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Quality Update - Committing to a Fix

Fall 2009

Committing to a Fix

Date: October 15, 2009

Trained in Lean Sigma at Johns Hopkins, an Ohio hospital gets fast results.

Melanie Lemos
Cytogenetic technologist Melanie Lemos retrieves tissue cultures from an incubator at Akron Children’s Hospital. The lab standardized how long cultures must be maintained, decreasing the staff time required to sustain them.

In the cytogenetics laboratory at Akron Children’s Hospital, overtime was a given. Technologists saw their workload mount as the Ohio medical center rapidly expanded, and they had to race to meet regulatory deadlines for producing results. In one year, the overtime tally for the lab’s 11-member staff reached $116,000.

Those costs weren’t the only concern. Knowing that the wait for genetic test results can be a highly anxious time for parents and future parents, the lab wanted to do better than meet the maximum turnaround times dictated by regulatory agencies, such as 28 days for blood analyses. But simply expanding the lab wasn’t the answer.

“We couldn’t solve it just by adding staff,” says Trauda Gilbert, a project leader with the Center for Operations Excellence at Akron Children’s. “We really needed to improve the process.” That was one of the lessons she took home from Lean Sigma Prescription for Healthcare, an intensive course offered by Johns Hopkins’ Center for Innovation in Quality Patient Care.

Combining two process-improvement tools pioneered in the manufacturing sector, Lean Sigma has proven a powerful strategy for helping health care teams to fix flawed and broken systems. Lean methods attack waste while Six Sigma identifies sources of defects and reduces variability.

The lab’s project is among several initiated by the Akron hospital’s Center for Operations Excellence. The center opened in October, but staff members wasted no time after completing the Johns Hopkins program the previous May. They began tackling chronic delays and inconsistencies, from the MRI scheduling office to the outpatient pharmacy.

Results came quickly. In their most ambitious project, the sterile processing department averted a proposed $3.5-million expansion by reconfiguring its layout and work processes.

“It’s a success story,” says Laura Winner, the Center for Innovation’s Lean Sigma director, about Akron Children’s commitment to honing its operations. “They’ve exceeded what we hoped would happen.” She still coaches the hospital’s staff by phone.  

Mark Watson, chief operating officer of Akron Children’s, says the Lean Sigma training will help the hospital to maintain its patient-centered approach amidst growing demand. “Over the past five to 10 years we’ve seen increased growth in inpatient stays, patient acuity continues to rise, and there’s more demand for ambulatory services. As you’re running to catch up with those trends, you don’t always do the best job of putting efficient processes in place.”

So far, 18 employees have participated in Hopkins’ Lean Sigma program, and Watson expects several more to go. “You can’t send two or three people to training and expect them to put together a program,” he says.

With Lean Sigma graduate LuAnn Sadowski, Gilbert sat down with the cytogenetics staff to find a fix for the overtime woes. Lean Sigma “teaches you to identify the key factors that are causing your problems and determine which ones you are going to tackle,” Gilbert says. “It’s a very structured way of going through a problem.”

Over four months, the group uncovered “layers of waste” contributing to the overtime glut. For example, employees lost time from detouring around stacks of files accumulating since the 1960s, or when they repeatedly crossed the room to retrieve labels from the only machine capable of printing them. “Those seconds add up,” says Sadowski, the hospital’s assistant administrative laboratory director.

The group’s solutions were often simple but significant. The files were whisked to storage. The label printer was moved next to the technologists’ work station.

Waste also surfaced when employees analyzed lab procedures, where they found variations in practice. For instance, when conducting genetic tests, some technologists dropped cells on four slides while others used six or more. The lab Lean Sigma team deemed the extra slides to be a waste of time; lab leadership agreed and four slides became standard.  

The payoff? Weekly paid overtime hours plummeted from 55.4 to 9.1. The unit is on track to save about $93,000 this year. And lab results are going out faster than ever.

Gilbert hopes that such success stories will permeate the hospital. “The techniques we learned at Hopkins work anywhere,” she says.