60x36 Poster Template

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On the Road to Process Control A Redesign Driven
by Data in Anatomic Pathology Sheila Herrington,
Isobel Lamarche, Heather Nymeyer, Robin Trerice,
Susanne Young Kelowna General Hospital
Terry Brent Laboratory Manager, OHSA 2180 Ethel
Street Kelowna, BC, Canada V1Y 3A1 Phone
250-870-5783  Fax [phone]   terry.brent_at_
interiorhealth.ca
Methods
Abstract
Layout and Workstation Design
Results
start
Improved Workplace Environment
Visual Performance Measures
Background The Anatomic Pathology Department at
Kelowna General Hospital has experienced an
increase in workload due to several new programs.
Additional staff resources had little effect as
turnaround time (TAT) continued to leave many
customers dissatisfied. The existing processes
did not meet current demands nor provide a
sustainable model to adapt to anticipated
workload increases. Objectives The main goal of
the project was to improve TAT of available
Pathology reports to 80 within 72 hours. A Lean
team focused on five critical areas layout and
workstation design, standardization of work
methods, visual performance measures, material
management and improved workplace
environment. Method Videotape data was collected
and analyzed for all processes in the Anatomic
Pathology Department. Current State Value Stream
Maps for Histology and Cytology identified over
sixty opportunities for waste reduction and
process improvements. Lean culture and quality
improvement discussions occurred with
stakeholders and staff members. Future State
Value Stream maps were envisioned and implemented
in a four month window. Results We now have a
controlled process with a 48 hour reduction in
TAT and 45 of Pathology reports available to
customers within 72 hours. Conclusions Despite a
few bumps along the way, a significant decrease
in TAT has been achieved. Daily metrics provide a
road map for continuous improvement to meet
current and future customer needs.
Distance Traveled 375 ft
Front line management and staff monitor highly
visual daily metric graphs and can tell at a
glance if TAT goal was achieved.
Stabilize
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Sort
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5S's
Its an organized lab!!!
WOW! an organized lab!!!
Is this heaven?
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KEY POINT A metric is a quantitative measure of
performance used to indicate progress or
achievement against a strategic goal.
Distance Traveled 115 ft
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Shine
5.
Sustain
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3.
Standardize
4.
Pre Lean data (Feb Mar 2008) shows it was
taking on average over 168 hours to sign out 80
of the cases. Post Lean data (July Aug 2008)
shows a decrease in TAT of 48 hours with 80 of
cases signed out within 120 hours.
KEY POINT The first step to a clean, organized
lab is 5 s. To achieve this, all items not
required were removed, equipment was arranged to
promote work flow, supplies were placed at point
of use and these areas were taped out or labelled.
STOP
KEY POINT The new lab layout was designed
statistically using videotape analysis and the
affinity graphs. Approx. 260 feet of wasted
product travel was eliminated for every sample
and an efficient single piece flow was achieved.
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Value Stream Mapping
Introduction
Standardization of Work Methods
In March 2008, Kelowna General Hospital began its
Process Excellence project in the Anatomic
Pathology Department. The purpose of this project
was to review all procedures and processes to
improve turn around time, reduce waste, improve
efficiency and quality of work life, decrease
department over-time hours ,build metrics that
were critical to care as defined by the
customer and assist in creating a culture of
change to incorporate Lean thinking. The scope of
the project included looking at specimen
receiving, grossing, frozen section processing,
Histology, Cytology and Transcription services
Five Lean team members were relieved of their
regular duties to work full time for four months
under the direction of a contracted Project
Manager from Valumetrix.
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• depicts the key process points, operator
  procedures, sequence of tasks, required tools,
  safety issues and quality checks for a particular
  task
  
• shift staff focus to areas where their time is
  most effective in the process

X

• Over a four month period many changes were
  implemented in the Anatomic Pathology Department.
  Over 60 improvements were identified including
• slides available for pathologist review by 900
  am versus 1130 am before Lean
• single piece flow has replaced batching in
  specimen reception and grossing
• implementation of a bar code labeling and
  numbering system
• specimens travel a significantly shorter
  distance through the entire process
• a technologist is designated for frozen sections
• standard work is in place for all work stations
• unnecessary photocopying and stapling of
  requisitions discontinued
• specimen blocks are embedded and cut on the same
  day
• an overall decrease of 6 in extra staffing
  hours is achieved
• Challenges faced during the project to achieve
  these results include
• working within the confines of long narrow room
  dimensions
• resistance to change
• development of a team spirit between all
  subdivisions of the department
• introducing a culture of continuous improvement
  and staff engagement

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STOP
KEY POINT Unnecessary storage time waste
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Kelowna is located in the Interior of British
Columbia, Canada. From championship golf courses
to internationally acclaimed wine tours, from
downhill skiing to Shakespeare in the Park,
Kelowna promises to entertain all who visit this
spectacular city on the lake.
KEY POINT Standard work defines the best way to
ensure performance consistency which is critical
to achieving a high quality product.
STOP
Points of storage
Eliminated storage time
X
Material Management

• A Kanban Inventory System
• kanban is a Japanese term where Kan means visual
  and ban means card
• based on actual usage rather than perceived
  need.
• prevents costly and wasteful overstocking,
  kanban cards are placed at the reorder point in
  the inventory
• allows system flexes for usage fluctuations
  orders are only placed when the card is at the
  reorder point

• Project Tools
• videotaping operators and product flow and
  analyzing the tapes using an Excel spreadsheet to
  identify potential for improvement
• voice of the customer surveys to gauge what
  was most important to our customers
• affinity charts to prioritize work station
  proximity and guide layout design
• personnel capability (cross training matrix) to
  utilize staff skill sets

Conclusions
KEY POINT Adding more staff is not always the
quick fix to improve TAT. Redesigning a
laboratory by using Lean principles based on
data, results in process control. Metrics
reviewed by the front line creates a climate of
ownership and awareness. We are on the road to
continuous improvement and have the tools to meet
our goal of 80 of Pathology reports signed out
in 72 hours.
KEY POINT Process Excellence is a systematic
approach to improving quality and reducing waste
in all aspects of our work. It utilizes
practices of Six Sigma, Lean Thinking and Design
Excellence.
STOP
STOP