Combining Real-Time Business Intelligence and Quality ... · updated, accurate data • Productivity and outstanding case information available to make management decisions regarding

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Combining Real-Time Business Intelligence and Quality Management Systems to

Turbocharge Lab Workflow and Productivity

Vince D’Mello

President

D’Mello LabMed Consultants

LQC 2015

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• Key industry trends and change drivers

• About Lean & Six Sigma & QMS

• Strategic change & improvements

• BI applications benefits / values

• Case studies

• Lessons learned

• Q and A

Today’s Discussion

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• Do more with less resources

• Escalating clinical demands, volumes and case complexity

• Increasing regulatory and administrative burden

• Low staff morale

• Pressure to reduce budgets, costs

• Increase operational efficiencies and productivity

• Negative media attention with errors

• Lack of transparency and availability of relevant real time information

Current Reality

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• Function of leadership

• Journey not a destination

• Opportunity to learn and improve

• Select the appropriate tool for the situation

• Involve front line staff

• Integrate clinical, operational, financial, and patient safety

criteria for best ROI

• TQM = Evidence based Excellence

The Fundamentals

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A sophisticated, comprehensive and flexible program for

achieving, sustaining and maximizing organizational

improvements, using a structured approach.

What is Six Sigma?

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Sigma Level Defects per Million Opportunities

2 308,537

3 66,807

4 6,210

5 233

6 3

What does “SIX SIGMA Mean?

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• Genuine Focus on the customer

• Data and Fact Driven Management

• Proactive management

• Collaboration

• Drive for excellence

SIX SIGMA Principles

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Strategy to eliminate waste and non value

added activities

What is LEAN?

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• Specifies value as defined by the client

• Value stream mapping to compare current vs. future state

• Workflow (continuous vs. batch)

• Customer wants vs. unwanted

• Perfection = LEAN culture (reduced errors, costs, effort,

space, time, inventory)

LEAN Principles

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• Six sigma helps reduce process variations and errors

• Lean reduces waste (not people)

• Biggest challenge with either is human aspects of change

management

• Six Sigma takes months (start-finish)

• Lean takes weeks

SIX SIGMA compared to LEAN

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• Learn, improve, move forward

• Zero tolerance for blame and shame tactics

• Patient focused problem resolution

• Respectful interactions

• Adopt “Just do it” mindset

• Evidence based decisions

Avoid

• Chasing the perfect solution

Change Management Principles

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• IQMH / ISO 15189 Accredited facility for more than 10 years

• Strong QI foundation and culture

• First LEAN study for both the Hospital and Lab

• Lab provided the leadership for the rest of the hospital to

embrace LEAN and BI

Hospital Pathology DepartmentCase Study:

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• Uncontrolled batch sizes

• Pre analytical, analytical, post analytical processes not integrated to

meet clients needs

• Pre assignment of cases to Pathologists

• Unbalanced workflow and workload

• Constant Prioritization & Reprioritization

• Significant backlog of cases, not transparent

• TAT’s not meeting clients needs

Pathology (Pre) Lean Issues

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Pre LeanSeptember

2011Post Lean

September2012

Post Lean

Accessioning backlogs

20 cases/day 0 0

Grossing 

Large Cases10 – 14 days 0 – 4 days 0‐6 days

Placentas 20 – 40 days 0 – 2 days 0 – 1 day

Bx/Routine 0‐2 days 0 ‐ 1 day 0 – 1 day

Gyne Cytology 3 – 5 days 0 – 2 days 0 – 1 day

Report Sign outs 52% in 5 days 88% in 5 days 82% in 5 days

30% > 10 days 2% > 10 days 4% > 10 days

Inventory – Lean Workflow

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• It is entirely about the client / patient

• Supermarket concept “client pulls service”

• Sequence of events :

Client Pathologist Technical Grossing Accessioning Specimen collection

• Pathologists set daily workflow “pace”

• Staffing schedules based on “continuous flow”

• Daily or weekly case input “Equals” reports signed out to achieve

“steady state”

• FIFO ( first in first out) workflow

Future State Vision

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Goals

Improve

• TAT’s 90% of all case types reported in 5 days

• Workflow processes

• Staff productivity/utilization

• Workload distribution

Eliminate

• Backlogs

• Non value added processes

Educate

• Staff about LEAN

• Transfer knowledge and skills

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• Eliminated pre-assignment of cases to Pathologists

• Clerical staff accession instead of MLT’s or TA’s

• Created work cell model (embed/cut/stain)

• Reduced re-screens of Gyne cases by 30%

• Adopted FIFO workflow from sample receipt to report sign out

• Pathologists pull cases from centralized “supermarket” in

standardized manner

• Pull vs. Push workflow model adopted

Key System Changes

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Outcomes Achieved - Lessons Learned

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10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

