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By Charles Miraglia
M.D., President and CEO PA Labs, LLC
02/19/08
The real challenge for most, if not all, businesses today is to continually improve the quality of goods and services delivered while decreasing the costs, thereby maximizing the margin available to the owners, whether for profit or not-for-profit. The laboratory is no different. Its customers, or more accurately, its physicians, continue to demand high-quality results with faster and faster turnaround times for less and less money. Since our product, the medical test information we provide, is needed to better care for our patients, we need to be vigilant and find ways to satisfy the demands of our valued customers.
The rest of this story will briefly outline our approach to this dilemma in a busy hospital-based laboratory challenged with finding a way to increase customer satisfaction—in this case the physicians and the patients they are caring for in a hospital setting—while reducing full-time employees (FTEs) and saving money for the laboratory; more specifically, to reach a customer-determined goal of 8 a.m. patient-result delivery for morning rounds and a laboratory-determined goal of FTE reduction in the process. The secret to accomplishing this daunting task is in the approach and the tools utilized.
Since much has been written and presented about LEAN manufacturing techniques, green belts, etc., I will resist the temptation to wax on about the virtues of these methods. Suffice it to say that we chose to train a number of employees in the ways of LEAN and set them loose to define, measure, analyze, improve, and control (DMAIC)—I couldn’t resist a little waxing! Anyway, with tools in hand they enthusiastically set out to bring tangible results in as short a timeframe as possible.
What these trained employees found was that the customer’s goal of having lab results on the chart by 8 a.m. (90 percent of the time) was far from being met. In fact, at the beginning of the project it was being met only 27 percent of the time. They quickly determined that the key to their success was to have specimens in the lab by 7 a.m. to allow plenty of time to reach the 8 a.m. goal. In the same time frame as above, the morning draws were completed by 7 a.m. only 39 percent of the time. Before we get to the project results, a few more statistics are important in order to have a true appreciation of the improvements achieved.
The team looked at the metrics for a single month and learned that 253 blood draws were being done per FTE phlebotomist and there were a total of 41.2 FTE phlebotomists in the hospital. In addition, the rate at which patients had to be redrawn for any reason was 3 percent. Since adding phlebotomists to boost performance was not an option, the team needed to improve efficiency by improving processes, balancing and sharing workload, and, of course, eliminating waste. After analysis, the team identified 16 improvements and designed a 60-day project to implement and measure the results.
At this juncture, it is important to remember that the real issue here is developing a culture within an organization that not only is capable of performing these projects, but is also stimulated at the individual level to look for ways to improve the manner in which work is done—not just once a year, but every single day. Since we are a very process-driven business, as most laboratories are, we decided to embrace LEAN/Six Sigma as our "quality culture" of choice, acquiring a working knowledge of the methodologies and developing a common understanding of how the tools of each are utilized.
The momentum we established with the first few projects has accelerated us to a point where the list of potential projects far exceeds our current capacity to tackle each and every challenge. The good news is that we will never run out of projects designed to eliminate waste from our organization or to improve some process in our laboratory and, perhaps more important, we will never run out of enthusiasm for being better than we were the day before.
Getting back to the results of this particular project, we defined the scope as beginning when a test order is received by the lab and ends with that specimen/order received at the analytical workstation. The initial objective was a 20-percent increase in "value-added" time or, in other words, an average of 303 monthly blood draws per FTE. In addition, we wanted to decrease the redraw rates for improved patient satisfaction and ultimately improve the turnaround time for the morning draws for improved physician satisfaction.
Just 60 days later, we had exceeded all of the goals set for the project. Draws per FTE increased to 309, a 22 percent improvement; morning draws received in the lab by 7 a.m. improved to 90.5 percent (remember, the goal was 90 percent); and redraw rates decreased from 3 to 1.9 percent. And the best part is that all of this was done while reducing the phlebotomy staff from 41.2 FTEs to 34.9 FTEs while maintaining or improving patient-satisfaction results (measured by Press Ganey surveys).
As we have found with each of the LEAN/Six Sigma projects we have undertaken, there were additional achievements beyond the goals initially established. The delivery frequency of specimens to specimen processing was increased, senior staff were designated to do re-collects, a staff tracking board was implemented, and new flexible staffing models for phlebotomy were implemented … just to name a few. Perhaps the best achievement, however, was the creation of a new department that includes both phlebotomy and specimen processing, cross-trained and working together to improve outcomes.
A favorite quote of mine from Albert Einstein comes to mind, "The significant problems we face cannot be solved at the same level of thinking we were at when we created them." This particular quote nicely summarizes what LEAN/Six Sigma really is … constantly looking at things a new way to continually improve them—whether it’s processes, space challenges, staffing issues, or supply storage, the solution is in the recognition that there is always a better way.
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