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LTU Six Sigma Group Project
TRI-CORE MEDICAL LABORATORIES
Six Sigma Black Belt Candidates:
Sample Project
Lawrence Technological University
April 14-15th , 2012
Tri-Core Medical Background
2
Founded: 1998
Number of Employees: Approximately 1,100
Headquarters: Albuquerque, New Mexico
Revenue: Approximately $2.3B
Areas of Focus: Blood Bank / Transfusion Medicine,
Chemistry, Coagulation, Cytogenetics, Cytopathology,
Dermatopathology, Endocrinology, General Surgical
Pathology, Genetics, Hematology, Hematopathology,
Immunogenetics, Immunohistochemistry, Oncology,
Immunology/Autoimmune, Infectious Diseases, Toxicology,
Renal Pathology, Transplantation
Tri-Core Medical Background
Vision:
To be the laboratory of choice through personal
commitment to excellence in patient care.
Mission:
Tri-Core leads the region in providing comprehensive
laboratory information of exceptional quality and value.
Leadership is achieved by dedicated people who support
innovation, advanced technology, customer service,
education and research.
Values:
Integrity, Compassion, Accountability, Respect,
Excellence
3
4
Project Goals:
(1) To understand and improve blood draw
operations and eliminate the high amount of
variance.
(2) To improve patient/doctor delivery time for
results .
Mr. Antonis - Tri-Core Medical - Director of Laboratory Services
offered the following comments:
“We do not have a good way to schedule appointments.”
“Many of our draws take too long and back us up.”
The Problem Statement
5
Tri-Core operates twelve laboratories with
identical equipment, personnel, and runs nearly
identical blood testing on a near-identical
patient population. Though designed to perform
at similar levels, there is a variance of as many
as 401 fewer blood draws per month from the
lowest producing lab to the highest. Annually,
this is creating a potential loss of approximately
31,092 blood draws overall.
Lab 5
Other
11 Labs
Key Laboratory Operations Data
Tri-Core Labs are conducting three different levels of
tests. These tests pay between $150-$250/test. For
the purposes of our calculations we used an average
of $200/test.
All labs run ten hours for six days a week, with one
hour for lunch and two fifteen minute breaks. This
equals 8½ hours/day of working time. With three lab
personnel (receptionist/two lab technicians) a total of
1530 minutes/day.
Average blood draw process time used is 23 minutes
– Upper Specification Limit (USL).
Labs on average operate 24 days/month; resulting
288 days/year/lab.
6
Financial Impact
Lost Revenue:
The current operation yields 141,708 blood draws/year
across all twelve laboratories, this is resulting in
$28,341,600/year.
If all twelve laboratories were performing at the level
of laboratory five (172,800 blood draws/year), revenue
would increase to $34,560,000/year.
Bottom Line: A potential loss of $6,218,400/year.
Note: A 50% improvement in blood draw throughput will
yield an increase in revenue of $3,109,200 / year.
7
8
Key Six Sigma Project Tools
Historical Data Tri-Core Medical provided us with data based on sign-in
sheets for 2010.
This data was verified against weekly lab output studies.
No significant difference was observed between weekly
detail data and monthly high level data.
Monthly high level data accurately represents output of all
laboratories.
9
Labs (level 1 & 2 blood draws) Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Averages
Lab 5 1188 1200 1209 1204 1210 1200 1196 1212 1206 1194 1190 1191 1200
Lab 8 890 882 880 882 882 870 876 880 885 878 880 875 880
Lab 12 1089 1088 1089 1087 1088 1089 1089 1091 1091 1089 1089 1089 1089
Weekly
data Lab 5 Lab 8 Lab 12 Lab 5 Lab 8 Lab 12 Lab 5 Lab 8 Lab 12
Week 1 308 221 299 308 217 287 328 223 297
Week 2 289 216 260 296 223 266 292 221 260
Week 3 311 227 251 293 225 260 280 226 254
Week 4 302 218 278 309 220 278 290 210 278
Total 1210 882 1088 1206 885 1091 1190 880 1089
ACTUALS SAMPLE DATA (Count is based on sign-in sheets for 2010)
WEEKLY DATA
NovSeptMay
Measurement System
Things that were not considered relevant to the measurement system
included - laboratory layout and patient demographics. The following
Cause & Effect Matrix was created and used to identify those
variables important for further review and analysis.
