Combining Real-Time Business Intelligence and Quality Management Systems to Turbocharge Lab Workflow and Productivity

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1 Combining Real-Time Business Intelligence and Quality Management Systems to Turbocharge Lab Workflow and Productivity LQC 2015 Vince D Mello President D Mello LabMed Consultants 1

2 Today s Discussion 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 2

3 Current Reality 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 3

4 The Fundamentals 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 4

5 What is Six Sigma? A sophisticated, comprehensive and flexible program for achieving, sustaining and maximizing organizational improvements, using a structured approach. 5

6 What does SIX SIGMA Mean? Sigma Level Defects per Million Opportunities 2 308, , ,

7 SIX SIGMA Principles Genuine Focus on the customer Data and Fact Driven Management Proactive management Collaboration Drive for excellence 7

8 What is LEAN? Strategy to eliminate waste and non value added activities 8

9 LEAN Principles 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) 9

10 SIX SIGMA compared to LEAN 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 10

11 Change Management Principles 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 11

12 Hospital Pathology Department Case Study: IQMH / ISO 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 12

13 Pathology (Pre) Lean Issues 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 13

14 Inventory Lean Workflow Pre Lean September 2011 Post Lean September 2012 Post Lean Accessioning backlogs Grossing Large Cases 20 cases/day days 0 4 days 0 6 days Placentas 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 14

15 Future State Vision 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 15

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 16

17 Key System Changes 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 17

18 Outcomes Achieved - Lessons Learned 18

19 Pathology Specimens Pre vs Post Lean TAT s 100% 90% Q1 Apr-Jun 2011 Pre Lean Percentage of cases signed out 80% 70% 60% 50% 40% Transition Q2 Jul-Sep 2011 Q3 Oct-Dec 2011 Q4 Jan-Mar 2012 Q1 Apr-Jun 2012 (Crisis) 30% Q2 Jul-Sep 2012 (Post Lean) 20% 10% 3 days 4 days 5 days 7 days 10 days Number of working days 19

20 TAT Pre vs. Post Lean All Specimen Types 100% 90% 87% 92% 80% 78% 76% Percent of cases signed out 70% 60% 50% 40% 54% 58% 63% 70% Q3 2010/11 Pre Lean Q2 2012/13 Post Lean 30% 20% 10% 4 days 5 days 7 days 10 days Months 20

21 Return on Investment Lean Study Project Expenses Project Expenses = (Staff time, 200 $45/hour + Advisor Fees) $45,000 Annual Project Savings Elimination of Non Valued added (NVA) processes = 18.25/hours/day $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 % Payback = $117,515/$45, Months 21

22 Engagement Survey 60% Response Rate to Survey 6 Months post Lean Comparing Pre & Post How would you rate What do you think our clients/patients would say about overall service delivery? Improved Significantly Improved Marginally Remained the Same Got Worse Don t Know 58% 38% 4% 0 0 Impacts on overall TAT s 75% 25% Reduction in processing bottlenecks and backlogs? How has implementation of FIFO and the supermarket model helped with integration of workflow? Productivity? Operational efficiencies Use of visual management tools/dashboards to manage workflow and address backlogs? 50% 38% 4% 4% 4% 79% 13% 4% 0 4% 33% 63% 38% 29% 21% 4% 4% 0 4% 4% 63% 29% 0 0 8% Overall job satisfaction? 25% 58% 8% 0 8% 22

23 Why Consider BI Applications? In God we trust, everyone else bring data 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 23

24 IT Considerations 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 24

25 BI - Applications Operational Workload Volumes vs. Staffing Turnaround/Wait Times Productivity Physician/ Clinical Quality Management Physician Practice Management Regulatory Reporting Financial Staffing and Budget Optimization Procedure/Test Cost Revenue/Expense Monitoring 25

26 Histology Dashboard 26

27 Pathologist Productivity 27

28 Outstanding Cases for Gross Dissection 28

29 Main System Dashboard 29

30 Benefits of Adopting BI 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 30

31 Success with Lean 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 31

32 Key Learnings 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 32

33 Tips to Sustain Performance 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 33

34 Takeaway Message L = Leadership E = Excellence A = Actions N = Never ends S I G M A = Strategic = Influence = Goals = Measurements (BI) = Accept change 34

35 Thank You Questions? Website: Phone:

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