Introduction of new Chemical Analyzer to ER lap

7/29/2019 Introduction of new Chemical Analyzer to ER lap

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Introduction Our hospital Cairo University Hospital serves about

600,000 students in all faculties and more than10000 staff members and employees.

It lies in Giza square surrounded by differentfaculties of Cairo University , being in such awonderful place it serves many people other thanthose getting benefit from the insurance .

As regard the emergency room it serves the wholepopulation of the university and the neighboringarea.


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The laboratory Department contains 4 units and a

specialized ER lab.

The ER lab plays a vital role in the process of rapiddiagnosis of the critically ill patients especially thosesuffering from suspected myocardial infarction.


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Introduction

of new Chemical Analyzerto ER lab

By:Noura Mohammad Nagib

Sara Ahmad Tarek

Sarah Omar Tawfik

Quality planning project


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Step 1

Step 2

Step 3

Establish the project.

Identify customers.

Discover customer needs.

Develop service.

Develop process.

Steps of quality improvement project :

Step 4

Step 5

Step 6 Develop process controls / transfer to operations.


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Step 1: Establish Project

Step 1

A. Identify project.

B. Establish project mission.

C. Establish team.

D. Verify mission.

E. Plan the project.


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A-Identify Project.

Step 1Step 1

The basis for identifying the project is to establish a

new chemical analyzer in the ER Lab for rapid

diagnosis of the critically ill patients and to

increase the service provided by the hospital Lab

Step 1 : Establish project


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Introduction of a new Chemical Analyzer

Machine in the ER Lab in the span of 7 months.This device will serve the E.R patients, rapidly doing

the urgent Chemical lab tests. The machine will be

able to analyze all the basic Clinical Chemistry tests

quickly, using recent technology in the industry. It will accomplish a rapid , accurate, safe , precise

service for ER patients

B- Mission statement

Step 1 : Establish projectStep 1 : Establish project


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1. To reduce the Central lab turn around time for getting the ClinicalChemistry result from 45 minutes to 20 minutes.

2. To manage the ER cases faster, reducing patient related mortality toless than 3%.

3. To capture 40% of the market share in the field of Emergencymanagement.

4. Increase customer satisfaction by at least 15%.

5. To increase the revenue of hospital as the project is expected to gainnot less than 100,000 LE by the first year of operation.

Goals

Step 1 : Establish projectStep 1 : Establish project


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C-Establishing a team

It is a cross-functional team formed of Chief Executive officer (CEO)

,the quality director and a representatives from the followingdepartments:-

ER department

Lab department

Nursing staff

Reception

Finance

Purchasing department

Supplier company

Maintenance department



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Team Charter:

The team is expected to apply the steps of the qualityplanning process.

Team members are to spend a 5 hours each week. The team will have access to resources.

The ER nurses will be responsible for preparing the meetingagenda

The team is supported and authorized from the highermanagement , arrangements are agreed upon for obtainingany additional resources if needed .



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D-Verify mission :Our quality planning goal respects the five characteristics

of the 'SMART' method as it is:

Specific as it deals with service provided to ER patientwho will need Chemical tests.

Measurable to perform 3000 lab analysis/month=3%market share.

Agreed upon after taking into account primary and

secondary research and facts from our market share data,we do believe that the objectives set are achievable

Realistic considering financial resources availably andmanpower expertise

Time phased it will be achieved in span of 7months .



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1- Tree Diagram

In tree diagram each step is further defined bykey activities and tasks to be done.

The primary goals are subdivided to secondary

project goals or activities and activities are

subdivided to the major tasks that are most

related to the first level goals.

After the Team finished the Brain storming ,they

began using their tools for planning the project .


bli h j


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B. Quality tool: Tree Diagram:-

Establish Newchemical analyzer in

ER lab

Establish the project

Establish the team

Verify the

mission

Plan the project

Identify customers

Create a flow diagram

List customers

and prioritize

Establish project

mission

Discover customer

needs

survey/interview key

customers

Complete needs

analysis

Determine unit of

measure and sensors

translate

Plan more data

collection

Design questions

Send questionnaires/

arrange interviews

Select sample s

List singledimension

needs


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Develop the service

Develop the

process

Optimize features

and goals

Select general

process design

Develop features

and goals

Identify operating

conditions

Identify process

features and goals

Publish final product

features and goals

Publish final product

design

Develop detailedfeatures and goals

Develop high level

features and goals

Determine methods

Optimize

Determine method

Identify process

anatomy

Design process

flow diagram


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Develop process

controls / transfer

to operations

Identify controlsneeded

Design feedback

loop

Plan for transfer to

operations


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It is a highly useful tool for taking a complex or long

term project and dividing it into specific tasks . Some tasks are performed sequentially while other

tasks on different paths do not depend on each otherand can be performed simultaneously.

