Aligning Workflow, Productivity, Quality in the Lab and other Clinical Services Using Lean, Automation, and Real-Time Management Dashboards

Transcription

1 Aligning Workflow, Productivity, Quality in the Lab and other Clinical Services Using Lean, Automation, and Real-Time Management Dashboards Linda M. Guay, MBA/HCM Associate VP of Laboratory Services Franciscan Health System Executive War College April 2014

2 About SJMC 361 acute care beds 65,000 ER visits/year Puget Sounds largest Heart & Vascular Center Largest hospital based dialysis center on the west coast Level II Trauma Level III NICU Stroke Center of Excellence Core lab for system s 5 hospital labs 3.5M 60% is outreach 1400s.f. Clinical Lab

3 FHS Labs The Saints St Anthony Hospital St Clare Hospital St Elizabeth Hospital St Francis Hospital St Joseph Medical Center Our new affiliations: Harrison Medical Center Silverdale Bremerton Highline Medical Center

4 We just keep growing 1993: We grow from 1 hospital to 3 3 Clinics to : Members of a JV PacLab as a means of growing Outreach 2007: We grow from 3 hospitals to 5 7 clinics to : Lean and our PI journey begins in earnest We streamline workflows, remodel to remove walls, install TLA to gain capacity, created a hub for testing and have not increased our testing FTEs since 2013: We grow from 5 hospitals to 8 15 clinics to 24

5 Our Lab s Journey

6 Then That BAD Lab Long LOS in ED is blamed on waiting for lab results Frequent calls to the lab from angry doctors wanting their labs, NOW! ED insists on having its own StatLab 24/7 Sad statement The lab wasn t that bad but perception was so TAT average was great variability was killing us

7 and now We started with PI initiatives Followed sample flow through the lab and addressed every process, involving ALL staff Became obsessed with collecting & studying data New Mantras: One Piece Flow, Pull vs. Push, Make no defects, accept no defects, Non-Negotiable Standards Incrementally closed our StatLab but didn t tell the ED until. We were ready to share the data and prove our case Since then we ve invited key Stakeholders to partner with us on Performance Improvement Initiatives

8 Today s Story: Reputation for PI Lab reputation for CPI is system wide Senior leadership sings our praises Best Performing Department Pillar Award Best Place to Work Pillar Award Dependence on Lab for data is staggering and we can t keep up with demand Pulling data, weeding through it and creating charts every month takes many hours The data we do pull seems outdated doesn t represent most current initiatives Can t stop as we re afraid we d send the wrong message What we can provide feels old last month s data Need to be more real time to monitor whether changes are having desired impact.

9 Data s Journey also Bad to Fab After many long hours Instantaneously

10 Have you ever wished You could observe staffing working and they actually didn't change what they do just because your watching? There s an App for that! You could validate the perception that one person just didn t seem to perform as well as his/her peers? There s an App for that! You could easily make schedule adjustments based on volume of work and time of day? There s an App for that!

11 Keep dreaming with me You could provide real time TAT data instead of rear view mirror approach? There s an App for that! A client wants to know if you ve albumins have shifted There s an App for that! Is your lab performing as well as others? There s an App for that! If patients really do have to wait more than 10 minutes to have their blood drawn? There s an App for that!

12 Performance Insights Dashboards Real time monitoring Ease of installation Can be configured on the fly to capture virtually any snapshot you can imagine Modules for: TAT Performance Quality Workflow, Productivity, Staffing Peer Comparisons Outreach/Client Performance

13 Nuria Adem, Manager of Science and Technology

14 Key Features Flexible Can customize reports: Test Priority (ST, RT, TS ) Patient Type Ordering Hospital Workstation Tech ID

15 More Features Can focus on any part of your process Order to Collect Collect to Receive Receive to Verify Others Reporting Ad Hoc (very customizable and quick) Scheduled Reporting Can create distribution routes to share PDF

16 TAT Monitoring Daily, hourly TAT and volume Demonstrates volume by hour Shows TAT by hour of day List of outliers Allows for real time follow up with staff Helps in identification of bottlenecks Reinforces Lean improvements Consistently sharing data is easy

17 Karen Lea, Lab Regulatory and Compliance Manager

18 Sample TAT: Analytical

19 Continue to shave off time Since dashboard we incrementally find time Shave off 2 minutes between October to March Meet target 94% of the time (75% before dashboard) A testament to daily monitoring of outliers

20 TAT by Hour

21 Proportion of Testing Meeting TAT Goal

22 Looks Great Doesn t It? And yet Our numbers don t match customers experience Just part of the story is told What happens before we begin testing? That s where we needed to engage the ED Part of the process not in our control Time to invite key stakeholders to join us in PI initiatives

23 Sample TAT: Pre-Analytical

24 Composite Turn Around Time Powerful tool for conversations with ED ED controls yellow and white bars. Lab is blue.

25 Ben Harris, Clinical Manager of Emergency Department

26 Quality Hemolysis/QNS report to ID units to retrain Categorize reasons for test cancellations Review Critical Value notifications Time between verify and call made to provider (by Tech ID) Assess difference in test results by period or instrument Preemptively find drifts before QC failures Quality Monitoring soon to be required by CMS Dialysis Unit monitors Albumin and is looking to us for trending data

27 Workflow, Productivity, Staffing Monitor flow by Patient collections Containers/tubes Accession Test Analysis of staffing requirements for any lab process Monitor frequency and size of batch processing Instrument Utilization and Spare Capacity

28 Cecil Dunn, Lab Operations Manager

29 Workflow: Activity by Hour

30 Sample Productivity Report

31 The benefits of such a change Significant improvement and reduction in outliers, both in lab and pre-lab Attaining best practice performance levels

32 Outreach Monitor Service Commitments Volume Trends Patient waiting vs. staffing

33 Peer Comparisons Dashboard users have access to industry s largest peer comparison turnaround time database Current 270 lab database covers all clinical path procedures (500 million performance measurements) Academic medical centers, teaching, community hospitals Children's hospitals Lean labs Specialty labs (ED, Oncology, clinic) Users can network with best practice labs Best practices may be result of Lean methods, technology or both.

34 IDTs to a New Level Transparency Share data yours and mine Shared accountability What we each will do to improve/sustain Better Together LOS Patient Satisfaction Reimbursement

35 What Gets Measured, Gets Done There is power in setting targets and measuring results Use the data to tell your story To Clients To Staff To Senior Leaders The only way to investigate quickly, remain nimble and make data driven change

36 How will we tell our story to Further involve stakeholders Keep staff engaged Identify capacity Increase our business Next Steps

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