Influenza Process Improvement Kaizen Event Report Out December 12, 2013

Influenza Testing at MDH-IDL Virologic surveillance for influenza activity in Minnesota, the United States and the world. Provide situational awareness as well as novel event detection. Participate in multiple projects. MDH-IDL tested >6,000 specimens for influenza.

Kaizen Team

Goals for the Future State While Flu is run 2x a week, reduce % of specimens that take > 6 days to verify. Reduce testing errors to 0 (testing error = specimen for flu being tested for something else, or vice-versa). Implement necessary and appropriate QA checks. Reduce hand-offs from processing to resulting. Improve communication between all staff handling flu specimens.

Scope of Kaizen event  Starting point: Specimen coming to the lab and in the silver fridge. (Specimen has entered our building, been given a unique identifier and its information has been entered into our system).  Ending point: Specimen is verified  NOT in Scope: Anything that happens in DASH

Current State Swim Lane Map

Observations of Current State Excess walking to get paper off printers Results A, B and Subtyping are all separate tasks. It is a clunky process. Unnecessary double and triple checking (sometimes too much QA, sometimes not enough) Not verifying we ran the right test Not verifying we had all the specimens we needed

Observations of current state (cont) Noticed implementation of ELIS focused on people and not the process Lots of forms in bins Shift in how testing is done pre-2009 Archiver and verifier – should work together on verification and storage of tests The most dots are around infrastructure (lack of).

Recommendations Issue: Unnecessary double and triple checking (sometimes too much QA, sometimes not enough). Solution: Defined roles and responsibilities of verifier and processor, including what demographics must be checked.

Recommendations Issue: Not verifying we ran the right test. Not verifying we had all the specimens we needed. Solution: Create a report to cross-check what tests/specimens are pending.

Recommendations Issue: Excess walking to get paper off printers. Solution: Add more printers in more convenient locations.

Recommendations Issue: Lots of forms in bins. Beginning steps for Flu PCR used to be part of the processor’s job. Solution: Auto-assign influenza tests during accessioning by project number.

Recommendations Issue: The most dots are around infrastructure (lack of). Solutions: Plan to network instrument computers to increase access to results. This will be a gateway to further infrastructure enhancements to the process. Form workgroup for confidential waste discharge.

Future State Swim Lane Map

CurrentFuture Qty.TimeQty.Time Tasks56 12 hrs hrs. Waits10 12 – 37 hrs. 8 8 – 32 hrs. Handoffs31 File/Store1410 Decisions54 Totals 24 – 49 hrs.18 – 42 hrs. Current & Future Process Metrics 17% reduction in task time 33% reduction in wait time (shortest scenario) (14% longest scenario) 25% reduction total time (shortest scenario) (14% longest scenario)

Benefits of Future State  Better quality assurance  Better, more appropriate checks  Reduction in error rate  Improved Turn Around Time  Reduction in time walking to printers and storage areas  Less hand-offs of specimens and paperwork

Benefits of Future State  More centralized computer work area Less time spent logging into multiple computers Less time printing and reprinting labels  Reduced time  Clearly defined roles and responsibilities Leading to improved communication

Action Plan Task (What)Lead (Who) Timeline (When) Resources Needed Draft roles and responsibilitiesTeam Purchase and install printersJason IT staff, funds Repeat test tracking as QA event Jen, Jason Angie Generate list of pending Flu PCR tests Sara IT staff Set up auto-assign of 493 and 1492 projects Sara Angie

Measurement Less than 10% of specimens will take greater than six days to verify from receipt to verification by May 30, 2014 Reduction of testing errors from 10 to 0 by May 30, 2014 Expand the number of flu processors from 1 to 7 by January 31, 2014 Expand the number of Flu PCR staff from 3 to 4 by May 30, 2014

Parking Lot ELIS: Auto entry of ABIs, ELIS file to create Excel auto- fill, arrowing down Explore redesigning flu test in ELIS More 7500s Tablets Electronic inventory system for specimens

Lessons Learned Our current Flu process is streamlined compared to pre There were fewer handoffs in the current process than anticipated. The team identified relatively cheap, low effort, high impact solutions that can be implemented quickly.

Lessons Learned Identified that IT is a critical component for implementing solutions The team identified long term goals that require significant IT resources. Appropriate scope Food is crucial for Kaizen survival

Lessons Learned Team focused on the process and not the people. Team was mindful to change the process, not transfer the tasks.

Questions?