1. Service Improvement and Culture Change in the Laboratory Services Reception Sarah E Ramsden MSc CSci FIBMS Objectives  To improve the quality of service delivery for all stakeholders: patients, service users, staff and other departments.  Standardisation of operating procedures  Develop mechanisms for identifying problem areas, poor quality data and samples, areas of poor practice and the systems to remove them  Produce workload statistics and a method of visual representation  Establish our capacity and staff the department appropriately  Produce positive quality targets and indicators for staff  Create a safe, clean and tidy environment, which is sustainable  Develop a mechanism for improving channels of communication  Develop a positive culture and team spirit within the department  Identify and deliver on staff training issues, developing a skilled and flexible workforce Six Sigma (6S) Sort:  Work surfaces and storage areas were cleared of items that didn’t belong there  All unnecessary, unused or defective items were removed to a “red tag” holding area  Items from “red tag” area were categorised as broken (can & cannot be repaired), not used or others. Within one week they must be disposed of, moved to a more suitable location or replaced exactly where it originally was. Straighten:  All work surfaces, storage areas and equipment organised and clearly labelled  Containers for supplies established and clearly labelled  Rejection boxes established for samples not meeting correct criteria  “Info Centre” notice board established to display measurement & management information. Scrub:  All work surfaces, equipment, shelves and storage areas cleaned and tidied daily  Waste is disposed of in correct and timely manner  Recyclables are disposed of on a regular basis and no build up occurs Safety:  Health and Safety & Fire Notices all current and displayed  First Aid box clearly marked and stocked  All assigned training has been done  Mandatory training up-to-date Standardise:  Roster identifying roles for keeping the area clean and tidy  Daily checklists implemented to ensure all tasks are completed  All operating procedures standardised using best practice from all sites Sustain:  6S Audit performed every two weeks  Daily checklist ensures all cleaning and work procedures are being completed  Info Centre board has current and relevant feedback information  All standard operating procedures and documents are up-to-date  No uncontrolled or documents with handwritten amendments 6S Audit The audit is performed every two weeks and results are displayed on the “Info Centre”. This has attracted staff interest and they now strive to maintain and improve performance. Introduction In 2007 the Pennine Acute NHS Hospitals Trust merged Pathology services to a central laboratory at the Royal Oldham site with essential service laboratories remaining at the Fairfield, North Manchester and Rochdale sites. Over the last three years outpatient and GP work has gradually been repatriated to the Royal Oldham site. The Laboratory services specimen reception has grown from 6 members of staff working mainly core day shifts to a team of 27 staff brought together from all sites who now provide a service from 8am to 10pm. Each site had its own working practices and operating procedures, which provided both management and training challenges. The absence of standard practices was causing poor performance issues, an “us and them” culture and a general lack of team spirit within the workforce. The specimen reception area had now effectively become a department in its own right, but it clearly lacked direction and leadership. In June 2009 the decision was made to appoint two specimen reception supervisors and the department came under the direct management of Biochemistry. Communication  Formalise the agenda for monthly staff meeting and invite a staff representative from the other departments to provide feedback on any areas for improvement  Introduce a weekly team briefing which takes place in the morning, afternoon and evening each Wednesday  Establish a formalised weekly roster so all staff are aware of their role.  Establish an “Info Centre” Notice Board on which all information is displayed  Workload statistics published and displayed monthly  Visual charts to indicate 6S Audit performance displayed and feedback sheets established. Any failures are raised at team briefings and staff are actively encouraged to suggest solutions to the problems  Mandatory Training charts displayed and staff now take responsibility for ensuring they are up-to-date with this training  Suggestions sheet for monthly meeting agenda items or service improvements ideas Workload Statistics  Workload figures for total number of requests per day are produced on a monthly basis and displayed on the “Info Centre” notice board.  The total of sample numbering and data entry errors are calculated as a percentage of the workload, allowing us to monitor quality.  Workload figures have allowed us to schedule more staff on the busy days. The Next Step  Work is currently in progress to develop a system of logging errors in our LabCentre laboratory computer system.  A non-reportable data field will be used to log the error code.  Error codes will be used for any samples rejected from source (incorrect or incomplete patient data, incorrectly labelled samples, no sample received) and data entry errors by the laboratory.  Statistical analysis will allow management to highlight areas of poor performance and take positive action to correct this through training and education.  Patients and service users will benefit from improvement in the quality of service delivery. Conclusion  Quality indicators have now been established against which the department can measure performance.  Accurate workload figures have given management the tools to staff the department at appropriate times to deliver maximum capacity.  Operating procedures have been standardised across all sites.  The number of errors made within the department has dropped substantially.  Giving staff ownership of arranging their own Mandatory Training sessions has increased take-up and compliance.  Use of 6S methods has lead to staff embracing the sustenance of a safe, clean and tidy environment.  Improved channels of communication, especially the inclusion of a team briefing for evening staff has reduced the “us and them” culture.  Department has a much more positive culture and team spirit, with staff engaging in the delivery of service improvement. References 1. George M L, Rowlands D, Price M and Maxey J (2005) The Lean Six Sigma Pocket Toolbook, New York, McGraw-Hill. 2. Birchen J and Holweg M (2009) The Lean Toolbox: The essential guide to lean transformation, Buckingham, PICSIE Books. 3. NHS Institute for Innovation and Improvement, Lean Six Sigma, http://www.institute.nhs.uk/quality_and_value/lean_thinkin g/lean_six_sigma.htm http://www.institute.nhs.uk/quality_and_value/lean_thinkin g/lean_six_sigma.htm http://www.institute.nhs.uk/quality_and_value/lean_thinkin g/lean_six_sigma.htm  The time of receipt of samples into the department was monitored for one week to establish the capacity required at different times of the day.  New staff have been recruited to work from 13:30 to 20:00 covering the times of greatest demand.