combining real-time business intelligence and quality ... · updated, accurate data •...
TRANSCRIPT
1
Combining Real-Time Business Intelligence and Quality Management Systems to
Turbocharge Lab Workflow and Productivity
Vince D’Mello
President
D’Mello LabMed Consultants
LQC 2015
2
• Key industry trends and change drivers
• About Lean & Six Sigma & QMS
• Strategic change & improvements
• BI applications benefits / values
• Case studies
• Lessons learned
• Q and A
Today’s Discussion
3
• Do more with less resources
• Escalating clinical demands, volumes and case complexity
• Increasing regulatory and administrative burden
• Low staff morale
• Pressure to reduce budgets, costs
• Increase operational efficiencies and productivity
• Negative media attention with errors
• Lack of transparency and availability of relevant real time information
Current Reality
4
• Function of leadership
• Journey not a destination
• Opportunity to learn and improve
• Select the appropriate tool for the situation
• Involve front line staff
• Integrate clinical, operational, financial, and patient safety
criteria for best ROI
• TQM = Evidence based Excellence
The Fundamentals
5
A sophisticated, comprehensive and flexible program for
achieving, sustaining and maximizing organizational
improvements, using a structured approach.
What is Six Sigma?
6
Sigma Level Defects per Million Opportunities
2 308,537
3 66,807
4 6,210
5 233
6 3
What does “SIX SIGMA Mean?
7
• Genuine Focus on the customer
• Data and Fact Driven Management
• Proactive management
• Collaboration
• Drive for excellence
SIX SIGMA Principles
8
Strategy to eliminate waste and non value
added activities
What is LEAN?
9
• Specifies value as defined by the client
• Value stream mapping to compare current vs. future state
• Workflow (continuous vs. batch)
• Customer wants vs. unwanted
• Perfection = LEAN culture (reduced errors, costs, effort,
space, time, inventory)
LEAN Principles
10
• Six sigma helps reduce process variations and errors
• Lean reduces waste (not people)
• Biggest challenge with either is human aspects of change
management
• Six Sigma takes months (start-finish)
• Lean takes weeks
SIX SIGMA compared to LEAN
11
• Learn, improve, move forward
• Zero tolerance for blame and shame tactics
• Patient focused problem resolution
• Respectful interactions
• Adopt “Just do it” mindset
• Evidence based decisions
Avoid
• Chasing the perfect solution
Change Management Principles
12
• IQMH / ISO 15189 Accredited facility for more than 10 years
• Strong QI foundation and culture
• First LEAN study for both the Hospital and Lab
• Lab provided the leadership for the rest of the hospital to
embrace LEAN and BI
Hospital Pathology DepartmentCase Study:
13
• Uncontrolled batch sizes
• Pre analytical, analytical, post analytical processes not integrated to
meet clients needs
• Pre assignment of cases to Pathologists
• Unbalanced workflow and workload
• Constant Prioritization & Reprioritization
• Significant backlog of cases, not transparent
• TAT’s not meeting clients needs
Pathology (Pre) Lean Issues
14
Pre LeanSeptember
2011Post Lean
September2012
Post Lean
Accessioning backlogs
20 cases/day 0 0
Grossing
Large Cases10 – 14 days 0 – 4 days 0‐6 days
Placentas 20 – 40 days 0 – 2 days 0 – 1 day
Bx/Routine 0‐2 days 0 ‐ 1 day 0 – 1 day
Gyne Cytology 3 – 5 days 0 – 2 days 0 – 1 day
Report Sign outs 52% in 5 days 88% in 5 days 82% in 5 days
30% > 10 days 2% > 10 days 4% > 10 days
Inventory – Lean Workflow
15
• It is entirely about the client / patient
• Supermarket concept “client pulls service”
• Sequence of events :
Client Pathologist Technical Grossing Accessioning Specimen collection
• Pathologists set daily workflow “pace”
• Staffing schedules based on “continuous flow”
• Daily or weekly case input “Equals” reports signed out to achieve
“steady state”
• FIFO ( first in first out) workflow
Future State Vision
16
Goals
Improve
• TAT’s 90% of all case types reported in 5 days
• Workflow processes
• Staff productivity/utilization
• Workload distribution
Eliminate
• Backlogs
• Non value added processes
Educate
• Staff about LEAN
• Transfer knowledge and skills
17
• Eliminated pre-assignment of cases to Pathologists
• Clerical staff accession instead of MLT’s or TA’s
• Created work cell model (embed/cut/stain)
• Reduced re-screens of Gyne cases by 30%
• Adopted FIFO workflow from sample receipt to report sign out
• Pathologists pull cases from centralized “supermarket” in
standardized manner
• Pull vs. Push workflow model adopted
Key System Changes
18
Outcomes Achieved - Lessons Learned
19
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
