Laboratory Management: Ch 16 - Process Design for Workflow and Staffing

Six Sigma Process

*D*efine *M*easure *A*nalyze *I*mprove *C*ontrol

FOCUS-PDSA

*F*ind an Opportunity: identify process needing improvement -> customer feedback/observations/quality trends *O*rganize a team: identify key players in process *C*larify current process: gather info to outline the *actual process*, use direct observations, time studies etc. *U*nderstand variation/root causes: analyze the process and identify *opportunities* for improvement. *S*elect improvements: brainstorm ideas with the team and analyze *feasibility, practicality, cost and effect* of the solutions *P*lan: how do the identified process changes get you to the desired future state? *D*o: actual *implementation* of the plan and data collection for the study phase *S*tudy: study the results of the changed process, collected during the Do phase *A*ct: based on the analyzed data of the new state, determine is changes will be kept or rejected an a new idea implemented.

Workflow

*Pathway* the work follows from the beginning to the end of the task. Each step has a predecessor step and successor step (except the first).

Laboratory Workflow

*Pre-Analytic phase*: Test Ordering, Request Generation, Patient Preparation, Sample Collection, Sample Receipt, Sample Transport *Analytic phase*: Quality Control runs, Specimen testing *Post-Analytic phase*: Results Interpretation, Record keeping, Results Reporting

5S Tool

*S*ort: proper arrangement of all items, equipment, tools, inventory, traffic etc. *S*hine: keep work area clean, return items used during day to proper location *S*traighten: determine best place to keep regularly-used items *S*tandardize: make things common and consistent where possible *S*ustain: make a habit of maintaining the system

Process Management

*Systematic*, data-based approach to making laboratory workflow more effective, efficient and capable of adapting to change. Uses proven problem-solving techniques to map the *current state* of operations and define an improved *future state*

Seven Sources of Waste

*W*aiting *O*verproduction - more output than in necessary. *R*ework - repetition or correction of a process due to *defects* *M*otion - unnecessary movement of parts/people within a process *P*rocessing - processing beyond the standard required *I*nventory - maintaining excess inventory *T*ransportation - unnecessary movement of parts/people between processes

Process Design influences

1. Size/setting of laboratory (e.g. on site, off site, STAT lab, esoteric testing) 2. Design (e.g. centralized, decentralized, core lab?) 3. Equipment (e.g. high-end automation) 4. Test methodology (e.g. fully automated, partially automated, manual testing, waived/moderate/high complexity testing?) 5. Regulations 6. Staffing (e.g. how many/what types of employees are necessary? are degrees or OJT required?) 7. When/how work is received (e.g. does it arrive at specific times? batches? Who delivers it - lab/non-lab personnel?) 8. Test priority (e.g. STAT testing only? routine testing?)

Self-Scheduling

Allows employees ability to choose their own shifts (within reason). Two important rules: 1. Organization/departmental needs must be covered 2. No one is *guaranteed* a specific schedule - this is a means to express preferences.

Scheduling

Assigning the employee to work-specific hours, to a specific department or to a specific task. Manager's responsibility.

Process Designs

Broad, *overall* plans used to develop and design a process or way of completing work or doing a task. Once designed, the workflow may be analyzed. 1. Must be cost effective 2. Needs to reflect organizational needs 3. Must be customer friendly 4. Must produce quality results.

Hiring

Consists of two main portions: application and interviewing.

40-hour Workweek Rule

Employee is allowed to work any number of hours per shift, but total hours must not exceed 40 for one week.

Floaters

Employee reassigned from job to job depending on where greatest need is at the moment.

Process Owner

Employee selected to be responsible for/manage stages of the process. Champions the process/ensures it meats accreditation/regulatory requirements. Has *authority* to escalate barriers/challenges to management.

Pro Re Nata (PRN)

Employee that *works when called* to either fill in for an absent employee or cover a special circumstance. Can give regular employees opportunity to make extra money or give skilled workers more control over their shifts/assignments. Does not receive medical insurance, vacation time or other benefits.

Absenteeism Management

Have *policies and procedures* in place to clearly state expectations and elaborate on consequences of excessive absences. Train laboratory leaders on their responsibilities re: employee attendance. Create an effective system to carefully *document* the absence/leave (especially for legally-protected leave).

Six Sigma

Methodical performance improvement approach. Sigma denotes variation from a standard - measuring defects in a process allows one to figure out how to eliminate them and get near perfection. Three fundamentals: 1. Customer Focus 2. Data driven 3. Robust Methodology

Value Stream Mapping

Methodology used to map the "current state" of the workflow to identify waste. It demonstrates what *happens to the product* as it flows through the value stream. Mapping always begins with the customer and works *backwards*.

8/80 Work Rule

Only allowed in *hospitals*. Covers a *two-week* time-frame: employee works an 8-hour day and any number of days in a row up to 10 (80 hours total) within two weeks. Additional time is compensated as overtime.

LEAN

Process management tool that focuses on eliminating processes which do not add value (waste or "muda"). Intended to increase velocity and create *continuous flow* of value-adding activities as defined by the customer.

Staffing

Processing of hiring, training, scheduling and retaining of the employee who will be doing the work or task.

Training

Program which helps employees learn specific knowledge or skills to improve performance in their current roles. Initial training - orientation/probation period.

Process Team Roles

Team leader, Team facilitator, Team members, Team Recorder, Timekeeper

Staffing Considerations

Test Mix: laboratory's test menu (may be mix of high/moderate complexity testing) require unique skills Hours of Operations Supervision: CLIA 88 mandates supervisory requirements (e.g. General supervisor required for high complexity testing) Service Levels: what activities are required 24/7 Productivity Levels

Spaghetti Diagram

Tools used to evaluate laboratory space and how well it is set up in terms of efficient movement.

Retention Considerations

Track your retention. Speak to your team (not just leadership) about reasons for leaving. Train your leadership team. Build an effective career ladder. Offer path to better pay, recognition and responsibility.