3 days 4 days 5 days 7 days 10 days

Number of working days

Per

cen

tag

e o

f ca

ses

sig

ned

ou

t

Q1 Apr-Jun 2011

Q2 Jul-Sep 2011

Q3 Oct-Dec 2011

Q4 Jan-Mar 2012

Q1 Apr-Jun 2012 (Crisis)

Q2 Jul-Sep 2012 (Post Lean)

Pre Lean

Transition

Pathology Specimens Pre vs PostLean TAT’s

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54%

63%

70%

76%

92%

58%

78%

87%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

4 days 5 days 7 days 10 daysMonths

Perc

en

t o

f cases s

ign

ed

ou

t

Q3 2010/11

Q2 2012/13

Pre Lean

Post Lean

TAT Pre vs. Post LeanAll Specimen Types

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Project Expenses

Project Expenses = (Staff time, 200 hours @ $45/hour + Advisor Fees) $45,000

Annual Project Savings

Elimination of Non Valued added (NVA) processes = 18.25/hours/day (@$45.00/hour) $213,525

Projected reduction in overtime = 79 hours/month $63,990

Less additional costs

Added 2.5 FTE’s (1 TA, 1 Clerical, 0.5 PA) = $/year $160,000

Anticipated savings per year $ 117,515

Return on Investment 261.14%

Payback = $117,515/$45,000 4.59 Months

Return on Investment – Lean Study

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Comparing Pre & Post

How would you rateImproved

Significantly

Improved

MarginallyRemained the Same

Got Worse

Don’t Know

What do you think our clients/patients would say about overall service delivery?

58% 38% 4% 0 0

Impacts on overall TAT’s 75% 25% 0 0 0

Reduction in processing bottlenecks and backlogs?

50% 38% 4% 4% 4%

How has implementation of FIFO and the supermarket model helped with integration of workflow?

79% 13% 4% 0 4%

Productivity?

Operational efficiencies33%

63%

38%

29%

21%

4%

4%

0

4%

4%

Use of visual management tools/dashboards to manage workflow and address backlogs?

63% 29% 0 0 8%

Overall job satisfaction? 25% 58% 8% 0 8%

Engagement Survey60% Response Rate to Survey – 6 Months post Lean

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• Trend setting Cloud technology (SAAS)

• Real time data through electronic dashboards

• Evidence based interventions / decisions

• Proactive vs. reactive issue management

• Data based client management/relationships

• Enhances continuous improvement culture

• Visual displays & daily workflow management

Why Consider BI Applications?“In God we trust, everyone else bring data”

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• Easy to maintain

• Minimal IT involvement in project start up requirements

• Minimal on-going IT support required

• Minimal IT hardware requirements

• Rapid start to finish implementation/validation and go-live (< 3

months)

• User friendly

• Low touch application

IT Considerations

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• Workload Volumes vs. Staffing• Turnaround/Wait Times• Productivity

Operational

• Quality Management• Physician Practice Management• Regulatory Reporting

Physician/ Clinical

• Staffing and Budget Optimization• Procedure/Test Cost• Revenue/Expense Monitoring

Financial

BI - Applications

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Histology Dashboard

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Pathologist Productivity

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Outstanding Cases for Gross Dissection

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Main System Dashboard

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• Reports can be created easily and quickly on a daily basis with

updated, accurate data

• Productivity and outstanding case information available to make

management decisions regarding prioritization of cases, staffing

requirements, overtime requirements

• Turnaround time reports and LEAN status available daily, quickly

and easily with detailed information as required

• Details can be reviewed by drilling down on information displayed

Benefits of Adopting BI

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• Eliminated SILO culture

• FIFO, supermarket working well

• Reduced overtime with improved TAT’s

• Not pre-assigning cases has improved efficiencies

• Front line staff engagement with OFI’s

• Evidence based problem solving and decisions

• Adopting visual controls/management tools

Success with Lean

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• Collaboration (internal/external) and teamwork is critical for success

• Takes focus, time and effort to get positive outcomes and sustain

improvements

• Skeptics will be pleasantly surprised with improvements & outcomes

• Challenge perceptions/opinions with supporting data

• Use relevant data to drive decisions and plan improvements

• Enjoy the journey and experiences

• Celebrate successes

Key Learnings

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• Daily Monitoring of workload and backlogs with timely interventions

is essential

• Critical to have minimum and back up staff available daily to meet

fluctuating workload demands

• Annual across the board budget cuts are significant impediments

with process improvement initiatives

• Use BI & real time dashboards

• Don’t underestimate the impacts of change on staff

• Embrace failures as opportunities to learn and improve

• Promote teamwork and performance accountability

Tips to Sustain Performance

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L = Leadership

E = Excellence

A = Actions

N = Never ends

S = Strategic

I = Influence

G = Goals

M = Measurements (BI)

A = Accept change

Takeaway Message

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Questions ?

Email: [email protected]

Website: www.dlmc.ca

Phone: 647-388-9872

Thank You