Anatomic Pathology and Quality Process Improvement 17 December 2013 - PowerPoint PPT Presentation

CLINICAL LAB PRODUCTS Webcast Anatomic Pathology and Quality Process Improvement 17 December 2013

Steve Halasey Chief Editor Clinical Lab Products

SPONSORS

TODAY’S WEBCAST Quality Process Improvement In ¡a ¡clinical ¡histology ¡laboratory, ¡the ¡goal ¡of ¡quality ¡process ¡ improvement ¡is ¡to ¡improve ¡and ¡ensure ¡the ¡safety, ¡quality, ¡and ¡ cost-­‑efficiency ¡of ¡the ¡lab. ¡

TODAY’S WEBCAST Topics for Today ’ s Webcast • The ¡principles ¡of ¡quality ¡process ¡improvement ¡ • The ¡advantages ¡of ¡quality ¡process ¡improvement ¡in ¡the ¡histology ¡lab ¡ • The ¡value ¡of ¡incorpora=ng ¡LEAN ¡into ¡the ¡histology ¡process ¡ ¡

PRESENTER William DeSalvo, BS HTL(ASCP) Owner, Collaborative Advantage Consulting Chair, NSH Quality Management Committee Board Member, Digital Pathology Association

William DeSalvo, B.S. HTL (ASCP) William DeSalvo, B.S. HTL (ASCP) System Production Manager in Anatomic Pathology Chairman, National Society for Histotechnology Quality Management Committee Board Member, Digital Pathology Association Owner/Consultant, Collaborative Advantage Consulting

Why Do We Need To Do This? Why Do We Need To Do This? } Develop new TOOLS to Manage Quality } Develop New Workflows } Efficiently Manage Workload } Better Utilize Technical Staff } Prepare for Personalized Medicine } Meet the Demands of Our Patients } Create a Competitive Advantage for the YOUR Lab

How How Do We Do This? Do We Do This? } Use Existing Methodology ◦ LEAN LEAN • Methodology used by manufacturing, most notably Toyota, that focuses on: SPEED ( Removing Wasted Time) ◦ Si Six Si Sigma gma • Methodology used in many businesses, most notably Quest and Motorola, that focuses on: QUALITY (Defect/Error Reduction) LEAN Six Sig LEAN Six Sigma ma Processes/Products with Better Quality Faster

How How Do We Do This? Do We Do This? } Couple Methodolog Couple Methodology w y with Technolog ith Technology y ◦ LEAN Production/Manufacturing • Reduce Waste Waste • Improve flow • Use a specific set of Tools Tools ◦ Implement Smart Automation Instrumentation Implement Smart Automation Instrumentation • Sakura Xpress, Auto-TEC, Prisma, ??

CO-LOCATION

What is Process Improvement? What is Process Improvement? } Strateg Strategic Manag ic Management ement ◦ Identifying, Analyze and Improve the existing process Best Practice Benchmarking } Best Practice Benchmarking ◦ Comparing your process with a better process to improve your process ◦ Remove Paradigm Blindness ◦ Improve effectiveness

What are the benefits? What are the benefits? } Increased Consistency through Standardization } Improved Efficiency } Increased Productivity } Customer Satisfaction – Decreased TAT } Employee Satisfaction – Workload Leveling, Stress Reduction } Reduced Supply Costs PATIENT SATISFACTION - DEMAND } PATIENT SATISFACTION - DEMAND

Understanding Understanding LEAN and Quality LEAN and Quality } A way to understand VALUE VALUE from the customer ’ s viewpoint (VOC VOC) } Remove non-value added activities to ELIMINATE WAS ELIMINATE WASTE TE } Create VELOCITY VELOCITY and CONTINUOUS CONTINUOUS FLOW FLOW in a process } Develop a process that is PULLED PULLED by the customer } Create SUPERIOR SUPERIOR and CONSISTENT CONSISTENT products } Reduce COST COST per test } Provide tools for CONTINUOUS IMPROVEMENT CONTINUOUS IMPROVEMENT

Understanding Understanding LEAN and Quality LEAN and Quality } LEAN PHILOSOPHY ◦ Produce WH WHAT is needed, WHEN WHEN it is needed - as specified by the CUSTOMER CUSTOMER – with the MINIMUM amount of materials, equipment, labor and space ◦ Provide an effective development, product and service delivery SYSTEM SYSTEM that maximizes the ability of employees to add value

Understanding Understanding LEAN and Quality LEAN and Quality } KEY LEAN PRINCIPLES ◦ Strive For Continuous One-Piece Flow (Hard to achieve) ◦ Place Linked, Value Added Processes Together (Co-Location) ◦ Standardize Work ◦ Eliminate/Reduce Inventory ◦ Balanced Workloads ◦ Segregate Processes By Complexity ◦ Establish A Visual Workplace ◦ Eliminate Loop-Backs

Non-LEAN Histolog Non-LEAN Histology Lab y Lab } Most Labs } Multiple bottlenecks in the work process } Long wait times from step to step due to batching } Staff scheduling not matched to workload/ workflow } Customer dissatisfaction – Pathologist/ Clinician/Patient } Inefficient/old equipment not designed for today ’ s requirements PATIENTS WILL NOT STAND FOR THIS } PATIENTS WILL NOT STAND FOR THIS

