Fairview Health Services: A LEAN Case Study Using Data to Make Decisions and Drive Quality and Resul

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Fairview Health Services A LEAN Case
StudyUsing Data to Make Decisions and Drive
Quality and Results

• Institute for Quality in Laboratory Medicine
• April 29, 2005
• presented by Rick Panning
• President, Laboratory Services
• Fairview Health Services

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The building blocks of Performance Excellence
Quality Improvement Methods (e.g., FOCUS- PDCA,
LEAN, 7-Step, DMAIC, Rapid Cycle Improvement)
Accelerated Change
Effective Results
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Performance Excellence Clinical and Financial
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Understanding the need for change

• How does your laboratory fit into the overall
  organization and provision of care?
• How can the laboratory enable high quality,
  cost-effective care?
• How is the laboratory performing? How will LEAN
  help you improve these measures?
• Productivity and Cost per test
• Turnaround time compliance
• Error rates (patient safety, quality)

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Lean is

• Waste

• Flow, Flow, Flow

• Applies to both Mfg. Non-Mfg. Environments

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What is Lean?
Relentless pursuit, identification and
elimination of waste in all business processes in
order to produce value for the customer.
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Best Quality, Cost, Delivery, Safety and Morale
Make problems visible Mistake proofing
Just in Time Right service Right amount Right
time Pull System Continuous Flow
People and Teamwork
Continuous Improvement
Waste Reduction
Stable and Standardized Processes Visual
Management
From J.Liker, The Toyota Way
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Core Principles of Lean(start with the
customer)

• One Piece Flow vs. Batch Queue
• Eliminates many forms of waste waiting,
  inventory, overproduction. Batching inhibits
  flow.
• Focus on 1 specimen/patient at a time
• First In/First Out
• Best approach for the customer and best
  utilization of resources
• Mistake proofing
• Prevent errors and defects

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Core Principles of Lean

• Unified Layout
• Move from value added step to value added step
• Standard Work
• Develop a standard based on the best known way to
  do the work, yields quality and reliability
• Visual Management Control
• Tells at a glance what should be done,
  distinguishes normal from abnormal

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How does Lean impact customers?

• Shorter and more consistent cycle times
• Reduction of costs lower prices
• Efficient use of resources allow your
  professionals to do the right stuff
• Consistent quality of outcomes
• Establishes standard work

Without defined standards, there can be no
improvement. T. Ohno, Toyota
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Reasons for implementing LEAN _at_ Fairview

• Significant need to
• Improve patient care services
• maximize efficiency / effectiveness of laboratory
  operations
• simplify processes

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Project Goals Value Stream
Operator Analysis
Product Flow
Group Technology
Job Guidance
Cell Layout
Work Station
Standardized Work
Performance Measures
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RESULTS2 Major changes

• Implementation of one automated work cell
• Previously in 2 separate rooms
• Previously in 6 separate workstations
• Implementation of one-piece flow phlebotomy
  process (24/7)
• Baseline Average phlebotomist was collecting
  3-4 specimens per hour
• Goal 11-12 per hour (currently at 10.5)

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Cycle Time Goal

• Goal 95 of tests will be reported within 30
  minutes from the time the patient is drawn.
• Previous standard Results reported within 60 min
  from the time the sample is received in the lab.

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Traffic
Chemistry (blue) Specimen Processing (red)
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Proposed Layout
After LEAN One person walking 6 cycles in 30 min
and operating 6 work stations
Core Work Area for the Clinical Lab Scientists
who perform 90 of all Lab tests
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Collection to Result (Compliance within 30 min.)
(Dec. 2002 to Dec 2004)

• Hemoglobin
• Dec. 2002 40
• Dec. 2004 90
• Potassium
• Dec. 2002 12
• Dec. 2004 91
• PTT
• Dec. 2002 5
• Dec. 2004 89

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Potassium Turn Around TimesCollection to Receipt
plus Receipt to Result
160 140 120 100 80 60 40 20 0
Dark Blue Collection to receipt Light Blue
Receipt to result
Project initiated
Baseline
Time In minutes
Time period (Dec 2003 - Feb 2004)
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PotassiumLab Collection vs. Nurse Collection
50 45 40 35 30 25 20 15 10 5 0
Blue Lab Pink Nursing
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Time in minutes (0 50 minutes)
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Weeks Dec. 28 Feb 14
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Troponin Its own challenges(goal is 95 within
45 minutes)

• Dec. 2002 10
• Feb. 2004 55
• SIGNIFICANT IMPROVEMENT BUT STILL NOT GOOD
  ENOUGH?!?!?!?!?!
• Consistency improved greatly
• Current (Dec 2004) consistently within 45
  minutes

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Troponin - but what does the customer need?

• Jan. 2005 Lab / ED piloting new POCT method on
  the I-Stat for the initial Troponin.
• Ultimately ED physicians decided not to implement
  because the laboratories turnaround time was
  consistently exceptional

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Summary of Benefits

• Testing thru-put (TAT) reduced by 50
• Productivity improvement gt40
• Cost reduction at 28
• Space savings of gt450 ft2
• Standardized work practices
• Reduction in Errors and Error Potential
• Specimen and patient ID errors reduced
• Performance measurement
• Elimination of excess unused inventory (16,100)
• 100 cross-training of staff

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Additional Benefits

• Development of a core team of people that has
  implemented Lean Manufacturing and are
  therefore available to spread the benefits
  organizationally
• Standard Work and Standard performance
  measurement tools developed
• 2004 employee engagement score in clinical lab
  rose by 0.48 on a 5 point scale
• Laboratory recognition from customers

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Cycle Time ImprovementsProject 2 Fairview
Ridges
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Example of daily reporting to staff (next step
drill down into defects)
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Quote from FRH physician

• I ordered a set of stat and comprehensive labs
  last Friday morning and I was astounded by the
  short turnaround time for all testing. The level
  of efficiency (15 minutes for a Basic Metabolic
  Panel) resulted in a much earlier treatment for
  a critical issue for this patient. Please extend
  my thanks to the staff for this excellent level
  of service
• (Physician came directly to laboratory to provide
  feedback and sent letter.)

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Eliminating wasteful and meaningless work
enhances the value of work for all employees and
better serves our patients and community.
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After the project is finished

• Insure that day-to-day operational leadership
  maintains the gain (supervisor)
• Compliance with standard work is the key
• Track down-time and evaluate reasons
• Measure daily, weekly, monthly
• Keep measures in front of staff
• Share positive feedback and impact on patient
  care with staff
• Laboratory professionals need to understand that
  the change made a difference.

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What have we found?

• If we use the tools and apply them as intended,
  the positive changes WILL occur
• If we try to fiddle with the model, it does not
  perform. Follow your rules! Dont waiver!
• LEAN ultimately is not rocket science. It is
  basic, logical and data driven.

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Lean Balance(behind every result is a properly
educated and trained laboratory professional)
Respect for Humanity
Scientific Management