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Process Improvement.

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Presentation on theme: "Process Improvement."— Presentation transcript:

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 Process Improvement-Module 15

5 W. Edwards Deming 14 Points for Quality
Two points address continual improvement: create constancy of purpose for improvement improve constantly and forever Process Improvement-Module 15

6 The Deming Cycle Plan Do Act Check Process Improvement-Module 15

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 Process Improvement-Module 15 7

8 Conventional Improvement Tools
internal audits external quality assessment external audit and accreditation management review opportunities for improvement quality indicators Process Improvement-Module 15

9 Opportunities for improvement
Monitoring Quality Quality Plan Monitoring Monitoring Monitoring Internal Audit External Audit Quality Assessment Quality Control Opportunities for improvement Quality Goal Process Improvement-Module 15

10 Lean New Trends-Improvement Tools
Optimizing space, time, and activity to improve the physical paths of workflow. Process Improvement-Module 15

11 Path of workflow and maintenance by blood culture technologist
Pre Lean Post Lean Process Improvement-Module 15

12 New Trends-Improvement Tools
Six Sigma A formal structure of project planning to implement change and improvement. Process Improvement-Module 15

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 Process Improvement-Module 15

14 What is Quality? “Quality is defined as conformance to requirements, not as 'goodness' or 'elegance'.” Philip Crosby Four Absolutes of Quality Management 1979 Process Improvement-Module 15

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) Process Improvement-Module 15

16 So… Quality Indicators indicate performance determine quality
highlight concerns identify areas needing further study track changes over time Process Improvement-Module 15

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 Process Improvement-Module 15

18 Eight Steps to Developing Successful Indicators
objective methodology limits interpretation limitations presentation action plan exit plan Process Improvement-Module 15

19 The BIG SECRET for Quality Indicator Team
Engage the folks who do the work, because they know what they do! Process Improvement-Module 15

20 Characteristics Process Improvement-Module 15

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 Process Improvement-Module 15 21

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. Process Improvement-Module 15

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 Process Improvement-Module 15

24 Most common indicators tracked (%) 2005
Reference: Hilborne L. Developing a core set of laboratory based quality indicators. IQLM Conference; 2005 Apr 29. Process Improvement-Module 15

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: Process Improvement-Module 15

26 Essentials for Implementation
Commitment Planning Structure Leadership Participation and Engagement Continual Improvement Process Improvement-Module 15

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? Process Improvement-Module 15

28 Leadership Fosters the culture for improvement:
openness that others have good ideas commitment that improvement will occur opportunity that staff can participate Process Improvement-Module 15

29 Participation management does not always know what workers know and do
continual improvement requires leadership and team participation Process Improvement-Module 15

30 Quality Improvement Activities
One project every 6 months. Set a timeline. Process Improvement-Module 15

31 Quality Improvement Activities
Use a team approach. Involve bench-level staff. Process Improvement-Module 15

32 Quality Improvement Activities
Use Quality Tools audits reviews EQA OFI indicators Six Sigma lean Process Improvement-Module 15

33 Quality Improvement Activities
Correct or prevent poor practices Report progress to management and laboratory staff Process Improvement-Module 15

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 ? Process Improvement-Module 15

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 Process Improvement-Module 15

36 Quality Indicators and Timing
Use an indicator only as long as it provides useful information. Don’t get tied to your indicators. Process Improvement-Module 15

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 Process Improvement-Module 15

38 Key Messages quality counts
continual improvement is the core of quality management Process Improvement-Module 15

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? Process Improvement-Module 15

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