1. Process Improvement

2. Learning Objectives
At the end of this module, participants should be able to:
Relate the historical perspective of process improvement.
Describe the importance of process improvement in maintaining quality.
Explain the need for tools to monitor laboratory processes.
Process Improvement-Module 15

3. Scenario
You have implemented CD4 testing in the laboratory. Staff are trained and comfortable using it. It has been validated, test results are being reported and it “seems” to be working well.
How do you know that the test is working well and will continue to work well in the future?
Process Improvement-Module 15

4. The Quality Management System
Organization
Personnel
Equipment
Purchasing & Inventory
Process Control
Information Management
Documents & Records
Occurrence Management
Assessment
Process Improvement
Customer Service
Facilities & Safety
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5. W. Edwards Deming 14 Points for Quality
Two points address continual improvement:
create constancy of purpose for improvement
improve constantly and forever
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6. The Deming Cycle
Plan Do
Act
Check
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7. Continual Improvement (ISO 15189:2007)
develop plan for improvement
identify potential sources of error
implement
adjust the action plan and modify the system
review the effectiveness of action
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8. Conventional Improvement Tools
internal audits
external quality assessment
external audit and accreditation
management review
opportunities for improvement
quality indicators
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9. Opportunities for improvement
Monitoring Quality
Quality Plan
Monitoring
Monitoring
Monitoring
Internal Audit
External Audit
Quality Assessment
Quality Control
Opportunities for improvement
Quality Goal
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10. Lean New Trends-Improvement Tools
Optimizing space, time, and activity to improve the physical paths of workflow.
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11. Path of workflow and maintenance by blood culture technologist
Pre Lean Post Lean
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12. New Trends-Improvement Tools
Six Sigma
A formal structure of project planning to implement change and improvement.
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13. Structure in Six Sigma control define measure analyze improve
Organized processes to assist in decision making for continual improvement:
control
define
measure
analyze
improve
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14. What is Quality?
“Quality is defined as conformance to requirements, not as 'goodness' or 'elegance'.”
Philip Crosby
Four Absolutes of Quality Management
1979
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15. Quality Indicators Definition
Established measures used to determine how well an organization meets needs and operational and performance expectations.
ISO 9001:2000 (5.4.1; 8.4)
ISO 15189:2007 (4.12.4)
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16. So… Quality Indicators indicate performance determine quality
highlight concerns
identify areas needing further study
track changes over time
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17. Measuring Performance
fewer quality indicators are better
link to factors needed for success
based on customer and stakeholder needs
start at the top flow down
change with changing environment and strategy
have targets or goals based on research rather than arbitrary values
Mark Graham Brown
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18. Eight Steps to Developing Successful Indicators
objective
methodology
limits
interpretation
limitations
presentation
action plan
exit plan
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19. The BIG SECRET for Quality Indicator Team
Engage the folks who do the work, because they know what they do!
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20. Characteristics
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21. Keeping Score
“Many organizations spend thousands of hours collecting and interpreting data. However many of these hours are nothing more than wasted time because they analyze the wrong measurements, leading to inaccurate decision making.”
Mark Graham Brown Using the Right Metrics to Drive World Class Performance 1996
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22. Computer Nonsense Indicators
[urine culture] * [glucose] * [INR]
[NUPA hr] * [Telephone minutes]
X100
Just because a computer can calculate a value, doesn’t mean that it should.
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23. Quality Indicators Examples
System
Preexam
-Examination-
Postexam
test order accuracy and appropriateness
patient identification adequacy
accuracy of point-of-care testing
critical values reporting
turnaround time
clinician satisfaction
accuracy of sample information
cervical cytology/biopsy correlation
clinician follow-up
clinician follow-up
diabetes monitoring hyperlipidemia screening
blood culture contamination
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24. Most common indicators tracked (%) 2005
Reference: Hilborne L. Developing a core set of laboratory based quality indicators. IQLM Conference; 2005 Apr 29.
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25. Caution
Theoretically, patient outcome indicators best assess quality, but are the most difficult to measure.
too many variables
require large amounts of data
need extended collection periods
David Hsia
Medicare Quality Improvement Bad Apples or Bad Systems?
JAMA. 2003;289:
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26. Essentials for Implementation
Commitment
Planning
Structure
Leadership Participation and Engagement
Continual
Improvement
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27. Planning Consider: root causes of error risk management
Errors?
Consider:
root causes of error
risk management
failures and potential failures and near-misses
costs, benefits, and priorities
costs of inaction
Benefits?
Failures?
Priorities?
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28. Leadership Fosters the culture for improvement:
openness that others have good ideas
commitment that improvement will occur
opportunity that staff can participate
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29. Participation management does not always know what workers know and do
continual improvement requires leadership and team participation
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30. Quality Improvement Activities
One project every 6 months.
Set a timeline.
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31. Quality Improvement Activities
Use a team approach.
Involve bench-level staff.
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32. Quality Improvement Activities
Use Quality Tools
audits
reviews
EQA
OFI
indicators
Six Sigma
lean
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33. Quality Improvement Activities
Correct or prevent poor practices
Report progress to
management and laboratory staff
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34. Quality Improvement Activities
Use available information to study:
customer’s suggestions or complaints
identified errors from occurrence management program
problems identified in internal audits ?
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35. Quality Improvement Activities
If possible, design a study so that results can be statistically measured.
Pre lean state for final positive blood culture reports
Post lean state for final positive blood culture reports
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36. Quality Indicators and Timing
Use an indicator only as long as it provides useful information.
Don’t get tied to
your indicators.
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37. Each step is essential to keep the quality cycle cycling.
Summary
Each step is essential to keep the quality cycle cycling.
Plan
Act Do
CHECK
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38. Key Messages quality counts
continual improvement is the core of quality management
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39. Purchasing & Inventory Information Management Occurrence Management
Organization
Personnel
Equipment
Purchasing & Inventory
Process Control
Information Management
Documents & Records
Occurrence Management
Assessment
Process Improvement
Customer Service
Facilities & Safety
Questions? Comments?
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