice of the customer / Who are the customers? External The Public Our Clients Our Partners Internal Other Agency Departments Our bosses Our employees
8 Wastes T Transport I Inventory M Motion Sorry Tim Woods! W Waiting O Overprocessing O Overproduction D Defects S Skills Under-utilized
Choosing Orchard With a Lean laboratory as our goal, selection of a new LIS began in 2012 Lab Information System Requirements Scorecards Test Ordering Sample Accessioning Remote Accessioning Sample Management Quality Control Cumulative Data Individual and Batched Lab Results Interfaces HIPAA Compliance
The Choice Was Clear Orchard Harvest LIS and Orchard Copia Highly customizable Intuitive design Detailed Help feature built into system Data mining and cumulative reports
Lean Project: Test Ordering
Lean Project: Test Ordering START Provider considers ordering tests from TCPHL Understand needs Understand current process Identify differences Identify opportunities to add value Identify opportunities to eliminate waste Implement strategies effectively Ensure clear communication A process for continuous improvement END At submitting facility, tests have been ordered, specimens collected and labeled.
Lean Project: Test Ordering Objectives Eliminate waste Add customer value Improve communication Improve accountability Increase Capacity (submitters and TCPHL) Time spent ordering tests at clinic dropped from 313 hours/year to 69 hours/year!
Lean Project: Test Ordering Voice of the Customer Value Stream Mapping Copia Paper requisitions eliminated Easier order history and lab report access Collection instructions Order choice descriptions
Value Stream Mapping
Lean Project: Test Ordering Simplified Ordering Screens Custom Order Choice Lists Copia Clinical Info Questions Interfaced with EMR
Lean Project: Test Ordering
Lean Project: Test Ordering
Lean Project: Test Ordering Objectives Eliminate waste Add customer value Improve communication Improve accountability Increase Capacity (submitters and TCPHL) Time spent ordering tests at clinic dropped from 313 hours/year to 69 hours/year! Time spent filling out paper requisitions was 4.5 minutes per sample. Now it takes them 45 seconds per sample to order electronically.
Lean Project: Specimen Accessioning
Lean Project: Specimen Accessioning START Submitter orders test, specimens collected and labeled. Understand needs Understand current process Identify differences Identify waste Identify opportunities to add value Identify strategies to eliminate waste and add value Implement strategies effectively Ensure clear communication A process for continuous improvement END Specimen is at the TCPHL and ready for testing.
Lean Project: Specimen Accessioning Objectives Eliminate waste Improve customer value Improve communication and accountability Increase capacity at the TCPHL Can now accession 100,000 samples in the same amount of time it used to take to accession 15,000!
Lean Project: Specimen Accessioning Standard Work Voice of the Customer Poke Yoke and Visible Process Controls Value Stream Mapping
Lean Project: Specimen Accessioning Under-utilization of Skills. Over-processing. Defects. Copia & Harvest Better time management Defined criteria for follow up Less mistakes Old Way New Way
Lean Project: Specimen Accessioning Objectives Eliminate waste Improve customer value Improve communication and accountability Increase capacity at the TCPHL Can now accession 100,000 samples in the same amount of time it used to take to accession 15,000!
Lean Project: Reporting
Lean Project: Reporting START Order Choice results are entered and approved in Harvest Understand needs Understand current process Identify opportunities to add value Identify opportunities to eliminate waste Implement strategies effectively Ensure clear communication END Reports received by submitting facility and public health partners
Lean Project: Reporting Objectives Improve communication Eliminate wasted time and motion Customized and consistent reporting algorithms Decreased wasted Public Health Microbiologist time/motion from 15 minutes and 1,639 steps per day to 0 minutes and 0 steps!
Lean Project: Reporting
Lean Project: Reporting Order Entry Rules Standardized, order-driven report delivery Results Evaluation Rules Standardized, results-driven report comments Standardized, results-driven report delivery Standardized, order-driven report delivery Send to Host Rules Control timing of billing and report delivery
Lean Project: Reporting Objectives Improve communication Eliminate wasted time and motion Customized and consistent reporting algorithms Decreased wasted Public Health Microbiologist time/motion from 15 minutes and 1,639 steps per day to 0 minutes and 0 steps!
Lean Project: Data Mining
Lean Project: Data Mining START End-user determines report is needed. Understand needs Understand current process Identify differences Identify waste Identify opportunities to add value Strategies for waste elimination and to add value Implement strategies effectively Ensure clear communication Continuous improvement process. END End-user has the report with all requested information in the requested format.
Lean Project: Data Mining Objectives Eliminate waste Add customer value Improve speed and accessibility Improve communication Decreased cost of reports-on-demand from $7-$190 to $1.25 each!
Lean Project: Data Mining Reports were not available or too expensive to produce. -Reportable disease counts -Infectious disease trends -Regular reports to CD Coordinator -Regular reports to Epidemiologist -Customer ordering trends -Volume fluctuations -Operational metrics Old Way New Way
Lean Project: Data Mining Objectives Eliminate waste Add customer value Improve speed and accessibility Improve communication Decreased cost of reports-on-demand from $7-$190 to $1.25 each!
Snap Shot (not a summary!) Reduced test ordering hands-on time by 75% Increased capacity in specimen receiving by 95% Decreased cost of data mining by an average of 92% per report Increased value to customers through higher quality and lower cost Intuitive LIS with process controls built in makes cross training easier More projects wrapping up and more in the pipeline. Lean is all about continuous improvement!
Tulare County Public Health Lab
To learn more Orchard White Paper: Tulare County Public Health Lab s Lean Journey http://www.orchardsoft.com/orchard-white-papers/
Lisa Seliskar Public Health Microbiologist Tulare County Public Health Laboratory lseliska@tularehhsa.org THANK YOU!