cytogeneticists in disguise lucy platts ne london regional cytogenetics laboratory great ormond...
TRANSCRIPT
CYTOGENETICISTS IN DISGUISE
Lucy PlattsNE London Regional Cytogenetics Laboratory
Great Ormond Street HospitalACC Spring Conference 2008
31st March to 2nd April Liverpool
Content of presentation
• Importance of booking in and problems
• GOS 2010
• Management concepts
• Outcomes
• Lessons learnt
Importance of booking in• Booking in a key stage affecting patient care
• Increasing complexity
• If booking in is wrong, everything else tends to go wrong!
Problems recognised
• Confusing, stressful, time consuming
• Time pressure, unpredictable
• Need to:-o eliminate failure to test incidentso reduce corrections at report authorisationo increase role clarity
• Transformation project, as part of GOS 2010
GOS 2010
• more efficient by focusing on quality
• GOS 2010 aims to:-o Make things better for patients while improving
financial positiono Make world-class and pioneering work standardo Encourage staff to work better with each other
transformation no waste-no waits-no harm
•Lab joined this hospital-wide initiative
•New operating system rather than patches
Management concepts
• Pragmatic approach
• Used variety of methodologies and techniques:-
o Lean Six Sigma o Multidisciplinary teamo Process mapping, analysis and redesigno PDSA cycleso 5S system
Multidisciplinary team
• Key to Lean Six sigma
• Team of 9, including 2 section heads, scientists, technologist, secretary, improvement facilitator
• Cover variety of roles
• Would have been helpful to have internal supplier – porter, referring clinician
Process mapping, analysis and redesign
• Process map – understand problems and how complicated process is – overview
• Once have map, need to analyse – number of steps and handovers, problems and complaints
• Then redesign process
Cytogenetics – Complete ‘booking-in’ of blood sample process
FIS
H te
am
lead
erA
naly
stC
heck
Lis
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cien
tist
Sec
reta
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uty
Sci
entis
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Update database with patient
details. Print tube labels
Print ‘send out’ sheet and put in
tray
Repeatedly check ‘booking-in’ office
for card arrival
Telephone to confirm test, if
required
Return cards to ‘booking-in’ office
A
Take copy of micro-array cards
to office
Print rapid FISH test
sheet/label
Check details and countersign FISH test sheet
Countersign FISH test sheet
C
D
Bottleneck
Take copy of micro-array cards
to office
FISH, HoD or HoS book in EDTA and
print DNA extraction sheet
Bottleneck
Cell suspension send out?
N
Print ‘send out’ sheet and put in
trayC
No Value
How it worked for us
• Process mapping was fun
• Demonstrated high level of confusion
• Solve problems – indication codes, samples received in error
• Design ideal system
PDSA cycles
• Can test ideas using PDSA cyclesPlan Do StudyAct
Our use of PDSA cycles
• Found hard to use
• Felt constrained by need for accurate SOP in place at all times
• Weekly changes – gradual adjustments
• Need to measure impact of change
• Problems with time delay for measurement and lack of baseline measurements
5S system
Sort – keep only what is neededSet in order – arrange items so easy to findSweep and shine – clean and tidy working
environment
5S system
Sort – keep only what is neededSet in order – arrange items so easy to findSweep and shine – clean and tidy working environment
Standardise – maintain first 3 S’s
Sustain – continuously improve
• Thorough review of SOP
Sweep and shine!
5S system
SortSet in orderSweep and shineStandardiseSustain
• Thorough review of SOP
• Printing of send out documentation
• Still receive old request cards
• Sustain improvements
Outcomes
• No booking in incidents that led to failure to test
• Reduced number of corrections made at report authorisation
% samples with one or more errors at reporting during baseline period
15%
85%
With Changes
No Changes
% samples with one or more errors at reporting during trial period
8%
92%
With changes
No changes
Outcomes
• No booking in incidents that lead to failure to test• Reduced number of corrections made at report authorisation
• Less role confusion
• Solve problemso Request card handovers reduced from 3 to 1
Cytogenetics – Complete ‘booking-in’ of blood sample process – New
Ch
eck
Lis
t D
uty
S
cie
ntis
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ecr
eta
ryB
loo
d S
ect
ion
H
ea
d/
Te
am
L
ea
de
rD
uty
Sci
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Te
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olo
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t
Unpack sample and card
Record blood volume and date
taken on sticker and attach to the card
Discuss problem case with blood section head or
team leader
Check paperwork and tube details match. Record
differences
Prioritise ‘rapid’ samples
Check database for previous
referral and print listings
Determine tests & tubes required. Complete sticker
Attach/complete appropriate
sticker, e.g. send out storage
AProblem case?
Y
N
Identify samples sent in in error, to be
forwardedB
Outcomes• No booking in incidents that lead to failure to test• Reduced number of corrections made at report authorisation• Less role confusion
• Solve problemso Request card handovers reduced from 3 to 1
o samples to be forwardedo Microarray samples
• Increased lab profile in hospital
Lessons learnt
• Need for constant communication
• Assistance of hospital facilitator
• Knock-on effects of changing one process
• Importance of a multidisciplinary team
• Huge time commitment
Further reading
• www.modern.nhs.uk/improvementguides
• www.institute.nhs.uk‘Going Lean in the NHS’
AcknowledgementsRoger Durack -improvement facilitator Gill HendryAnn Jackson Kamila JagielloRodger PalmerClaire PearceDenise RooneyBev Setterfield
Thanks to Denise Rooney and Mike Tinsley for help with the images