10
Rating of Importance to
Customer →5 7 9 9 3 3
Process Outputs (Effects) → 1 2 3 4 5 6
Process Inputs (Causes) ↓ Next
day s
chedule
Confirm
tT
est
/ P
ull
patient
chart
Blo
od d
raw
Testing r
eport
Lab c
leaned f
or
next
patient
Lab r
e-s
tocked a
nd
pre
pped f
or
next
day
Total
Receptionist duties 9 9 3 7 7 9 2463 Different lab processes 7 3 7 5 7 7 206Receptionist's skill set & education 5 7 3 3 5 5 158Patient demographics 3 3 5 3 3 3 126Laboratory layout 3 3 3 3 3 3 108
Tri-Core Cause & Effect Matrix
Note: scoring scale using 3, 5, 7, and 9.
Graphical Analysis
Different types of analysis tools were used to help
determine which variables (X’s of interest) should be
pursued and data collected. The following chart shows in
those input variables (X’s) and their respective order of
importance .
11
12
Graphical Analysis
Statistical Approach
Several different types of statistical methods were used to
determine critical inputs and root causes. The results from
an ANOVA is highlighted below.
ANOVA was used to determine if a difference existed
between the three different blood draw processes. Actual
sample data was used.
13
The Result: we accept Ha and reject Ho
Since Fobs (9957) is > Fcrit (3.29) [p=0], reject Ho and conclude that the
differences in blood draw processes does increase total blood draw
throughput.
Analyses Summary
It was determined through observation, FMEA and Takt
time analysis that the Receptionist /Lab Technician
duties in laboratory five played a significant role in the
blood draw throughput.
The balance of our time was spent on the following
activities: Establishing daily blood draw targets
Developing a Pilot Test program
Implementing Process Control procedures, including control charts
Review all recommended changes with Mr. Antonis –Director of
Laboratory Services
14
Blood Draw Target:
The target for the lab processes is to increase the blood
draws performance from 11,809 / month to 14,400 / month
(theoretical max. 19,152 / month), while increasing the
number of personnel active in the process from two to three
persons (Receptionist will help the Lab technicians in the
overall blood draw process).
The blood draws/day values are the following:
- Other 11 Labs: 40.1
- Lab 5: 50.0
- Ideal Lab: 66.5
15
Establishing The Targets
An initial goal of 45 blood draws/day/lab; results in a
50% improvement !
ESTABLISHING THE TARGETS
16
Improve Laboratories Performance
0
10
20
30
40
50
60
70
Other 11 Labs Lab 5 Ideal Lab
40.1
50
66.5
2 3 3
Blood draws / day
Number of personnel
The initial goal is to move
the average daily blood
draw to 45 resulting in a
50% improvement
Pilot Program
Pick one lab other than Lab 5 (e.g. Lab 9), for a pilot program
and ask the Receptionist/Lab tech to shadow the Lab 5
Receptionist /Lab tech for one week to observe their day-to-
day operation.
This enhanced role for the Receptionist/Lab tech should be
put into practice for one month to determine the change in
blood draw throughput.
Chart the number of daily blood draws for one month in the
pilot lab.
If pilot program is successful, implement this new process in
the other 10 laboratories and chart the results for 3 months.
Review results with Tri-Core Medical Director and Six Sigma
Black Belt team to determine rate of improvement and
compare to baseline.
17
Developing Potential Solutions
Process Control Plan
1. Observe and document Lab 5 Receptionist and Lab
technician duties/responsibilities. Update employee
handbook and job description with these improvements.
2. Train all receptionists and lab technicians from the other
10 labs with these enhanced duties, and monitor blood
draw throughput (see page 68 for detailed receptionist’s
work instructions).
3. Standardize all lab operating procedures for Tri-Core
Medical on a company wide basis.
4. Create a daily patient blood draw completions database
system to monitor performance.
18
Process Control Plan (continued)
19
5. Monitor all Labs utilizing a control chart (see example
page 64).
6. Implement quarterly meetings (Kaizen), to determine if
other cost saving/employee efficiency suggestions should
be added to Tri-Core Medical processes/procedures
manual.
7. Reward top 2 Labs (e.g. small bonus, vacation time, etc.)
every month based on superior performance.
8. If necessary, change the Receptionist position description
to include medical assistant training and/or experience.
20
1. Improve as quickly as possible 11 Tri-Core Medical Laboratories with
reduced blood draw throughput.