It is often developed based on a tree diagram

2- Planning network



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1/1-20/1

20days

Create flow

diagram

6/2-6/3

30days

Design

questionnaire

6/2-13/2

8days

Select sample21/1-5/2

16days

List

customer

&prioritize

7/3-22/3

16days

interview

7/3-10/3

4days

Sendquestionnaire

7/3-22/3

16days

Plan more

data

collection

23/3-22/4

31days

List single

dimension

needs

Planning Network


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23/5-7/6

16days

Determine unit

of measure &

sensor

23/4-22/5

30days

Place on service

design

spreadsheet

23/4-8/55

16days

translate

8/6-12/6

5days

Select high

level service

features &

goals

13/6-17/6

5days

Developed

detailed

service

features &

goals

18/6-22/6

5days

Determine

the design of

process

anatomy

CRITICAL PATH: The path with the largest total elapse time labeled by blue colors


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23/6-27/6

5days

Develop

process flow

diagram

28/6-4/7

7days

Construct

detailed

process

features &

goals

spreadsheet

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3days

Develop

feedback loop

8/7-10/7

3days

Develop

process

control

spreadsheet

The overall project days = 192 days

CRITICAL PATH: The path with the largest total elapse time labeled by blue colors.Lost time for any of these tasks would put the entire project behind schedule


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Step 2: Identify customers

A. Construct a high level flow diagram

B. Construct a detailed flow diagramC. Create a list of all external customers

D. Create a list of all internal customers

E. Prioritize customers lists

F. Vital few customers

S 2 Id if


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ER physician making a lab request

ER nurse takes the suitable sample for the requested test

Porter delivers sample to the ER lab

Sample taken correctlyand suitable for testing?NO

yes

Lab chemist records the requested test and related information

in the ER lab register

Lab chemist performs the test on the sample and reads the

result

ER lab

reg

ER lab

req

A

D

etailedflowdiagram

Step 2 : Identify customers

St 2 Id tif t


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Lab chemist delivers the result to the lab dr

Lab dr interprit the result and write the report ER labreport

Lab porter takes the reportand deliver it to the ER phys

B


Is the

resultcritical?

NO

yesLab DR calls the

ER phys and report

him

St 2 Id tif t


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Internal Customers External Customers

ER physician ER patients

Porters. Families of patients.

ER nurse. Supplier of medical equipments

Administration staff. Ministry of health.

ER lab doctor. Health insurance organization.

Financial staff Market.

Purchasing,.

Lab chemist

Infection control team

Customerch

icklist


St 2 Id tif t


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It organizes data into sets of items to be

compared. The diagram graphically shows

relationships and/ or evaluates the strengths of

relationships between the items in each set.

The team brainstormed a list of possible criteria

to use in prioritization the external and internalcustomer

Impact (Prioritization) Matrix


St 2 Id tif t


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SELECTION MATRIX FOR PRIORITIZATION OF

EXTERNAL CUSTOMERS

Customer Revenue Impact

on our

image

Shut us

down

Decrease

morbidity

& mortality

Bring

new

business

Total

Patient 9 9 1 9 9 37

Suppliers 9 3 1 3 3 19

Patients

families

9 9 1 1 9 29

MOH 3 1 9 1 1 15

Market 9 9 1 1 3 23

Insurance 9 9 1 1 9 29

Scale : 9 ( very strong ) 3 ( strong) 1 ( weak)


Step 2 Identif c stomers


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SELECTION MATRIX FOR PRIORITIZATION OF INTERNAL

CUSTOMERSCustomer Revenue Impact on

our image

Shut us

down

Decrease

morbidity

Bring new

business

Total

ER physicians. 9 9 1 9 3 31

porters 1 3 1 3 3 11

ER lab

physician

9 3 1 3 3 19

Admission

staff

3 3 1 3 3 13

ER nurse 9 9 1 3 3 25

Finance staff 9 1 1 1 1 13

purchasing 9 1 1 1 1 13

Lab chemist 9 9 3 1 1 23

Lab clerk 3 3 1 1 1 9

Inf. cont team 3 3 3 9 1 19

Scale : 9 ( very strong ) 3 ( strong) 1 ( weak)




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Vital few customers were identified as follows:

Patient ( ext.)

