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Hospital: Laboratory Workflow
As part of a larger project for improving operations of a California Rural Hospital District, this project was for improving the efficiency of the hospital laboratory operations through a number of initiatives based on and analysis of the existing operation.
The objectives for this project were to :
Improve Laboratory Work Flow, Traffic and Sample Management
Improve Visibility and Management of Laboratory Work Tasks
Improve the Order Receipt and Entry Process.
Improve Accessibility, Management and Usability of Laboratory Procedures and Instructions
This hospital district contains many business units in order to serve the health care needs of an entire mountain resort community and surrounding areas. The particular challenge in the laboratory was that a number of the laboratory employees were part time (by choice) since they moved to the area to enjoy the recreational opportunities of the area. A number of these employees were long term employees and had never been challenged to make changes to accommodate improved overall results.
1. The Workflow was changed to a lean production like flow with dedicated work units/cells to accommodate one piece flow per lean manufacturing practice.
Application of Lean workflow principles resulted in a simple one piece flow through the laboratory. This resulted in a dramatic reduction in daily movement among the lab staff. It also increased the laboratory’s overall capacity such that formerly outsourced tests were brought in house without any increase in lab personnel while lowering costs for these tests.
Rework of personnel schedules and imposition of new procedures resulted in all physicians’ lab orders left in the evening hours during rounds being collected, processed and resulted for physicians’ examination by rounds the next morning by 7:00AM. This had been a source of physician complaints to the lab.
2. The lab was further improved by improving the work status visibility and refocusing management attention on sample and test results.
Management and supervisory attention was refocused to the Work Order status using the Lab Information System whereas the focus previously was on lab requirements shown on printed labels in the lab. New reports were identified in the LIS that provided current status on all outstanding orders and was implemented as the preferred method of managing lab work. This provided insight into lab orders that were falling behind preferred response times providing the lab team the opportunity to recover before test results were declared late.
Lab Supervision was re- focused on providing leadership and direction of the current lab demand and delivery of results improving throughput and visibility as well as maintaining lab objectives for response time.
3. The Order Receipt and Entry was improved resulting in reduction of errors and improved throughput for lab sample processing and analysis.
Changing the workflow to dedicate personnel to either Order Entry or Sample Processing resulted in a reduction of patient wait times. 73% to 93% of patients originally were seen in 20 minutes or less. This was improved to 90% of patients waiting 15 minutes or less. (At least a 25% improvement). This is contributing to improved patient satisfaction.
Since the leading source of error for the lab was attributed to order entry errors, additional procedures and work instructions were implemented to provide detailed instructions and minimizing and eliminating order errors. An independent verification by a second lab person of each order upon entry into the LIS was instituted using a standard procedure. This enabled detection and correction of errors prior to release into the system and eliminating subsequent errors caused by incorrect ordering.
Changes and improvements in the lab order forms used by outside physicians eliminated the need to rely on interpretation of handwriting for recognition of the Lab Order details.
4. Accessibility, Management and Usability of Laboratory Documents including Procedures and Instructions was improved
This resulted in elimination of time wasted by lab personnel looking through paper manuals for required test standards and procedures.
A document imaging system being implemented hospital wide was adopted for converting miscellaneous documents and reports from the lab to electronic format and making them available to users throughout the system.
A Document Management System was developed and implemented for managing the multitude of lab test procedures and standards in the lab providing instant access to all lab personnel as well as providing a Search capability to enhance locating applicable test procedures and instructions. Prior test resulted in personnel not able to find three test procedures in any reasonable time. (None of the three were located by conventional means)
Description of Services
As part of our overall project to improve operations for the Hospital District, Insight 1, Inc. performed the following tasks in support of the Laboratory operational improvement:
Developed a set of process diagrams for the laboratory operation including inpatient, ED and outpatient sample collection, order entry, sample processing, analysis and reporting. We also documented the Blood bank operation as well as laboratory management, regulatory compliance, and equipment maintenance and calibration.
Restructured the processes to implement a Lean Production Workflow.
Facilitated new personnel assignments and schedules.
Documented the processes with 26 Standard Operating Procedures.
Retrained lab personnel on new processes roles and procedures.
Adopted new report s for use in managing laboratory workload and results.
Utilized Insight 1, Inc.’s unique methodologies for facilitation and documentation of hierarchical business processes as well as application of lean practices to eliminate waste, improve product flow and reduce errors.
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