Lean Six-Sigma to Reduce Cycle Time and Inventory

Transcription

1 Lean Six-Sigma to Reduce Cycle Time and Inventory

2 Business Case Patient samples are drawn during the day at patient service centers. The lab to continue to drive down operating costs. The lab has the opportunity to surpass the competition in the Long Island market place by offering same day testing to our clients. Define: Team Charter Scope Start: When a patient has their sample taken at a patient service center Stop: When the specimen is resulted. Problem Statement 37% of our clinical requisitions are collected at the patient service centers. Only 7% of our routine clinical requisitions are entered in the lab system by 5:00 pm. 30% of our employees work the 2nd & 3rd shifts. Lab space and equipment are under utilized during the 1st & 2nd shifts. Goal Collect, process and result 90% of the patient service center clinical work by 6:00 pm.

3 Define: CTQ Voice of the Customer Client: Specimens collected today need to be reported to the doctor by tomorrow morning at 8am for routine testing. Patient: I don t want to wait more than 15 minutes for my specimen to be collected.

4 Define - Business Unit Alignment Phase Description PSC Daytime Testing Phase 1 Accessioning in the PSC Pilot Accessioning in the PSC Roll Out PSC Daytime Testing Phase 2 Phase 1 (Nov Sept 2005) Focus on Getting PSC Specimens Delivered and Accessioned by 5 pm Phase 2 (Sept Jan 2006) Pilot Accessioning in the PSC Phase 3 (April July 2006) Roll Out Accessioning in the PSC to all PSCs Phase 4 (June Oct 2006) Focus on Testing and Reporting of PSC Specimens by 6 pm {Multi-Generational Plan to Accomplish Day Time Testing

5 Measure Current State Value Stream Map Improvement Future State Value Stream Map Collect Pat Paperwork Wait Specimen Collected Specimen Processed Computer System Entry Specimen Pick Up Lab Sys Entry Wait Wait Wait Wait Wait Lab Testing Current State could take 12 hours for the specimen to get processed Future State would ensure better flow, QC earlier in the process and shorter TAT

6 Measure: Cumulative Volume 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 5% 5 Large PSC Cum T otals by Half Hour 89% of Patients have Signed in by 2 pm 42% 35% 29% 23% 17% 10% 67% 61% 55% 49% 85% 81% 76% 72% 99% 100%100% 96% 92% 89% 0% 6:30 AM 7:00 AM 7:30 AM 8:00 AM 8:30 AM 9:00 AM 9:30 AM 10:00 AM 10:30 AM 11:00 AM 11:30 AM 12:00 PM 12:30 PM 1:00 PM 1:30 PM 2:00 PM 2:30 PM 3:00 PM 3:30 PM 4:00 PM 4:30 PM Most of our PSCs open by 6am. By 2:00 pm 89% of patients have signed in at the PSC. These specimens can be tested and resulted the Same Day!

7 Measure: Patient Flow S yosset V ariation M on - Fri by H our Q 1 M in M edian M ax Q 3 Poly. (M edian) C loses at 4:00 0 6:00 7:00 8:00 9:00 10:00 11:00 12:00 1:00 2:00 3:00 4:00 Typical PSC Patient Sign in Volume by Hour. Volume in the PSCs are the heaviest in the first half of the day.

8 Analyze: Potential Causes Methods Materials Personnel PSC Office Flow SOPs Followed Client alerts Name Mismatches Hours Open # hrs after close schedules clericals ESL Triage Person ICD Calling Dr Phone Calls Bad Orders from Dr Scripts vs Reqs Patient Flow Billing calling for UPIN CS calling for Problems CS calling for Dr Telephone no # of Employees Chain of Custody Medicare Mix Organizational Skills Turnover Open Positions Training Complexity Site Supervisors New Employees Staff Experience Offsite Supervision Employee Productivity TOROL Proficiency TOROL Down Time Physical Layout Patient Volume How many TOROLs Landlord Issues Patient Population TOROL Speed Team Work Measure Machines Environment

9 Innovative Improve PSC Changes PSC Draws Blood & Processes Logistics Picks Up & Delivers to Accessioning Accessioning Processes Specimens Lab Processes & Results Specimens being processed at the PSC in the second half of the day!! Need to have ready earlier for pickup by courier. Analyze - Challenges Computer System Becomes rate limiting step when PSC is busy Varying levels of proficiency by PSC employees Staffing High Turnover/Too long to fill positions 6 day/10 hour operating hours Communication 36 different locations Innovative Improvements Process Change - Every patient must be entered in Computer prior to draw Evaluation of Skills of Clerical and Phlebotomy staffing Added additional Computer units and training Replace positions with clerical employees in large PSCs made available to all PSCs for communication Individual patient service center level measures on specimens available at pickup