Patient families ( ext.)

Insurance (ext)

ER physicians ( int.)

Lab chemist (int) ER nurse(int)

Vitalfewcustomers



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Step 3: Discover customer needs

A. Plan to collect customer needsB. Collect list of customer needs in their language

C. Examine and prioritize customer needs

D. Translate their needs into your language

E. Establish unit of measurement and sensors

Step 3 : Discover customer needs


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Understanding customer needs

The team decided to collect the needs of the

vital few external and internal customers. They

prepared different customer questionnaires and

conducted face to face interviews with the

customers.




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Questionnaire(for external customers)

Name: Sex: Occupation:

Please check your answers & explain when needed:

1- How often do you visit the Cairo university hospital?

2. How many times did you come to our ER ?3. Are you satisfied with our waiting time for results of our ER

laboratory?

satisfied Neutral Dissatisfied.

4. If you are not satisfied , please tell us why do u feel that way ?

5. How satisfied are you with our ER lab. Service?

6. How do you compare us with other similar hospitals providing ER

lab. Service?

7. What suggestions do u have to improve our ER lab service?




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Some answers were as following :

4. If you are not satisfied, please tell us why do you feel that way?

Delayed results of ER tests.

Multiple sampling trials.

Sometimes, there are errors in the reports.

ER devices look somehow old, not recent.

Delay in transporting samples to ER lab.

Re-analysis due to lab mistakes or sampling mistakes.

Painful, uneasy sampling. Unfriendly behavior of the personnel at the ER.

Not all the ER tests are always available at the ER lab.




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5. How satisfied are you with our ER lab service?

Its location is easy to reach.

Many ER lab residents available at the place.

7.How do you compare us with other similar hospital providing ER lab

service?

Same.

8. What suggestions do you have to improve our ER lab service?

Updating the ER lab service.




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Questionnaire ( for internal customers)Name: Sex: Occupation:

Please check your answers & explain when needed:1- Do you think that applying a new chemical analyzer in ER lab to avoid sending

sample to the central lab is a good idea and why?

2- Do you prefer a nurse to take the sample or a Lab technician and why?

3- Do you think the presence of work instruction attached to any device is a good

idea?

Yes No Somehow

4- What are your requirements for a new chemical analyzer device?

5- Do you think a 24 hour,7 days week availability of this service is a must?


6- Do you think explaining what goes on to the patient is important, why?7- Do you have any suggestion for a better lab service?

8- Do you need easy, rapid communication between ER dep and lab dep when

there is a critical values?



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Some answers were as following

1- Do you think that applying a new chemical analyzer in ER lab to avoid sending

sample to the central lab is a good idea and why?Yes it will decrease the TAT for central lab and will increase ability to rapidly

diagnose and management

2- Do you prefer a nurse to take the sample or a Lab technician and why?

A well , trained nurse

4- What are your requirements for this device?

Reliable, results , safe , rapid , user friendly ,calibrated , regular maintenance.

5- Do you think a 24 hour,7 days week availability of this service is a must?

Yes


6- Do you think explaining what goes on to the patient is important, why?

Yes

8- Do you need easy, rapid communication with the doctor when there is a

critical values?

Yes



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List of Customer Needs(ext. & int. customers)

Short TAT for test result

Accurate results with low error rate.

Skilled lab chemist

Taking suitable sample to prevent re sampling .

Availability of all ER tests.

Friendly device.

Using latest, easier & updated technology.

24 h/7 days week ER device service.

Safety.

Enough training on ER lab chemical devices.




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Privacy & security.

Written work instructions.

Contact with ER device supplier specialist in case of anyproblem.

Easy & rapid communication between ER dep and ER lab in

case of critical values.

Clarified criteria of ER device. Comfortable working environment ( availability of reagents

& materials)


List of Customer Needs(ext. & int. customers)



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Translation of customer needs:

Needs expressed asfeatures

Needs expressed as benefits

Using latest, easier & updated

technology.

Rapid, accurate & user friendly equipment.

Short waiting for ER testresults.

Lab. results arrive on time.

Accurate results with low error

rate.

The No. of reports repeated for not being

accurate in relation to total No. of delivered

reports per month.

Safety Provide manual for infection control.

Following the instructions in this manual.

Easy & rapid communication

between ER lab and ER dep in

case of critical values.

Lab DR have to call immediately ER doctors

in case of critical value.




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Translation of customer needs:

Needs expressed as

features

Needs expressed as

benefits

Availability of all ER tests. All are ER test kits and devices

should be available in the lab.