2. Investigate 3 different laboratory blood draw processes for takt time
and operational efficiency.
3. Identify all reasons that cause Lab 5 throughput to be significantly
higher than the other laboratories.
4. Quickly standardize Lab 5 Receptionist/Lab technician duties and
responsibilities for all other labs.
5. Develop new monthly blood draw baseline for all labs to achieve, and
monitor their behavior with new control chart.
6. Document and standardize Tri-Core Medical employee handbook
with new Receptionist/Lab technician enhanced duties and
responsibilities, and hiring requirements if necessary.
Tri-Core Medical Project Summary
Back-up Slides: Tri-Core Medical
Six Sigma Project
DEFINE Phase: slides 22 - 30
MEASURE Phase: slides 31 - 46
ANALYZE Phase: slides 47 - 54
IMPROVE Phase: slides 55 - 62
CONTROL Phase: slides 63 - 68
21
Project Charter
22
Project Name Tri-Core Medical Laboratories Business / Location Albuquerque, NM
Green Belt Jim Steiger Telephone Number 810-227-1638
Black Belt Telephone Number
Champion Yolanda Ntseful Telephone Number 248-204-4050
Start Date: July 25, 2011 Target End Date: Dec 6, 2011
Project Details
Project Description To improve the throughput in monthly blood draw performance by determining the cause of the differences among laboratories. This will improve the overall blood draw process and patient/doctor delivery time. This project is Critical To Delivery (CTD).
Business Case Tri-Core Medical Labs is losing on average $200 per blood draw in lost opportunities across 11 of their 12 laboratories. If all labs were performing at the rate of Lab 5, the increase in revenue $11,404,800/year.
Problem Statement Tri-Core Laboratories is conducting 141,708 blood draws/year out of 172,800 blood draws/year, leading to a loss of 31,092 blood draws/year, costing an average of $6,218,400/year.
Process & Owner Blood Draw Operational process – Laboratory Director – Mr. Antonis
Scope Start: Stop: Includes: Excludes:
Pre-24 hour advance call to patient Next day’s lab preparation Patient arrival and check-in; Blood draw completion (Level 1, Level 2); Blood sample processing Blood draw completion (Level 3), performed by two external labs (at hospital facilities)
Project Goals Metric Baseline Current Goal Theoretical Max.
Increase blood draw performance
Blood Draws /month 11,809 blood draws/month
across 12 labs
11,809 blood draws/month
across 12 labs
14,400 blood draws/month
across 12 labs
19,152 blood draws/month across
12 labs
Expected Business Results
Increase blood draws by 50%
Increase blood draws by 90%
Expected Customer Benefits
Improve the patient/doctor delivery time for results.
Team members Radu Muresan
Support Required Tri-Core Medical HR Manager/Director, along with Mr. Antonis – Lab Director Lab 5 Receptionist
Risks or Constraints The fear of change by some receptionists with enhanced duties.
Findings and Action Plan
Title: Tri-Core Medical Six Sigma Project JPS
Background
Current Situation
Goal
Analysis
Recommendations
Plan
Follow - up
Tri-Core Medical Laboratories is experiencing
significantly different monthly blood draw
throughput among its 12 labs.
The Laboratory Director wants us to investigate
the cause for the laboratory variance.
Bring the other 11 labs in-line with Lab 5.
Identify possible causes and determine how best to
correct the problem quickly.
It was determined through our analyses that the
Receptionist duties and responsibilities are the
leading cause for differences in blood draw
throughput among Tri-Core Medical Labs.
1st – Expand the roles & responsibilities of the
Receptionist/Lab tech in the other 11 labs.
2nd - Explore streamlining the Lab tech’s duties to
determine if the overall laboratory process can be
improved.
Pick one lab Receptionist (other than lab 5) in a pilot
program and ask the Receptionist/Lab tech to shadow
the Lab 5 Receptionist/Lab tech for one week to
observe their day-to-day operation. Then this
enhanced role for the Receptionist/Lab tech needs to
be put into practice for one month to determine the
change in results.
After one month, analyze the data for improvements. If
successful, implement this process among the other 10
labs as quickly as possible. After 3 months, re-analyze
the data from the other 11 labs to determine the
improvement. Personnel changes may be necessary if
desired results are not meeting expectations.
Tri-Core Medical Labs has identified 3 different
operational processes being used among their labs.
