There is a severe problem on the night shift and there have been complaints about the delays in the turn-around time of the specimens from the operating room. On the night shift, there is one specimen accessioner and one supervisor and a person in each of different departments. There are hematology-coagulation, chemistry, blood bank and microbiology-immunology. In the healthcare system, turn-around time is a crucial factor in running the laboratory. Turn-around time can affect the treatment of the patient, for instance to specific treatment of the disease. The turn-around time is defined differently to patients, physicians and lab techs.
To the patient, the turn-around time is when they arrive to the physician’s office to when he/she received results from the physician. To the physician, the turn-around time is when they order the tests to when they receive the results from the lab. To the lab techs, the turn-around time is when they receive the specimen to when they send out the result. (Chima 518) When the specimen is in the lab getting tested, this is the analytical phase of testing. To physician, the turn-around time includes all three phases. This time is the analytical phase of the turn-around time and to the physician the turn-around time includes all three phases.
Customers, including physicians, are more focused on turn-around time particularly since there is more point of care testing available where results are available within few minutes. With the point of care, patients can obtain the results faster but it is questionable if it is most effective and efficient in means of producing test results. (Howanitz 314) The turn-around time can be divided into 3 phases; pre-analytical, analytical, and post-analytical. The pre-analytical period is from specimen collection to the specimen arriving to the lab.
The analytical phase is from the lab receiving the specimen to lab giving out the results to physicians. Lastly, the post-analytical phase is when the results are accessed by the physicians. If the prolonged turn-around time is pre-analytical or post-analytical, the problem lies not on the testing time but on the transportation time. If there is prolonged pre-analytical / post-analytical turn-around time, the hospital should focus more to shorten the transportation and delivery of specimen to the lab (Kilgore 1597). Also, the laboratory might have to communicate to the physicians about how the STAT testing might affect the turn-around time.
When the physicians need the results faster they can order their patient’s specimen as STAT testing. The increasing number of STAT tests can decrease the work flow leading to prolonged turn-around time. (Howanitz 311) If there is prolonged turn-around time in the analytical phase, the laboratory should try finding the root cause of the prolonged turn-around time. To find the root cause and solve the turn-around time issue, the laboratory should find a strategy to help solve the problem. One of the ways to solve turn-around time issue is to increase the quality. W.
Edwards Deming was the person that came up with idea of increasing quality. Deming went to Japan to help with their manufacturing quality. Before Deming went to Japan, the Japanese products were considered cheap and they needed to change their reputation. After Deming went to Japan, he changed Japanese methods and improved their quality. By improving quality resulted in increased productivity and Japan became successful. Deming’s main goal was to satisfy the customers and focus on what the customers needed. One of the key methods of Deming was to decrease the variation in the product in order to increase quality.
To increase quality and decrease variation Deming had the plan-do-study-act cycle. First step is to plan the new method and do is to practice the new method and study is to study the results and the last step is to act on the results. This cycle is repeated to earn even better method or results than the first one. (Kurth 569) After discovering the new method, the techs in the lab have to learn the new method and the new method will decrease the variation because everyone would be taught the same method and procedure. **Deming’s idea of increasing quality can be accomplished by providing quality assurance.
Quality assurance is used to maintain the W. Edwards Deming‘s principles of quality was reinterpreted into Lean Six Sigma. Lean Six Sigma is used in the laboratory to improve quality in the laboratory. Lean Six Sigma is finding the root cause of problems and reducing the extra steps to increase the quality and remove extra costs. W. Edwards Deming stated that documentation is important for quality and it is now critical part of the laboratory’s quality. (Jacobson 142) In the laboratory, the technician documents all the quality controls and problems with the machines and everything that was done when the technician was at work.