3 days 4 days 5 days 7 days 10 days
Number of working days
Per
cen
tag
e o
f ca
ses
sig
ned
ou
t
Q1 Apr-Jun 2011
Q2 Jul-Sep 2011
Q3 Oct-Dec 2011
Q4 Jan-Mar 2012
Q1 Apr-Jun 2012 (Crisis)
Q2 Jul-Sep 2012 (Post Lean)
Pre Lean
Transition
Pathology Specimens Pre vs PostLean TAT’s
20
54%
63%
70%
76%
92%
58%
78%
87%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
4 days 5 days 7 days 10 daysMonths
Perc
en
t o
f cases s
ign
ed
ou
t
Q3 2010/11
Q2 2012/13
Pre Lean
Post Lean
TAT Pre vs. Post LeanAll Specimen Types
21
Project Expenses
Project Expenses = (Staff time, 200 hours @ $45/hour + Advisor Fees) $45,000
Annual Project Savings
Elimination of Non Valued added (NVA) processes = 18.25/hours/day (@$45.00/hour) $213,525
Projected reduction in overtime = 79 hours/month $63,990
Less additional costs
Added 2.5 FTE’s (1 TA, 1 Clerical, 0.5 PA) = $/year $160,000
Anticipated savings per year $ 117,515
Return on Investment 261.14%
Payback = $117,515/$45,000 4.59 Months
Return on Investment – Lean Study
22
Comparing Pre & Post
How would you rateImproved
Significantly
Improved
MarginallyRemained the Same
Got Worse
Don’t Know
What do you think our clients/patients would say about overall service delivery?
58% 38% 4% 0 0
Impacts on overall TAT’s 75% 25% 0 0 0
Reduction in processing bottlenecks and backlogs?
50% 38% 4% 4% 4%
How has implementation of FIFO and the supermarket model helped with integration of workflow?
79% 13% 4% 0 4%
Productivity?
Operational efficiencies33%
63%
38%
29%
21%
4%
4%
0
4%
4%
Use of visual management tools/dashboards to manage workflow and address backlogs?
63% 29% 0 0 8%
Overall job satisfaction? 25% 58% 8% 0 8%
Engagement Survey60% Response Rate to Survey – 6 Months post Lean
23
• Trend setting Cloud technology (SAAS)
• Real time data through electronic dashboards
• Evidence based interventions / decisions
• Proactive vs. reactive issue management
• Data based client management/relationships
• Enhances continuous improvement culture
• Visual displays & daily workflow management
Why Consider BI Applications?“In God we trust, everyone else bring data”
24
• Easy to maintain
• Minimal IT involvement in project start up requirements
• Minimal on-going IT support required
• Minimal IT hardware requirements
• Rapid start to finish implementation/validation and go-live (< 3
months)
• User friendly
• Low touch application
IT Considerations
25
• Workload Volumes vs. Staffing• Turnaround/Wait Times• Productivity
Operational
• Quality Management• Physician Practice Management• Regulatory Reporting
Physician/ Clinical
• Staffing and Budget Optimization• Procedure/Test Cost• Revenue/Expense Monitoring
Financial
BI - Applications
26
Histology Dashboard
27
Pathologist Productivity
28
Outstanding Cases for Gross Dissection
29
Main System Dashboard
30
• Reports can be created easily and quickly on a daily basis with
updated, accurate data
• Productivity and outstanding case information available to make
management decisions regarding prioritization of cases, staffing
requirements, overtime requirements
• Turnaround time reports and LEAN status available daily, quickly
and easily with detailed information as required
• Details can be reviewed by drilling down on information displayed
Benefits of Adopting BI
31
• Eliminated SILO culture
• FIFO, supermarket working well
• Reduced overtime with improved TAT’s
• Not pre-assigning cases has improved efficiencies
• Front line staff engagement with OFI’s
• Evidence based problem solving and decisions
• Adopting visual controls/management tools
Success with Lean
32
• Collaboration (internal/external) and teamwork is critical for success
• Takes focus, time and effort to get positive outcomes and sustain
improvements
• Skeptics will be pleasantly surprised with improvements & outcomes
• Challenge perceptions/opinions with supporting data
• Use relevant data to drive decisions and plan improvements
• Enjoy the journey and experiences
• Celebrate successes
Key Learnings
33
• Daily Monitoring of workload and backlogs with timely interventions
is essential
• Critical to have minimum and back up staff available daily to meet
fluctuating workload demands
• Annual across the board budget cuts are significant impediments
with process improvement initiatives
• Use BI & real time dashboards
• Don’t underestimate the impacts of change on staff
• Embrace failures as opportunities to learn and improve
• Promote teamwork and performance accountability
Tips to Sustain Performance
34
L = Leadership
E = Excellence
A = Actions
N = Never ends
S = Strategic
I = Influence
G = Goals
M = Measurements (BI)
A = Accept change
Takeaway Message