23
Key Assumptions:
1. Labs run at 6 days/week; 10 hours /day. 1 hour for lunch, and two15 min
breaks = 8.5 hours/day of working time. With 3 lab personnel = 1530
minutes/day.
2. Average blood draw process time used is 23 minutes.
3. Labs on average operate 24 days/month (taking into account
longer/shorter months & holidays)
4. Total working days/year/lab = 288.
5. Average lab test pays $200.
Lost Opportunities:
1. 1530 min/day (3 lab personnel) divided by 23 minutes/blood draw
process = 66.5 blood draws/day “in a perfect world “= 1596/month
(Theoretical Maximum).
2. Currently Lab 5 is operating at 50 blood draws/day = 1200/month
(Pacesetter).
3. Other 11 Labs are averaging 40 blood draws/day = 960/month (Current
Level)
4. Lost opportunities vs. Pacesetter = 1596 – 1200 = 396/month
5. Lost opportunities vs. current (except Lab 5) = 1596 – 960 =
636/month/lab
24
Key Assumptions and COPQ
25
Cost of Poor Quality (COPQ):
1. Lab 5 – 396/month x 12 months x 1 lab x $200/test = $950,400/year
2. Other 11 Labs – 636/month x 12 months x 11 labs x $200/test =
$16,790,400/year
3. Total COPQ under current conditions = $950,400 + $16,790,400 =
$17,740,800/year
Note: If all Labs were running like Lab 5 the COPQ would be
reduced to $11,404,800/year
Key Assumptions and COPQ
The COPQ from lost opportunities = $17,740,800/year
Define the Process
26
Supplier Input Process Output Customer
WHO are your
primary
customers?
WHAT does the
customer
receive? (Think of
their CTD’s)
What STEPS are Included
in the Process today?
(high level)
What is
provided to
START the
process?
Who
PROVIDES
the input?
(Who) (Nouns) (Verbs) (Nouns) (Who)
24 hour advance call to patients
Patient arrival & check-in by receptionist
Patient blood draw by lab tech1
Analyses of Blood by lab tech 2 & report sent to Doctor
Lab area prepared for next patient by lab tech 1
Prep for next days patients by all lab personnel
Instrument
Manufacturers
Computer
Manufacturers
Medical Supply
Company
Phone Company
Medical Disposal
Company
Receptionist
Lab Technicians
Completed
Analyses
Electronic
Reporting
Filled Blood Vials
Patient
Communication
Removal of Medical
Waste Bins
Prepare Lab for
next Days’
Schedule
Blood Analyses
Reports; prep for
next day
Lab Technicians
All Lab Personnel
All Lab Personnel
Patients & Lab
Personnel
All Lab Personnel
Patients
Patients & Doctors
DEFINE
Analysis Instruments
Computers &
Printers
Syringes, Alcohol,
Cotton Swabs
Phones, Answering
Machine
Medical Waste Bins
Patient Scheduling
and Log-in
Blood Draws,
Specimen Vials
27
DEFINE
28
DEFINE
29
DEFINE
30
DEFINE
MEASURE
31
Note: scoring scale using 3, 5, 7, and 9.
Rating of Importance to
Customer →5 7 9 9 3 3
Process Outputs (Effects) → 1 2 3 4 5 6
Process Inputs (Causes) ↓ Next
day s
chedule
Confirm
tT
est
/ P
ull
patient
chart
Blo
od d
raw
Testing r
eport
Lab c
leaned f
or
next
patient
Lab r
e-s
tocked a
nd
pre
pped f
or
next
day
Total
Receptionist duties 9 9 3 7 7 9 2463 Different lab processes 7 3 7 5 7 7 206Receptionist's skill set & education 5 7 3 3 5 5 158Patient demographics 3 3 5 3 3 3 126Laboratory layout 3 3 3 3 3 3 108
Tri-Core Cause & Effect Matrix
32
MEASURE
RPN Scoring used for PFMEA
Example of a scoring scale using 1, 3, 6, and 9.
Designed to achieve a greater spread when rating severity, occurrences
and detection categories of a Failure Modes & Effects Analysis.
