making a positive impact on patient care: a case study of children’s national medical center...

Making a Positive Impact on Patient Care: A Case Study of Children’s National Medical Center Clinical LaboratoryPresented by: Joseph M. Campos, PhD, D(ABMM), F(AAM)Children’s National Medical Center, Washington, DC

Your Presenter Today

• Obtained AB (1968), MA (1970), and PhD (1976) in Bacteriology from the University of California, Berkeley.

Joseph M. Campos, Ph.D.,

D(ABMM), F(AAM)Children’s National Medical Center, Washington, DC

2© 2010 Guidon Performance Solutions, LLC. All rights reserved.

University of California, Berkeley.• Served as Director of the Microbiology Laboratory at both Children’s Hospital of

Philadelphia (1978-1985) and at Children’s National Medical Center (1985-present). He is also Director of the Molecular Diagnostics Laboratory and Director of Laboratory Informatics at Children’s National Medical Center.

• Tenured Professor of Pediatrics, Pathology, and Microbiology/Immunology/Tropical Medicine at George Washington University Medical Center and is board-certified by the American Board of Medical Microbiology.

• Currently is serving his fourth year in the elected position of Secretary of the American Society for Microbiology.

What We’ll Cover Today

• Healthcare and Laboratory Testing Using Lean

• 5 Lean Principles that Apply to the Laboratory

• Case Studies– Microbiology Laboratory Workload and Staffing

DataData

– Microbiology Incoming “Work Cell”

– Automated Culture Plate Inoculation

• Microbiology Testing – Traditional vs. Lean Approach

• Summary


Healthcare and Lean

• Lean principles can be applied to activities that have a defined series of steps during preparation of products

• Healthcare and laboratory testing in particular are ideal targets for Lean

• Presently the waste in the healthcare system of the U.S. alone is monumental amounting to $850

Start

Step 1

Decision Step Y1Yes

is monumental amounting to $850 billion per year

• A Lean overhaul of the hospital laboratory can eliminate wasteful activity and inactivity, reduce costs, improve patient outcomes, and provide for safer healthcare encounters


Step N1

Step 3

Finish

Step Y2

No

Laboratory Testing and Lean

• The main objective of a Lean laboratory reorganization is to deliver the highest quality test results, at the lowest cost, within the shortest time frame, while improving physician/patient satisfaction

• The deliverables of a • The deliverables of a successful Lean laboratory reorganization are: – Improved operational performance

– Standardized processes

– Fewer errors during testing

– Better employee morale

– Increased patient/employee safety


Five Lean Principles that Apply to the Laboratory

1. Value: Strive to increase the value of testing from the physician/patient perspective

2. Value Stream: Define the steps of testing processes and eliminate wasteful activities and inactivities

3. Flow: Make each testing process flow as consistently as process flow as consistently as possible

4. Pull: Maintain a “just-in-time” inventory of supplies

5. Continuous Improvement: Seek perfection by constantly reviewing the steps of the testing processes


Implementation of Lean at CNMC

• Microbiology Laboratory workload and staffing data were pre-submitted to Guidon Performance Solutions

• A 3.5 day laboratory assessment was conducted on-site by Guidon

• The focus was on the blood culture • The focus was on the blood culture and urine culture value streams

• Recommendations were made regarding maximal use of available staff, opportunities for automation, and more efficient utilization of laboratory space


Microbiology Testing – The Traditional Approach

0000 – 1600

New specimens are examined microscopically and inoculated to culture media

Day Zero 1600 – 2400


0800 – 1600

Culture media are examined for growth and identification/antimicrobial susceptibility tests are set up

Day One 0800 – 1600

Culture media are reincubated to allow more time for organisms to grow


0800 – 1600

Identification/antimicrobial susceptibility test results are reviewed and released to the physician

Day Two 0800 – 1600


Day Three 0800 – 1600


Microbiology Testing – The Lean Approach

0000 – 2400


Day Zero

0000 – 2400


16 Hours Later


susceptibility tests are set up

0000 – 2400


18-24 Hours Later

Traditional Versus Lean Microbiology Testing

• In the traditional testing scenario, work is performed when the laboratory staff is ready –organisms wait for the staff to be available on the next day shift

• In the Lean testing scenario, work is performed when the organisms are ready – staff is always available to begin work on available to begin work on positive cultures

• In the traditional testing scenario, final results of positive cultures are available in 40-64 hours

• In the Lean testing scenario, final results of positive cultures are available in 34-40 hours


Other Lean Microbiology Improvements

• Creation of “work cells” to minimize unnecessary movement and motion

• More frequent deliveries of culture media and reagents to lessen inventory storage requirements and deterioration of labile materials

• Automation of mindless repetitive • Automation of mindless repetitive steps to eliminate human error and free up staff for brain-intensive activities

• Use of information technology to standardize culture workups –reducing inefficiency and mistakes


Microbiology Incoming “Work Cell”

• Photo A– Specimen processing hood, continuously monitored

blood culture instruments, and Gram staining sink in the left foreground

• Photo B– Automated culture media inoculator and incubators


(A) (B)

Automated Culture Plate Inoculation

• The goal of a microbiology culture is to furnish well-isolated

Manual ManualAutomated Automated

• The goal of a microbiology culture is to furnish well-isolated colonies for additional testing

• The photos above illustrate how much better the automated culture medium inoculator does than a human

• In this example, identification and antimicrobial susceptibility results would be available at least 18 hours sooner from the media inoculated with the automated instrument


Summary

• While still in progress, the Lean-based reorganization of our Microbiology Laboratory has already eliminated a great deal of wasted time and effort

• The changes to our laboratory are being achieved without increasing our space nor the increasing our space nor the number of our staff

• Most importantly, the clinical utility of our test results are being improved because they are less prone to human error and are available on a more timely basis


Mission Accomplished!

Questions?


Guidon Performance Solutions

Thank YouGuidon Performance Solutions

866-986-4414 or [email protected]

www.GuidonPS.com

© 2008 Guidon Performance Solutions, LLC. All rights reserved. Guidon Performance Solutions is a licensee of LeanSigma®, a service mark of TBM Consulting Group.


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