10 Innovative Improve Accessioning & Logistic Dept Changes PSC Draws Blood & Processes Logistics Picks Up & Delivers to Accessioning Accessioning Processes Specimens Lab Processes & Results Now that the specimens are ready at the PSC We Need to get them into the Laboratory to be Accessioned! Analyze - Challenges Flow Need multiple pick ups at the 36 locations in order to level flow into accessioning Service Need to maintain service level on STAT testing service Communication Ability to be flexible depending on PSC Readiness Need to identify differences in STAT testing and routine PSC samples Innovative Improvements Shared Goals created Goalsharing targets for daytime testing impact all employees Accessioning staffing moved earlier to handle new volume Nextel phones in all PSCs for checkpoint prior to pickup. 2 additional daytime routes added for sweeps of the PSCs and STAT pickups

11 Analyze: Flow Cedarhurst to Riverhead approximately 65 miles Long routes with large amounts (batches) Dense Geographic Region of Patient Service Centers

12 Improvement: Reduction of Batches Cedarhurst to Riverhead approximately 65 miles Shorter routes with smaller amounts coming in more often Continuous Flow

13 Control Monitor Daily PSC Delivery 100% Source - Logistic courier count PSC Samples Delivered By 5 pm Logistic Count February Present Good 90% 80% Goal 90% UCL= CEN= LCL= UCL= CEN= LCL= % 60% UCL= CEN= LCL= UCL= CEN= LCL= UCL= CEN= LCL= % Afternoon Ice/Snow Storm Additional 2 Routes Added PSC Staffing Crisis PSC Staffing Stabilized 40% 2/7 2/14 2/21 2/28 3/7 3/14 3/21 3/28 4/4 4/11 4/18 4/25 5/4 5/11 5/18 5/25 6/2 6/9 6/16 6/23 6/30 7/8 7/15 7/22 7/29 8/5 8/12 8/19 8/26 9/2 9/12 9/19 9/26 10/3 10/10 10/17 10/24 10/31 11/7 11/14 11/21 11/29 12/6 12/13 12/20 12/28 1/5 1/12 1/19 1/26 2/2 2/9 2/16 2/23 3/2 3/9 3/16 3/23 3/30 4/6 4/13 Continue to Improve on PSC Specimen to Lab Delivery- Currently at 84% by 5pm!

14 Improve Load Leveling Sept & Feb Avg Mon-Fri PPC Data :00-7:00 7:00-8:00 8:00-9:00 9:00-10:00 10:00-11:00 11:00-12:00 12:00-1:00 1:00-2:00 2:00-3:00 3:00-4:00 4:00-5:00 5:00-6:00 6:00-7:00 7:00-8:00 8:00-9:00 9:00-10:00 10:00-11:00 11:00-12:00 12:00-1:00 1:00-2:00 2:00-3:00 3:00-4:00 4:00-5:00 5:00-6:00 Number of A & D entries Time 6 AM - 6 AM Volume Shift from Beginning of Project Sep-04 Feb-05

15 Good 40% 35% Clinical Specimens Accessioned by 5 pm PSCs Make up 37% Goal 33% (90% of PSC Volume) 30% 25% 20% 15% 10% UCL= CEN= LCL= UCL= CEN= LCL= UCL= CEN= LCL= UCL= CEN= LCL= UCL= CEN= LCL= UCL= CEN= LCL= % 0% 8/2/04 8/9/04 8/16/04 8/23/04 8/30/04 1/6/05 1/13/05 1/20/05 1/27/05 2/3/05 2/10/05 2/17/05 2/24/05 3/3/05 3/10/05 3/17/05 3/24/05 3/31/05 4/7/05 4/14/05 4/21/05 4/28/05 5/5/05 5/12/05 5/18/05 5/25/05 9/2/05 9/12/05 9/19/05 9/26/05 10/4/05 10/11/05 10/18/05 10/25/05 11/1/05 11/17/05 11/25/05 12/2/05 12/9/05 12/16/05 12/23/05 1/3/06 1/10/06 1/17/06 1/24/06 1/31/06 2/7/06 2/14/06 2/21/06 2/28/06 Goal 33% Day After Thanksgiving September 2004 Baseline PSC Process Changes Snow Day Routes Started Extra Sweep Runs added for PSCs for 2pm Accessioning Resources Allocated Towards ISIS at the PSC Control Chart of Percent Accessioned by 5 pm Increased from 8% to 18%!

