Process Improvement

1. Process Improvement

2. Learning Objectives At the end of this module, participantsshould 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 testingin 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 Process Control Purchasing & Inventory Information Management Assessment Documents& Records Occurrence Management Process Improvement Customer Service Facilities & Safety Process Improvement-Module 15

5. W. Edwards Deming14 Points for Quality create constancy of purpose for improvement improve constantly and forever Two points address continual improvement: 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

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

10. New Trends-Improvement Tools Lean 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 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 asconformance 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 DevelopingSuccessful 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 BrownUsing the Right Metrics to Drive World Class Performance1996 Process Improvement-Module 15

22. [urine culture] * [glucose] * [INR] X100 [NUPA hr] * [Telephone minutes] Computer Nonsense Indicators Just because a computer can calculate a value, doesn’t mean that it should. Process Improvement-Module 15

23. Quality Indicators Examples 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 indicatorsbest assess quality, but are themost difficult to measure. too many variables requirelarge amounts of data need extended collection periods David Hsia Medicare Quality Improvement Bad Apples or Bad Systems? JAMA. 2003;289:354-356. Process Improvement-Module 15

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

27. Planning 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 leadershipand 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 providesuseful information. Don’t get tied to your indicators. Process Improvement-Module 15

37. 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. Organization Personnel Equipment Process Control Purchasing & Inventory Information Management Assessment Documents& Records Occurrence Management Process Improvement Customer Service Facilities & Safety Questions?Comments? Process Improvement-Module 15