Rating Severity of Effect Likelihood of Occurrence Ability to Detect
9 Hazardous defect noticed by all customers Failure is inevitable Can not detect
6 Major defect noticed by most customers Frequent failures Moderate chance of detection
3 Minor defect noticed by some customers Relatively few failures High chance of detection
1 No effect Failure is unlikely Certain detection
33
MEASURE
34
Labs (level 1 & 2 blood draws) Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Process
Lab 1 1100 1100 1100 1100 1100 1100 1100 1100 1100 1100 1100 1100 B
Lab 2 900 900 900 900 900 900 900 900 900 900 900 900 A
Lab 3 910 910 910 910 910 910 910 910 910 910 910 910 A
Lab 4 800 800 800 800 800 800 800 800 800 800 800 800 A
Lab 5 1200 1200 1200 1200 1200 1200 1200 1200 1200 1200 1200 1200 C
Lab 6 1114 1114 1114 1114 1114 1114 1114 1114 1114 1114 1114 1114 B
Lab 7 900 900 900 900 900 900 900 900 900 900 900 900 A
Lab 8 880 880 880 880 880 880 880 880 880 880 880 880 A
Lab 9 799 799 799 799 799 799 799 799 799 799 799 799 A
Lab 10 1008 1008 1008 1008 1008 1008 1008 1008 1008 1008 1008 1008 B
Lab 11 1109 1109 1109 1109 1109 1109 1109 1109 1109 1109 1109 1109 B
Lab 12 1089 1089 1089 1089 1089 1089 1089 1089 1089 1089 1089 1089 B
HISTORICAL DATA (YEAR 2010)
MEASURE
35
Labs (level 1 & 2 blood draws) Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Averages
Lab 5 1188 1200 1209 1204 1210 1200 1196 1212 1206 1194 1190 1191 1200
Lab 8 890 882 880 882 882 870 876 880 885 878 880 875 880
Lab 12 1089 1088 1089 1087 1088 1089 1089 1091 1091 1089 1089 1089 1089
Weekly
data Lab 5 Lab 8 Lab 12 Lab 5 Lab 8 Lab 12 Lab 5 Lab 8 Lab 12
Week 1 308 221 299 308 217 287 328 223 297
Week 2 289 216 260 296 223 266 292 221 260
Week 3 311 227 251 293 225 260 280 226 254
Week 4 302 218 278 309 220 278 290 210 278
Total 1210 882 1088 1206 885 1091 1190 880 1089
ACTUALS SAMPLE DATA (Count is based on sign-in sheets for 2010)
WEEKLY DATA
NovSeptMay
MEASURE
36
Process A Process B Process C
Blood Draw Differences 864 1084 1200
0
200
400
600
800
1000
1200
1400
Ave
rag
e N
um
be
r o
f B
loo
d D
raw
s p
er
Mo
nth
Blood Draw Differences
MEASURE
PERFORMANCE STANDARDS
The specification:
Taking into account the initial data received from the
management of Tri-Core Medical Laboratories, we have
the following:
50% Level 1 tests/lab (20 min/test) ;
30% Level 2 tests/lab (30 min/test);
20% Level 3 tests/lab (20 min/test).
The specification against every improvement will be
compared was calculated at the following value: USL= 23
min/test (for this process there is no LSL).
37
MEASURE
MSA – GAGE R & R
Discrete (Attribute) Data:
The Actual Sample Data, from Tri-Core Medical Laboratories
will be used to perform the Gage R&R (Attribute Agreement
Analysis); only a minimum score of 80 % is acceptable.
The initial set-up conditions:
3 appraisers used (Receptionist, Lab tech 1, Lab tech 2);
3 trials were performed;
36 items were inspected: the monthly data for the Lab 5
Lab 8, and Lab 12 (counting the patients);
2 standards accepted : “Good” (patient have the test);
“Bad”(patient miss the test).
38
MEASURE
39
MEASURE
40
Lab tech 2Lab tech 1Receptionist
100
80
60
40
20
0
Appraiser
Pe
rce
nt
95.0% C I
Percent
Lab tech 2Lab tech 1Receptionist
100
80
60
40
20
0
Appraiser
Pe
rce
nt
95.0% C I
Percent
Date of study: 09/03/2011
Reported by: Radu Muresan
Name of product: Blood draw process
Misc: TRI-CORE Medical Laboratories
Assessment Agreement
Within Appraisers Appraiser vs Standard
MEASURE
MSA – GAGE R & R
Conclusions:
The minimum score of 80 % is acceptable, after performing the
analysis we obtained a score of 92.02 % , and a Kappa
coefficient of 1 (minimum acceptable is 0.9).
The Gage R&R was successful, therefore we can trust and
use with confidence the historical data from Tri-Core Medical
Laboratories.