16 Innovative Improve Laboratory Testing & Resulting PSC Draws Blood & Processes Logistics Picks Up & Delivers to Accessioning Accessioning Processes Specimens Lab Processes & Results Measure Created to Evaluated % of Key Test TAT resulted by 6:00 pm. Testing and Reporting will be addressed in Phase 2 of Day Time Testing Project Analyze Challenges Staffing Technologist positions difficult to fill Flow into laboratory Reporting Need Information at client level to measure impact VOC needed Innovative Improvements Create Day Time testing TAT measure Monitor Key Test TAT by hour for accessioned and resulted Greenbelt project started on Reporting Mechanisms by Client

17 Control Monitor Day Time Tests TAT 100.0% 90.0% Data Source Lab Service Grid UCL= Chemistry Testing % Accessioned by 5 pm and Resulted by 6 pm Good 80.0% CEN= % 60.0% LCL= % 40.0% Data Source Lab Service Grid 100.0% UCL= PT Testing % Accessioned by 5 pm and Resulted by 6 pm Good 90.0% 80.0% CEN= % 60.0% 50.0% LCL= % Control Chart of Chemistry & PT Testing Accessioned by 5 pm and Resulted by 6 pm

18 Long Island has increased processed samples by 5:00 pm from 7% to 19% since September. The first milestone goal of 30% has moved up 3 hours. Sep-04 Hourly Avg Sept Sept Apr-05 Hourly Avg Apr mon Tue wed thu Fri % of total 4/25 4/26 4/27 4/28 4/29 6:00-7: % 2 0% :00-8:00 6 0% 12 0% :00-9: % 13 0% :00-10: % 15 0% :00-11: % 99 1% :00-12: % 132 3% :00-1: % 313 5% :00-2: % 333 9% :00-3: % % :00-4: % % :00-5: % % :00-6: % % :00-7: % % :00-8: % 1,074 40% :00-9: % 1,074 50% :00-10: % % :00-11: % % :00-12: % 1,043 71% :00-1: % % :00-2: % % :00-3: % % :00-4: % % :00-5: % % :00-6: % % 10,598 10,

19 Control Plan Daily Lab Service Grid Includes Daytime Testing Measures 1.Delivered 2.Accessioned 3.Key Test Result 4.Accessioning in PSC Business Unit Daily Metrics Indicates Prior Days Performance on Daytime Testing and Accessioning at the PSC

20 Define Tools Charter Voice of the Customer Critical to Quality CTQ Multi Generational Plan Value Stream Mapping

21 Measure Tools Data Collection Plan Bar Charts Control Charts

22 Analyze Tools Value Stream Map Box Plot Cause & Effect Diagram (Fishbone) Graphs, charts Value Stream Mapping

23 Improvement Tools Brainstorming Employee Involvement Continuous Flow Reduction of Batches Reduction of Waste (Waiting/Inventory) Load Leveling

24 Patient Service Center Daytime Testing Executive Summary Problem Statement/Defect Definition: PROBLEM STATEMENT: 37% of our clinical requisitions are collected at our PSCs. Only 7% of our routine clinical requisitions are accessioned by 5:00 pm. 30% of our employees work the 2nd & 3rd shifts. Lab space and equipment is under utilized during the 1st & 2nd shifts DEFECT DEFINITION: A specimen that is collected in our PSC that is not delivered to the laboratory by 5pm. Results: Baseline Current DPMO: 276, ,939 Estimated Financial Benefits: $169K Current Financial Benefits: $113K YTD Key Root Causes/Solutions: Primary Root Causes not entering into computer system upfront before patient is drawn. Logistics not delivering to lab during the day. Solutions: Process Changes in PSCs. Addt l logistics routes. Balance of clerical to phlebotomist. Shift changes in processing department. Process Improvements: Nextel radios for PSC communication. Feedback to PSC on performance. Key Learnings/Issues Pending: Measures should be created before a project starts for a multi-departmental endeavor. Patient wait time was the primary inhibitor to PSC change. This stopped some of the progress made by other departments.