This improves the quality of the laboratory because the manager will know what is happening in the lab and if all the test results that are sent out can be validated. W. Edwards Deming’s idea of improving quality has gotten the attention of the healthcare administrators. Deming’s idea was reformed into a method that can be used in healthcare and called it Lean. Lean is one of the ways that can help the laboratory “remove the waste” meaning to eliminate all the unnecessary procedures that do not produce product or service. Lean can be the pathway to increase quality and decrease the costs.
Lean can be divided into principles and by understanding and successfully applying all the principles in the laboratory will earn the full potential of Lean. The first principle is attitude toward continuous improvement; this principle is using Deming’s idea of plan-do-study-act cycle. The Deming’s cycle will help the laboratory to continuously improve their methods to increase the quality and decrease the cost and turn-around time. The second principle is to improve the value. A value stream map is created to remove the steps that do not produce value.
This principle should be detailed because all the steps to the method should be marked on the map and determine if it is needed for this method. In the laboratory, the spaghetti chart can be used to draw technician’s path. It is essential to draw the entire path to get a clear understanding and how to decrease the path and decrease the overlapping areas. The next principle is gathering employees to aim at the purpose of the laboratory. The managers should communicate with the frontline employees to proceed them to the right method to aim at the laboratory’s goal.
The employees and management should communicate about different ideas and gather the best method. Communicating back and forth will build knowledge, unity, and commitment around the purpose. The next principle is the management trusting the frontline employees. The employees should be the main person that changing and renovating the methods/procedures that are done in the laboratory. The frontline employees are people who are actually doing the work so they will be more aware of what the problem is and how to fix it.
The management should have respect for people that are working in the frontline because they will have further knowledge about the methods that they are using now, so the management should listen and trust the frontline employees. The next principle is to find the root cause of the problem, this is critical in solving the problem. (Toussaint 75-80) Deming stated that quality will spread to not only producing goods but to the service industries. In recent years, the quality has become important part in the laboratory. Deming also stated that the quality is based on the values of consumers.
This is true because in the laboratory, the consumers which are the physicians and the patients value their results and the time it takes them to get their results. W. Edwards Deming emphasized that quality was important and it does not conflicts with the productivity because quality guides to better productivity. This is because if quality is affirmed that there are less rework, and shortened the time and increase productivity and lower the costs. (Siriwardena 128) W. Edwards Deming first stated that the quality over quantity and this was said to the industrial business world but now it became an important part in the health care as well.
By having quality in the lab, the physicians and patients could trust the results from the lab. By having quality in the lab, the lab not only increases their quality but also can shorten the turn-around time and increase productivity and lower costs. This is true because when the test in the lab is done right on the first place, there is no reason to run the specimen twice. One example of the use of Lean helped to decrease turn-around time is at Fairview Health Services. Fairview Health Services is eight hospitals that are combined to a health system.
It had inconsistent and prolonged turn-around time and they used Lean to solve their problem. At Fairview, they first tried to find the root cause why there are delays. They videotaped the specimens flow in the laboratory. The filmed video showed that the specimen was going to chemistry many times and the technician walking to coagulation and hematology which was far from the chemistry department. They found the root cause of traveling time, so they changed the places of analyzers and they also figured out that some analyzers are used more often than others so they placed the most used analyzers close together to decrease the traveling time.
Also, outside the lab, phlebotomists had problem with the phlebotomy trays. There were more than 40 trays and trays had variations. One of the Lean methods was to decrease the variation, so they made all the trays the same and it made the job easier. The laboratory also communicated well during the changes, they told the employees that it was not employees fault that they had to change; it was the laboratory that had problems. The laboratory told employees weeks before that they had to change some of the processes and communicated many times with the employees before the change happened. Panning 9)
In the healthcare setting, the turn-around time is becoming essential to patient care. If turn-around time is prolonged, treatment of the patient can be affected. The key to decrease turn-around time is to use Deming’s ideas to increase quality and decrease costs and decrease the variation. The hospital should find the root cause of why there is prolonged turn-around time and assemble a team to fix the problem and communicate often to the frontline employees.