Contact with ER device/

supplier specialist in case of

any problem.

Calibrate before starting work.

Maintenance contract with supplier.

Customer satisfaction. No. of repeated customer/relatives

visits/ year for the same or other

service.




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Customer Needs Spreadsheet:




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Customer

Vital few

Using

latest,

technol

ogy

Short

waiti

ng

time

accurate

results

Commu

nic. for

critical

values

Availabilit

y of all ER

tests

24 hrs,7

days

week ER

device

service

safety written

work

instructi

ons

Patient 1 9 9 3 9 9 9 1

Lab

chemist

9 1 9 9 3 3 9 9

Patientfamilies

9 9 9 3 9 9 9 1

ER nurse 3 9 3 9 1 1 9 9

ER

physician3

9 9 9 9 9 1 1

insurance 1 3 3 1 3 3 3 1

Total 26 40 42 34 34 34 40 22

Scale : 9 (strong) 3( medium ) 1 ( week)




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Prioritized list of needsof external and internal customers

1- Using latest, easier, updated technology

2- Short waiting time for test results

3- accurate results with low error rate

4- safety

5-Easy,rapid communication with the ER physician in case of

critical values

6- 24 hrs,7 days week ER device service

7-written work instructions

8- contact with the device supplier specialist in case of any

problem.




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The team recognized that some of the needscollected from customers were broad and

required further definition in order to be

addressed.

So, the team decided to review the list of

needs and break them down to a precise

enough that a single response to each need

could be developed.They used a needs analysis spread sheet to do

this.




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Needs analysis Spreadsheet:




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Primary needs Secondary needs Tertiary needs

Safety Proper infection control

system

Implementation of infection control system in the

ER lab

Establish policy & procedure for infection controlWell ventilated

Properly cleaned

Implementation of safety measures for taking

sample

Rapid serviceRapid sample withdrawal

by the ER nurse.

Buying a new machine

using the recent updated

technology.

24h/ 7 days available lab

Chemist.

Providing a budget for buying the machine and

vacutainer materials.

Training courses for ER nurses on vacutanier.

Dividing the day to 3 shifts for the chemist

Accurate results Adequate calibration for

the machine.

Well trained lab chemist

Qualified lab doctors.

Checking the machine manual for required QC &

calibration.

Training courses for the Chemist. on the machines.

Choosing doctors with highest qualification & past

experience in ER lab.




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Primary needs Secondary needs Tertiary needs

Comfortable service

(24hrs,7 days available)

All ER tests are available.

Available kits & reagents.

Sample taking once.

Providing a budget for

buying a new machinedoing all ER chemical tests.

A store for the kits &

reagents inside the ER lab.

Trained ER nurse on takingsample.

Written work instruction Easy operation on the

device

From manual

Customer satisfaction Provided patient with

needed information

Effective treatment.

Education

Accurate result

S ep 3 sco e cus o e eeds



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Determine units of measures and sensors:

Customer need Unit of measurement Sensor

Rapid service ER lab T.A.T for chemical

analysis less than 20 min.

Numbers of ER results than took

more than 20 min.

Accurate results Complaints of ER

physicians.

No. of tests repeated.

Monthly questionnaire ER

physician.

No. of tests repeated permonth.

Comfortable service Yes/no Complaints report

Customer satisfaction No. of new patients using

our service.

Customer survey monthly

random.

Direct communication with

customer to view their

satisfaction.

p


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Step 4: Develop the service

A. Group together related customer needs

B. Determine methods for identifying product

featuresC. Select high level product features and goals

D. Develop detailed product features and goals

E. Optimize product features and goals

F. Set and publish final product features andgoals

G. Set and publish final product design

Step 4 : Develop the service


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Group together related customer needs:

The team should prioritize and group

together those needs which relate tosimilar functionality

(clustering the needs)

Tool: Affinity diagram

p p



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ER lab.Staff2

Highqualityneeds

ERchemical

tests

Safetyneeds

Trainingneeds

Reports

Qualified

doctors

Latest

technologyRapid results

Sample taking

once

Qualified lab

doctors.

Provided

patient with

needed

information

Availableporters Rapidresults AccurateresultsAll ER tests areavailable

Well trained lab

chemist Lab report withno errors

Well trained

lab chemist

Accurate

results

Short ER lab

turnaround

time

Accurate results Well trained ERnurse

User

friendly

All test kits

available

Regularly

maintained

Daily

calibration

Affinitydiagram

p p



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Brain storming: to identify product features.

