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On the Road to Process Control: A Redesign Driven by Data in Anatomic Pathology Terry Brent Laboratory Manager, OHSA 2180 Ethel Street Kelowna, BC, Canada V 1 Y 3 A 1 Phone: 250 -870 -5783 Fax: 250 -852 -3736 terry. [email protected] ca Sheila Herrington, Isobel Lamarche, Heather Nymeyer, Robin Trerice, Susanne Young Kelowna General Hospital Abstract Methods Background: The Anatomic Pathology Department at Kelowna General Hospital has experienced an increase in workload due to several new programs. Additional staff resources had little effect as turnaround time (TAT) continued to leave many customers dissatisfied. The existing processes did not meet current demands nor provide a sustainable model to adapt to anticipated workload increases. Objectives: The main goal of the project was to improve TAT of available Pathology reports to 80% within 72 hours. A Lean team focused on five critical areas; layout and workstation design, standardization of work methods, visual performance measures, material management and improved workplace environment. Method: Videotape data was collected analyzed for all processes in the Anatomic Pathology Department. Current State Value Stream Maps for Histology and Cytology identified over sixty opportunities for waste reduction and process improvements. Lean culture and quality improvement discussions occurred with stakeholders and staff members. Future State Value Stream maps were envisioned and implemented in a four month window. Results: We now have a controlled process with a 48 hour reduction in TAT and 45% of Pathology reports available to customers within 72 hours. Conclusions: Despite a few bumps along the way, a significant decrease in TAT has been achieved. Daily metrics provide a road map for continuous improvement to meet current and future customer needs. Improved Workplace Environment start Is this heaven? It’s an WOW! organize an d lab!!! organize d lab!!! Distance Traveled ~115 ft 3. STOP KEY POINT: The first step to a clean, organized lab is “ 5 s”. To achieve this, all items not required were removed, equipment was arranged to promote work flow, supplies were placed at point of use and these areas were taped out or labelled. STOP X X www. Poster. Presentations. com KEY POINT: The new lab layout was designed statistically using videotape analysis and the affinity graphs. Approx. 260 feet of wasted product travel was eliminated for every sample and an efficient single piece flow was achieved. • depicts the key process points, operator procedures, sequence of tasks, required tools, safety issues and quality checks for a particular task X X STOP KEY POINT: Unnecessary storage time = waste X XX X X X Points of storage X X X X POSTER TEMPLATE BY: Pre Lean data (Feb & Mar 2008) shows it was taking on average over 168 hours to sign out 80% of the cases. Post Lean data (July & Aug 2008) shows a decrease in TAT of 48 hours with 80% of cases signed out within 120 hours. Standardization of Work Methods In March 2008, Kelowna General Hospital began its Process Excellence project in the Anatomic Pathology Department. The purpose of this project was to review all procedures and processes to improve turn around time, reduce waste, improve efficiency and quality of work life, decrease department over-time hours , build metrics that were “critical to care” as defined by the customer and assist in creating a culture of change to incorporate Lean thinking. The scope of the project included looking at specimen receiving, grossing, frozen section processing, Histology, Cytology and Transcription services Five Lean team members were relieved of their regular duties to work full time for four months under the direction of a contracted Project Manager from Valumetrix. ™ STOP KEY POINT: A metric is a quantitative measure of performance used to indicate progress or achievement against a strategic goal. start Introduction KEY POINT: Process Excellence is a systematic approach to improving quality and reducing waste in all aspects of our work. It utilizes practices of Six Sigma, Lean Thinking and Design Excellence. Visual Performance Measures Distance Traveled ~375 ft Front line management and staff monitor highly visual daily metric graphs and can tell at a glance if TAT goal was achieved. Value Stream Mapping Kelowna is located in the Interior of British Columbia, Canada. From championship golf courses to internationally acclaimed wine tours, from downhill skiing to Shakespeare in the Park, Kelowna promises to entertain all who visit this spectacular city on the lake. Results Layout and Workstation Design X XX X X X • shift staff focus to areas where their time is most effective in the process X X Eliminated storage time Material Management STOP KEY POINT: Standard work defines the best way to ensure performance consistency which is critical to achieving a high quality product. A Kanban Inventory System: Project Tools • kanban is a Japanese term where Kan means visual and ban means card • based on actual usage rather than perceived need. • prevents costly and wasteful overstocking, kanban cards are placed at the reorder point in the inventory • allows system flexes for usage fluctuations – orders are only placed when the card is at the reorder point • videotaping operators and product flow and analyzing the tapes using an Excel spreadsheet to identify potential for improvement • “voice of the customer” surveys to gauge what was most important to our customers • affinity charts to prioritize work station proximity and guide layout design • personnel capability (cross training matrix) to utilize staff skill sets Over a four month period many changes were implemented in the Anatomic Pathology Department. Over 60 improvements were identified including: • slides available for pathologist review by 9: 00 am versus 11: 30 am before Lean • single piece flow has replaced batching in specimen reception and grossing • implementation of a bar code labeling and numbering system • specimens travel a significantly shorter distance through the entire process • a technologist is designated for frozen sections • standard work is in place for all work stations • unnecessary photocopying and stapling of requisitions discontinued • specimen blocks are embedded and cut on the same day • an overall decrease of 6% in extra staffing hours is achieved Challenges faced during the project to achieve these results include: • working within the confines of long narrow room dimensions • resistance to change • development of a team spirit between all subdivisions of the department • introducing a culture of continuous improvement and staff engagement Conclusions STOP KEY POINT: Adding more staff is not always “the quick fix” to improve TAT. Redesigning a laboratory by using Lean principles based on data, results in process control. Metrics reviewed by the front line creates a climate of ownership and awareness. We are on the road to continuous improvement and have the tools to meet our goal of 80% of Pathology reports signed out in 72 hours.