1. Dr Khalida Parveen Basha N Lean six sigma black belt NABL assessor
Improvement in the TAT of laboratory reports using six sigma methodology
Dr Khalida Parveen Basha N
Lean six sigma black belt
NABL assessor
Certified CAP team lead

2. DEFINE PHASE PROJECT NAME
Improvement in the turn around time of laboratory reports
In the FY % of the laboratory reports had TAT outliers(>240 mins) ) impacting patient clinical care.
PROBLEM STATEMENT
GOAL STATEMENT
Reduce the TAT outlier to < 5 %
Patient care service/general duty assistant not under direct
control
No audit trail for transport time from collection to accession and from accession to the biochemistry department.
No audit trail for report dispatch
- HIS not user friendly
CONSTRAINTS

3. Project objective Status at the start of the project (April 2015)
9.1 % TAT outlier (defects)
Test load : 172 tests per day
Status aimed at the end of the project
(Nov 2015)
< 5% TAT outlier (defects)
To increase the number of tests per day by 36 tests
Increase in the financial benefit between Rs 3960 /day to Rs. 86,400/day

4. Scope: All biochemistry reports
Out of bounds:
IP and outsourced tests
samples billed before 6AM and after 4PM
National holidays and Sundays
Timed samples
Urine and other fluid samples

5. Patient/Requesting doctors
SCHEDULE
Define
Measure
Analyse
Implement
Control
 4th May 2015
11th May -25th May 2015
Aug 7th- Sept 5th 2015
Oct 1st - 30th Oct 2015
Nov 2nd- Nov 10th 2015
Dr Khalida Parveen
Dr Shabnam Roohi
Mr Deepak Agarkhed
 Dr Khalida Parveen
PRIMARY CUSTOMER
Patient/Requesting doctors

6. MEASURE PHASE Turn around time from billing to report verification
TYPE OF MEASURE
DATA COLLECTION STRATEGY
HIS biochemistry data of two weeks
Sample audit, time and motion study of two days (Gemba)
TAT more than target time i.e
4 hours (240 minutes)
OUTLIER

7. PROCESS MAP Billing of the tests Sample collection Phlebotomy
Target time from billing to collection: 10 mins
Billing of the tests
Sample collection
Phlebotomy
Target time from collection to acknowledgment: 45 mins
Sample transport
Sample acknowledgement
Accession
Sample receipt
Target time from acknowledgment to verification :
120 mins
Result entry
Biochemistry Department
Result verification

8. Cause and effect diagram (Ishikawa)
Report delay

9. IMPACT CONTROL Prioritisation of Xs: Control / Impact Matrix HIGH
MEDIUM
LOW
Shortage of staff
Delay in sample transport
Sample rejection & follow up
Delay in sample receipt in the department
Equipment breakdown
Equipment sample process time
Wrong billing correction
Improper information about the change in the billing
Improper information about the samples billed earlier & collected late
GDA unavailable
Bar code alignment issue
IP sample collections in HIS without collecting the sample
Preventive maintenance
One PCS staff in the 7AM-11:30AM shift
Delay from phlebotomists
Inexperienced GDA
Inexperienced PCS
Inexperienced accession personnel
Delay from GDA
Difficult vein
Patient's queries
Bar codes not read by the equipment
EI worklist delay
Equipment not interfaced
All investigations not mapped
Power failure
Temperature not maintained
HIS not working
No reagent supply
Tight full sleeves dress
Telephonic queries
Patient queries
Latest billing not reflecting on the first page
Pending worklist not available
- Increased sample load
CONTROL
IN OUR CONTROL
OUT OF OUR CONTROL

10. Source: 1. HIS 2.Gemba-time and motion study Data: Population
HIS data
ANALYSE PHASE
Gemba-time and motion study
Target time:10 mins
Source: 1. HIS 2.Gemba-time and motion study
Data: Population
Area: Phlebotomy

11. Source: 1. HIS 2.Gemba-time and motion study Data: Population
HIS data
Gemba-time and motion study
Target time: 45 mins
Source: 1. HIS 2.Gemba-time and motion study
Data: Population
Area: Accession

12. Source: 1. HIS 2.Gemba-time and motion study Data: Population
HIS data
Gemba-time and motion study
Target time: 120 mins
Source: 1. HIS 2.Gemba-time and motion study
Data: Population
Area: Biochemistry

13. Improvement strategy Phlebotomy: Accession:
Non value added steps reduced in the sample collection process
Takt time analysis done and staff allotted for sample collection during the peak time and back up provided for sample collection when there are more three patients waiting
Two dedicated GDA staff & their back up trained for sample transport and time management
Accession:
GDA training for the transport of samples from accession to the biochemistry department
Specific time to be allotted for outsource report dispatch

14. Improvement strategy Biochemistry department:
Pending lists monitored at frequent intervals
The unresolved IT issues were compensated to some level by the technical staff suggestions in the brainstorming session: 1. Manual dilution programming for auto calculation (manual calculation step was skipped) 2. Manual assignment of the position and rack ID (helped in the reduction of number of steps in the manual process)
Suggestions that were not implemented-
Two dedicated staff to be provided covering 7AM-5:30PM
Target time of the transport time to be revised to 10mins from 45mins as we have pneumatic chute system for sample transport

15. Performance measurement

16. Project objective Target Achieved
Status aimed at the end of the project
< 5% TAT outlier (defects)
To increase the number of tests per day by 36 tests
Increase in the financial benefit between Rs 3960 /day to Rs. 86,400/day
Achievement at the end of the project
4.6 % TAT outlier (defects)
Increased the number of tests per day by 76 tests
Financial benefit achieved between Rs 8360 /day to Rs. 1,82,400/day
Target Achieved

17. CONTROL PHASE For the sustenance of the TAT
The pending tests list is monitored twice daily at 11 AM and 4 PM by the biochemistry department to control the TAT of the tests.
Monthly TAT review in the laboratory quality meeting and quarterly TAT review by the hospital quality department.

18. Conclusion
Lean six sigma methodology has helped in the achievement of the following:
increasing productivity without any additional resources;
improving quality by reducing the opportunities for error; and
ensuring the improvements are maintained through systematic and timely monitoring.
The stakeholders have noticed the change and improvement in the turnaround time of biochemistry reports.
Staff feel appreciated and motivated as their suggestions has played a vital role in the success of this project.
Furthermore, this project has served as a model that launched other quality improvement programs in the hospital