1. Sutter Solano Laboratory Lean Six Sigma Project
“Getting Our Ducks In A Row”
Joe Wells, MT, MA, Laboratory Supervisor
Progress as of July 22, 2008

2. Business Process Management Key Process Mapping
Clinical Laboratory Processes
Pre-Analytical Process
Analytical Process
Post Analytical Process
Collection
Labeling
Delivery
Receiving
Specimen Processing 2

3. Define: ProcessExpressSM Project Charter
Business Case:
Expected laboratory turnaround times are not being met for ER samples and early morning draws. This impacts laboratory customer satisfaction, patient care and finances.
Problem Statement
Sutter Solano laboratory is not consistently meeting stated turnaround times for ER samples and early morning draws. Variability in testing turnaround times is resulting in customer dissatisfaction. 
Results for early morning draws should be on the charts by 7:30am for ICU and 8 am for Med/Surg.
Target= 95%
2007 Average= 85%

4. Organizational Pillars
Service
TAT AM & ER
Physician & Patient Satisfaction
Quality
Reporting Timeliness
Order entry errors
Drawing Issues
Finance
Workload Balance
Variance
Overtime
People
Employee Satisfaction (EOW)
Growth
Community

5. Define: Process Map Routine AM

6. Fishbone & Brainstorming Notes

7. Root Causes Initial “Just do its” List of patients with lines on floor
Supported by data
Phlebs start time does not allow for completion by goal time
Many ER calls for draw throughout the day
Process imperatives
Communication of PIC line patients is key to decreasing time in early morning draws
Batching in early morning rounds needs to be reduced
Initial “Just do its”
List of patients with lines on floor
Pick up of specimens by morning CLSs
ER sample rack
Share patient satisfaction survey comments at staff meetings
Eliminate 2 sets of labels printing
Labels for UA sent to departments: 2-3 labels
STAT notification: Dynamic pending log
Quick reference on floors for order codes
Update physician phone directory
Back time (duplicate) IT fix
Provide charge nurse cell phone number for critical values

8. Majority of phone calls deal with: Transfer, Information or Results
Measure: Phone Calls
Measure / Analyze Observations:
Rounded with AM Phlebotomists on early morning collection
Collected data on phone call interruptions & peak draw times
Sample Lounges
Wasted Steps
Majority of phone calls deal with: Transfer, Information or Results

9. Improve: Brainstorming Results
Weekends should be staffed as weekdays (7)
Autoverification (6)
If ER prints order just go (6)
Nurse education (6)
CLS help if phlebs are short (5)
Schedule break times (5)
Use volunteers to run ER samples to lab (5)
Monitor for pending draws (4)
Critical value call process (4)
Lab personnel in ER during peak times (4)
Change phleb times (and possibly techs) to start earlier (4)
Revise parameters for 8am TAT report
Buttons for line draws on floors
Add ons added as a test
Stat spin centrifuge for coag
Have dedicated person to receive labs in computer
Second microscope set for AM diffs
Have techs drawing pre-AM ask if can combine draws
Scanners for quick entry
Redesign of Heme and Chem (in process)
Slidemaker/Stainer
Add call in phlebs

10. Dynamic Pending Monitor
Improve: Solutions Implemented
Dynamic Pending Monitor
Standardized Phlebotomy Carts

11. Improve: Additional “Aha” Moments and “Just Do It’s”
Fix lab intercom
I-Stats in ER (Go-Live July 30, 2008)
Phlebotomy carts standardized and ready for use in AM
2-way cell phone for ER communication (Coming soon!)
Regular pick up times on floors for early morning draws and nurse draws
Getting current SRMF list of doctors

12. How We Track Our Success- Daily Report
Daily metrics tracking keeps everyone focused

13. Share Results & Celebrate!
TAT target goal of 95% achieved, significant improvement from 2007 average of 85%

14. Between 1/6/2008 and 4/13/2008, the standard deviation was 5
Between 1/6/2008 and 4/13/2008, the standard deviation was 5.4 and between 5/25/2008 and 8/17/2008 the standard deviation was This represents a 54% reduction in the process variation.

15. Patient Satisfaction Scores
Improved patient satisfaction percentile rank from 15 to >60 within six months

16. Reducing Waste: 5 S Applied to Lab Closet After Before

17. Kan-Ban in Lab Supply Closet Before After

18. Lessons Learned
Keep employees informed-communicate the good, bad and the ugly along with the project goals
Make sure everyone knows their role and are included in the decision processes
Simple rewards and reminders keep everyone aware that the process is always active-never stops just because we hit the mark
Advertise to the facility-share the information and get other departments involved (IT, nursing, physicians, other hospital staff)
Next Steps:
Evaluation of Phlebotomy Morning Start Times (4:30am versus 5am)
Evaluation of workspace in laboratory and potential options for reorganization of work stations for optimal efficiency
Evaluation of inventory control and par levels
Finalize FMEA for mislabeled specimens 18