1 Workflow Optimization | Our assessment approach Respond to the Challenge | What will be your approach?

2 People: The rate limiting factor of Change Top 10 Barriers to Success “Source: Deloitte & Touché Survey of CEO's regarding Business Transformation: Top 10 Barriers to Success, 2004.”. No Change Management Program Project Team Lacked Skills 36% 41% 43% 44% 46% 54% 65% 72% 82% IT Perspective not Integrated Not Horizontal Process View Scope Expansion / Uncertainty Case for Change not Compelling Poor Project Management Unrealistic Expectations Inadequate Sponsorship Resistance to Change PERCENT OF FIRMS “Soft skills”? Hard Impact. Resistance to change is a significant barrier to realizing results and savings When pursuing transformations, organizations rarely realize the benefits or retain the value they anticipated. While there are many reasons for this, the following survey of CEO’s shows that 5 out of the top 10 business transformation showstoppers are ‘people and organizational’ issues.

Change is not managed 3 Time Commitment to change UNAWARE CONFUSION NEGATIVE PERCEPTION SUPPORT WITHDRAWN GO-LIVE ROI PROJECT TERMINATED AWARENESS UNDERSTANDING ADOPTION COMMITMENT GO-LIVE Project Rework Sub-Optimized Delivery Lack of Project Team and Leadership Alignment Delay/No Adoption Missing Accountability Minimized/Missed Benefit Realization Lost Investment Opportunity Change is managed effectively Process of Change Management

4 Staff schedules Staff priorities Volume patterns Turnaround time analysis Specimen physical flow Value streams Unnecessary or over-processing opportunities Creating the “LEAN” Microbiology Lab 1. Strategic Assessment Unbiased LEANSigma observation and data analysis of your lab 2. Transformation Collaborative group effort Kaizen events Rapid Improvement Workshops

5 Strategic Assessment Introductory visit with site leadership Pre-audit data request Type/volume of samples Segmented staffing data Working hours Organization chart Performance metrics Building layout Discuss challenges Introductions & kick-off Review schedule Walk the process Data gathering Pareto analysis Physical Layout "Cycle time analysis' or snapshot observation Volume arrival patterns Spaghetti diagrams Current state value stream map Lead time analysis Interviews Data analysis potential linkages between observation and performance Current state data validation with site leadership Define "improvement roadmap” Process Layout Staffing Equipment Future state definition Prepare final report Recommendations for improvement Quantify benefits Review opportunities and next steps with stakeholders Pre-workKick-off Data Collection Future state Report-out Strategic Assessment

What is Important to the patient? © 2009 Guidon Performance Solutions, LLC. All rights reserved. Guidon Performance Solutions is a licensee of LEAN Sigma ®, a service mark of TBM Consulting Group. OPERATIONAL LEAD TIME Wasted Time & Activity Core Process Value Excessive Motion (Walking to Next Task, etc.) Defective Process (Identifying, Handling, Fixing) Missing Information Waiting for next Process Call or Log information Backlog of requests Review/QA Key: Improved Processes to Increase “Core Value”

7 You must optimize the whole, not just the parts…

8 Transformation Review opportunities and next steps with stakeholders Pre-visit planning Collaborative group engagement Lean training Map the current state from specimen receipt to result Review the process for improved turnaround times, eliminate waste, reduce errors, minimize touches. Standardize the process Develop and map the new process Assign ownership of key tasks Training in change management Recommendations for improvement Prepare final report Follow up to measure improvements Pre-workKick-off Current state Future state Follow up Kaizen Event: Transformation

9 Workflow Optimization | Our assessment approach 5 S Projects :| Organization Methodology Before After

10 Lab Planning | Designing the Future Laboratory Defining the future laboratory and meeting the needs for growth Current and future state analysis Technology and infrastructure options that facilitate change Design approaches that facilitates lean and workflow optimization Lab space planning and design Approaches to lab automation Technology assessments Workflow planning Lab Relocations

11 Workflow Optimization | Our assessment approach Lab Transformation :| Keys to Success

12 >80% Examples of performance improvement – Maximize Quality We saw improvements quickly (over two months). Over 6 months, contamination from 18% to < 4% Reduce cost by $30k per month Over 1100 urine were contaminated/month 50% were causing re-work and over-processing Design new process and monitor improvement Performance Improvement: Reduction in Contamination

13 Examples of performance improvement – Rapid Decision Support Performance Improvement 6 months later Median: 87 hour  63 hour Top 25%: 119 hour  89.1 hours Identify drivers for this distribution Design new process and monitor improvement 24 hours

14 Example of performance improvement – Patient Centric “Two years later, the results on workflow, turnaround times (TATS), and patient outcomes have been dramatic.” Joseph Campos, Ph.D. Director of the Microbiology and Molecular Diagnostics Laboratories Children’s National Medical Center

15 In summary  Clinical microbiology will remain a “growth based” science  Automation will remove “touches” from the manual process, but will not be effective unless you transform your workflow to maximize the technology investment  We must focus on efficient delivery of clinically relevant results in order to accelerate therapeutic decisions and improved patient outcomes  Performance Assessment and Transformation is a Quality Initiative  Focus is on processes and systems that serve the Patient  Improve level of service and customer satisfaction  Improve employee satisfaction  Free up resources and be prepared for increasing test volumes

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