41
MEASURE
PROCESS CAPABILITY (BASELINE)
The initial data:
For each laboratory there are employed 3 people:
Receptionist, Lab tech 1, Lab tech 2.
Working schedule is: 6 days / week, with 1 shift of 10
hours / day (1 hour for lunch time, and 2 breaks of 15
minutes / day are allowed).
The effective time of work: 8.5 hours / day / employee,
25.5 hours / day / lab, 1530 minutes / day / lab.
42
MEASURE
PROCESS CAPABILITY
43
Lab Type of Draws / Max. expected Actual Missing DPMO Current
number process month draws / day draws / day opportunities / lab / day per lab σ level
L 1 B 1100 66.5 45.8 20.7 311,278.2 1.992
L 2 A 900 66.5 37.5 29.0 436,090.2 1.661
L 3 A 910 66.5 37.9 28.6 430,075.1 1.676
L 4 A 800 66.5 33.3 33.2 499,248.1 1.502
L 5 C 1200 66.5 50.0 16.5 248,120.3 2.180
L 6 B 1114 66.5 46.4 20.1 302,255.6 2.018
L 7 A 900 66.5 37.5 29.0 436,090.2 1.661
L 8 A 880 66.5 36.6 29.9 449,624.0 1.627
L 9 A 799 66.5 33.2 33.3 500,751.8 1.498
L 10 B 1008 66.5 42.0 24.5 368,421.0 1.836
L 11 B 1109 66.5 46.2 20.3 305,263.1 2.009
L 12 B 1089 66.5 45.3 21.2 318,796.9 1.971
MEASURE
44
MEASURE
COST OF POOR QUALITY (COPQ)
45
Lab Type of Draws / Max. expected Actual Missing Avg. value COPQ
number process month draws / day draws / day opportunities / lab / day per test [ $ ] [ $ / month ]
L 1 B 1100 66.5 45.8 20.7 200 99,360
L 2 A 900 66.5 37.5 29.0 200 139,200
L 3 A 910 66.5 37.9 28.6 200 137,280
L 4 A 800 66.5 33.3 33.2 200 159,360
L 5 C 1200 66.5 50.0 16.5 200 79,200
L 6 B 1114 66.5 46.4 20.1 200 96,480
L 7 A 900 66.5 37.5 29.0 200 139,200
L 8 A 880 66.5 36.6 29.9 200 143,520
L 9 A 799 66.5 33.2 33.3 200 159,840
L 10 B 1008 66.5 42.0 24.5 200 117,600
L 11 B 1109 66.5 46.2 20.3 200 97,440
L 12 B 1089 66.5 45.3 21.2 200 101,760
MEASURE
46
MEASURE
ANALYZE
47
SAMPLING PLAN
48
WEEKLY DATA
Weekly May Sept Nov
data Lab 5 Lab 8 Lab 12 Lab 5 Lab 8 Lab 12 Lab 5 Lab 8 Lab 12
Week 1 308 221 299 308 217 287 328 223 297
Week 2 289 216 260 296 223 266 292 221 260
Week 3 311 227 251 293 225 260 280 226 254
Week 4 302 218 278 309 220 278 290 210 278
Total 1210 882 1088 1206 885 1091 1190 880 1089
ANALYZE
POTENTIAL “X” MATRIX
49
Key process inputs (X's) Origin Appropriate Result Is input vital ?
test / analysis (Yes / No)
X1 Receptionist duties Fishbone Chart FMEA RPN=729 Yes
X2 Three different lab processes Process Map 2 Sample t-test p-value = 0.0 Yes
X3 Patient scheduling C&E Matrix FMEA RPN=324 Yes
X4 Receptionist's skills set & education Fishbone Chart FMEA RPN=108 Yes
X5 Laboratory layout C&E Matrix FMEA RPN=54 No
X6 Patient demographics Historical Data FMEA RPN=9 No
ANALYZE
50
ANALYZE
51
ANALYZE
HYPOTHESIS TESTING
2 Sample t-Test and CI: Lab 8 - Process “A”, Lab 12 - Process “B”
The 2 sample t-test for Lab 8 - Process A vs. Lab 12 - Process B results:
N Mean St.Dev SE Mean
Lab 8 - Process A 12 880.00 5.06 1.5
Lab 12 - Process B 12 1089.00 1.13 0.33
Difference = µ (Lab 8 - Process A) - µ (Lab 12 - Process B)
Estimate for difference: -209.00
95% CI for difference: (-212.26, -205.74)
H0: µ 1 - µ 2 = δ0 versus H1: µ 1 - µ 2 ≠ δ0
t-test of difference = 0 (vs. not =): T-Value = -139.57 P-Value = 0.000 DF = 12
Power of the test: 1-β = 0.854
Conclusions:
The p-value=0.00 risk=0.05 , the null hypothesis H0 is rejected in favor of the alternative hypothesis H1 . The mean of data from process type A is statistically different from the mean of data from process type B.