LEAN Pressures on the Histolog LEAN Pressures on the Histology Lab y Lab } The FUTURE IS NOW } Decrease TAT for tissue processing } Decrease TAT for all Staining – IHC/Molecular } Reduce rework to maintain and/or reduce cost } Improve Quality } Increased Productivity } Be the Benchmark Lab of Choice

Quality LEAN Histolog Quality LEAN Histology Lab y Lab } Purchase instruments designed to work with LEAN Process } Standardize all or PART of the Process } Reduce the Bottlenecks } Eliminate Waste } Reduce Cost } Improve QUALITY } Improve Patient Satisfaction

Quality LEAN Histolog Quality LEAN Histology Lab y Lab What are the Obstacles? Lack of Standards Lack of Standards • Individual standard operating procedures; Site QC/QA • Lack of Documentation Lack of Documentation • Procedures/Policies; Training/Competency; Validation • Subjective Quality Subjective Quality • Single point QC; End-Point QC •

Quality LEAN Histolog Quality LEAN Histology Lab y Lab What are the Obstacles? Misunderstanding Misunderstanding of Process of Process • Communication; Engagement • Statistics Statistics • Data Collection; Data Crunching • Everyone Must Participate Everyone Must Participate • Responsibility; Engagement; Continuous Improvement •

Quality LEAN Histolog Quality LEAN Histology Lab y Lab BATCH AND QUEUE PROCESSING Processing Inspection l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l FIRST IN => SOMETIME OUT l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l CONSTANT BOTTLENECKS DELAYED ACTION - SLOW FEEDBACK

Quality LEAN Histology Lab Quality LEAN Histolog y Lab ONE PIECE/SMALL BATCH CONTINUOUS PROCESSING Processing / Inspection l l l l l l FIRST IN => FIRST OUT l l l l l l l l l l l l l l l l l l l l l l l l l l l l CONTINUAL FLOW / INSPECTION IMMEDIATE ACTION - IMMEDIATE FEEDBACK


 Quality LEAN Histolog Quality LEAN Histology Lab y Lab STAFF SCHEDULE FOR CONTINUOUS FLOW PROCESSING ONE SHIFT - DAY 6:00 AM 7:00 AM 8:00 AM 9:00 AM 10:00 AM 11:00 AM 12:00 PM 1:00 PM 2:00 PM 3:00 PM 4:00 PM 5:00 PM 6:00 PM HT1 HT2 HT3 HT4 HT5 HT6 STAGGER STAFF SCHEDULES TO MEET THE DELIVERY OF SPECIMENS END OF DAY - SUSPEND PROCESSING AND PICK-UP NEXT MORNING


 Quality LEAN Histolog Quality LEAN Histology Lab y Lab DELIVERY OF SLIDES TO PATHOLOGISTS - CONVENTIONAL PROCESSING 6:00 AM 7:00 AM 8:00 AM 9:00 AM 10:00 AM 11:00 AM 12:00 PM 1:00 PM 2:00 PM 3:00 PM 4:00 PM 5:00 PM 6:00 PM CASES 35 30 25 160 TOTAL CASES DISTRIBUTED 20 15 10 0 BATCH WORKLOAD - LINEAR TASKING / NO LEVELING DELIVERY OF SLIDES TO PATHOLOGISTS - CONTINUOUS FLOW PROCESSING 6:00 AM 7:00 AM 8:00 AM 9:00 AM 10:00 AM 11:00 AM 12:00 PM 1:00 PM 2:00 PM 3:00 PM 4:00 PM 5:00 PM 6:00 PM CASES 35 30 195 TOTAL CASES DISTRIBUTED 25 20 20% PRODUCTIVITY INCREASE 15 10 0 WORKLOAD LEVELING & MULTI-TASKING ALL DAY

Quality LEAN Histolog Quality LEAN Histology Lab y Lab The QUALITY Model The QUALITY Model • Increased Production Performance (Productivity) • 20- 20-40% 40% increase in cases processed per hour per tech • Reduced repeat work 40% • Reduced reagent costs 50% • Reduced TAT • Employee satisfaction through Workload Leveling


 Quality LEAN Histolog Quality LEAN Histology Lab y Lab The Cost of Quality The Cost of Quality • Controllable – direct costs to ensure that only acceptable products and services reach the customer • Equipment - costs to invest in equipment to measure, accept, or control a product or service COQ COQ Cost of Units Produced (C x #units) = COQ Cost of Units Produced (C x #units) = COQ COPQ COPQ Cost of Unit (C x #units) + Cost of Rew Cost of Unit (C x #units) + Cost of Rework (Cx4-10 x #units) = COQ ork (Cx4-10 x #units) = COQ Reduce Rew Reduce Rework and Reduce Cost ork and Reduce Cost

Quality Quality LEAN LEAN Histolog Histology Lab y Lab Ø Smartest Automation Cannot Fix Lab Process Problems Ø Select Instrumentation that can be Flexible Ø Implement Instrumentation to Assist in Change and Improve Quality Ø Focus on Overall Process Improvement Ø Commit to Continuous Process Improvement Ø Be Patient Centric Be Patient Centric