Benchmarking:to make a point of comparison or measure what our

competitors have achieved with their ER lab matched to us.

Basic research:to explore the feasibility of the productand productfeatures

Market experiments:introducing and testing ideas for productfeatures which allow us to analyze our team's recommendations. This is

done through focus groups to compare our expectations with the actual

market requirements.

Determine methods

for identifying service features:

p p



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Select high level

product features & goals:

Available


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Customerneeds

Available

Service

test

Regular

mainten

ance

Calibrate

d

machineMachine

Latest tech

Qualified lab

physicians

Trained

Lab

chemist

199999Safety

999939Rapid

199999accurate

333311comfortable

133319Written workinstruction

933333Customersatisfaction

931911

Availability of

all chemicaltests

Service

available

24/7

Accurate

results

longer

life span

int. & ext

quality

proficien

cy?

Model 2010-

2011Master Degree

Well

trained

Lab

chemist

Servicefeature goals

333937452741Total


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Step 5:Develop process

A. Review product goals

B. Identify operating conditions

C. Collect known information on alternateprocesses

D. Select general design

E. Identify process features and goals

Step 5 : Develop process


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The main activity:

Process anatomyProcess flow diagram

Process features & goals spreadsheet

Step 5 Step 5 : Develop process


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Process development is the activity which

determines how our lab service will be

delivered, the aim of process development

is to provide the operating forces with

means for meeting operating goals

Step 5 Step 5 : Develop process


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Process anatomy

It is a coherent structure which binds or holds the

process together.

It guides the flow of the work from start to finish.

Shows in schematic form where the various sub-processes reside, how they are linked together, and

where the inputs enter and the outputs go.



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Item Process Process anatomy

Macro process Chemical analyzer Assembly tree

Sub process Lab request Assembly tree

Withdraw sample Procession

Performing the test Procession

Report Procession

Processanatomy



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Patient

Administration

Admission

Investigation

Labreport

Medical / record

Main lab

Nursing

Physician

Lab register

Finance

Lab chemistProcessanatomy

Assemblytree



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Lab request

Withdraw sample

Performing

The test

ReportDelivering the report Writing the report

Calibrate the equipment

Preparing the patientSafety measures

HIGHLEVELFLO

WD

IAGRAM

(PROCESSA

NATOMY)



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Process features & goals spreadsheet

The process features can be categorized underprocedures, methods, equipments and supplies,materials, people, training and knowledge and otherresources.

The process goals are like other goals should beSMART



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Proces

sfeaturesand

goalsspreads

heet

Process features

Service features Service goals Procedure People equipment Material

Trained Lab

chemist

Well trained for

(2weeks) Lab chemist

O * O O

Qualified lab

physicians

Master Degree # # O O

Machine Latest

technology

Model 2010-2011 * O * *

Calibrated machine int. & ext quality

proficiency

O * * *

Regular

maintenance

Accurate results longer

life span

* * * *

Available

Service test

Service available 24/7 * * # #

Process goals

* Very strong

# strong

O weak

90 % of

results

achieved

95% of

people do

the required

job

95% of

equipment do

the required job

90% of material

r available


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Step 6:Develop process controls

/ transfer to operations

A. Identify controls neededB. Design feedback loop

C. Plan for transfer to operations

Step Step 6 : Develop process controls/transfer to operations


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Feedback loop

Feedback loop is the tool for

monitoring the actual performance of

a process and keeping it performing

as it was designed

Step 6 : Develop process controls/transfer to operations


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Process control spreadsheet

This tool will enable the team to identify:-

1. The control subject.

2. The target goal

3. Criteria for taking action

4. Who takes action

5. What action they take

6. Where they do it7. When they do it

8. How they do it



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By phoneimmediately

Mantainence

dep.

Call the

maintenanc

e

Seniornurse

Brock down of

any device

100%accuratedevice

Functioni

ng

device

Formal

request

After 1 m of

completionof initialtraining

Organization

management

More

training tostaff

Head of

lab dep

More than 3%

error

100% ptsatisfaction

Calibrati

on andset

errors

Standard

method

Once

discovered

ER labDiagnoseof the

cause ofdelay

Head ofLab dep

More than 20

min

Max 20min

Long TAT

Formal or

oral request

After one

month of

training

Organizationmanagement

Calls formore

trainingnurse

Head ofER

More than 10 %

of cases need

more than

withdrawal trial

Rapid,Painlesssample

withdrawalfrom thefirst time

% of

multiple

sampling

trials

Process control spreadsheet


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Documents

Introduction of new Chemical Analyzer to ER lap