52
ANALYZE
HYPOTHESIS TESTING
53
ANALYZE
HYPOTHESIS TESTING
54
Lab 12 - Process BLab 8 - Process A
1100
1050
1000
950
900
Dat
a
Boxplot of Lab 8 - Process A, Lab 12 - Process B
ANALYZE
IMPROVE
55
56
In Symbols In Words
HO D5=D8=D12 The differences in Blood Draw processes does not increase blood draws.
HA Not Ho The differences in Blood Draw processes does increase blood draws.
D=Blood Draws from labs 5, 8, & 12
ACTUAL SAMPLE DATA:
LAB 5: Number of items= 12
1188. 1190. 1191. 1194. 1196. 1200. 1200. 1204. 1206. 1209. 1210. 1212.
Mean = 1200
95% confidence interval for Mean: 1197. thru 1203.
Standard Deviation = 8.28
Hi = 1212 Low = 1188
Median = 1200
Average Absolute Deviation from Median = 6.83
LAB 8: Number of items= 12
870. 875. 876. 878. 880. 880. 880. 882. 882. 882. 885. 890.
Mean = 880.
95% confidence interval for Mean: 876.7 thru 883.3
Standard Deviation = 5.06
Hi = 890. Low = 870.
Median = 880.
Average Absolute Deviation from Median = 3.50
ANOVA ANALYSIS
IMPROVE
57
LAB 12: Number of items= 12
1087. 1088. 1088. 1089. 1089. 1089. 1089. 1089. 1089. 1089. 1091. 1091.
Mean= 1089
95% confidence interval for Mean: 1086. thru 1092.
Standard Deviation = 1.13
Hi = 1091 Low = 1087
Median = 1089
Average Absolute Deviation from Median = 0.667
ANOVA RESULTS:
Source of Sum of d.f. Mean F
Variation Squares Squares
between 633,610 2 316,800 9957.
within 1050. 33 31.82
total 634,660 35
The probability of this result, assuming the null hypothesis (Ho), p is = 0.000
The Decision:
Since Fobs (9957) is > Fcrit (3.29) [p=0], reject Ho and conclude that the differences
in blood draw processes does increase total blood draw throughput.
ANOVA ANALYSIS
IMPROVE
58
ANOVA ANALYSIS
IMPROVE
59
ANOVA ANALYSIS
IMPROVE
60
MEASUREMENT SYSTEM ANALYSIS (MSA)
Purpose:
Ensure that the difference in the Laboratory data is due to
actual differences in what is being measured, and not
variation in the measurement methods.
Conclusions:
The number of blood draws completed is calculated based
on actual Lab study results;
High level observed data was verified against detailed
weekly Lab output studies;
No significant difference was observed between weekly detail
data and monthly high level data;
Monthly high level data accurately represents output of the
Labs.
IMPROVE
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PROCESS CAPABILITY
Tests
Opportunities
per test
Total
Opportunities Defects DPO DPMO P(good) Z long term Z short term Ppk Cpk
11,809 1 11,809 259.1 0.0219 21,941 0.9781 2.015 3.515 0.672 1.172
Tests
Opportunities
per test
Total
Opportunities Defects DPO DPMO P(good) Z long term Z short term Ppk Cpk
11,809 1 11,809 2,591 0.2194 219,409 0.7806 0.774 2.274 0.258 0.758
Tests
Opportunities
per test
Total
Opportunities Defects DPO DPMO P(good) Z long term Z short term Ppk Cpk
11,809 1 11,809 1295,5 0.1097 109,704 0.8903 1.228 2.728 0.409 0.909
The baseline:
The 50% improvement:
The 90% improvement:
IMPROVE
Potential Cause(s) Occurrence Recommended Action(s)
Receptionist training has not been
standardized across all labs
9 Observe & document duties for
receptionist in Lab 5 and cross train in the
other 11 labs
Applicant pool for receptionist
position varies
6 Raise the minimum required education
level
Receptionist never advised to
increase patient numbers
6 All lab personnel need to strive for 50
blood draws/day
No consistent company employee
established process/procedures
6 Tri-Core Medical Employee handbooks
need to be developed incorporating
enhanced redeptionist duties &
responsibilities
Commercial space availability &
cost/sq. ft.
3 Make sure all labs have a pleasing
environment and are wheel chair
accessible
Labs located closer to Senior
Centers and Assisted Living
facilities
1 Consider a mobile lab to help older
patients in specific areas of need
Modified FMEA
62
IMPROVE
CONTROL
PROCESS CONTROL:
1. Maintain two-week control charts for each lab,
and use 50 blood draws/day as a lower spec.
2. Have Monday morning meetings with all lab
personnel to discuss previous weeks results.
Make necessary improvements as needed.
3. Update employee handbooks for current policies
and procedures.
4. Hold quarterly Kaizen events to discuss overall
progress and identify other areas of
improvement.
63
Example Control Chart:
64
1 2 3 4 5 6 7 8 9 10 11 12
Daily Completed Blood Draws 45 48 41 43 37 49 42 48 39 41 45 50
Level 1 Tests 23 24 21 22 19 25 21 24 20 21 23 25
Level 2 Tests 14 14 12 13 11 15 13 14 12 12 14 15
Level 3 Tests 9 10 8 9 7 10 8 10 8 8 9 10
0
10
20
30
40
50
60
70
Dail
y B
loo
d D
raw
s
2-Week Laboratory Control Chart
Theoretical Maximum Lab 5 Performance
Current 11 Labs Performance
DAYS
CONTROL
65
CONTROL PLAN
Process Process Input Output Process Cpk / Measurement % R&R Control Who ? Where ? When ? Reaction
step specification Ppk system method plan
Blood Pre-24 hour Appointment list / Next day's schedule / N/A N/A Visual check N/A Self - Receptionist Schedule Beginning Check
draw advance call Voice mails/E-mails / Wait list / checking list of each per SOP
process to patient Active phone line Reschedule patients day reference
Blood Patient arrival Sign-in lab forms / Confirm test / N/A N/A Visual check N/A Self - Receptionist Patient After Check
draw and check-in ID card (document) / Pull patient chart / checking chart every per SOP
process Med. insurance card Patient prepared sign-in reference
Blood Blood draw 2nd ID verification / Label specimen vials LSL = N/A Cpk=0.5 Syringes, vials, 92.02% Counting Lab Patient After Check
draw completion Triage patient Patient released / USL = 66.5 Ppk=0 test strips technician 1 chart every per SOP
process (weight, general info) Specimens submitted [ draws / day ] draw reference
Blood Blood sample Labeled specimen Specimens grouped, LSL = N/A Cpk=0.5 Microscopes, 92.02% Counting Lab Testing After Check
draw analysis and vials with blood processed, recorded / USL = 66.5 Ppk=0 analysis technician 2 report every per SOP
process processing sample Testing reports out [ draws / day ] instruments recording reference
Blood Lab area Remove the Notify receptionist / N/A N/A Visual check N/A Self - Lab The lab End of Check
draw prepared for medical waste bins / Next patient charts / checking technician 1 area each per SOP
process next patient Prepare instruments Patient prepared and 2 test reference
Blood Next day's lab Dirty lab rooms / Cleaned-up lab / N/A N/A Visual check N/A Self - Receptionist The lab End of Check
draw preparation Empty bins without Replenish the bins / checking and Lab area each per SOP
process medical supplies New appointments technicians day reference
CONTROL
66
CONTROL
67
CONTROL
68
1. Print patient schedule / appointment list.
2. Clear voice mails from last evening.
3. Remove forwarding to emergency line.
4. Pull patient charts.
5. Confirm appointments for following day (call to confirm date and
time, re-schedule cancellation, start waiting list, update daily
schedule with wait listed patient confirmed).
6. Check-in patients (sign-in, confirm test, insurance card update).
7. Triage patient (weight, general information of visit).
8. Take sample (when possible).
9. Perform test (when possible).
10. Patient release (payment, next schedule, work / school excuse).
11. Clean lab rooms.
12. Call next patient for lab work.
13. Create tomorrow lab work (patient schedule / appointment list).
Receptionist’s Work Instruction:
CONTROL
