103 - Lean Methodology to Standardize Laboratory Workflows and Improve the Working Environment in the Microbiology Lab

Health Care Problem
A root cause analysis (RCA) was performed in the microbiology lab as a result of incorrect specimen labeling, attribution of results and incorrect incubation time of a specimen. This error resulted in a patient safety incident. Investigation revealed specimen processing is complex, requires multitasking in a dynamic working environment and is subject to individual variability.

Educational Strategy
A diverse team of laboratory staff began meeting weekly in July of 2016. By using extensive process mapping, waste identification, root cause analysis and KAPS (Keeping All People Safe) data, the team was able to identify the need to decrease excessive motion in the accessioning area of the lab as well as specific workflows to be standardized. The team studied the current working environment of the accessioning area of the lab, and developed current and future state illustrations using spaghetti diagrams to document placement of workstations and equipment before items were relocated. Data was gathered before and after moving workstations and equipment to measure the impact on motion in the accessioning area of the lab. The team also identified variability in laboratory workflows, and came to consensus for standardizing culture reading workflows.

Patient-Level Outcome(s) Measured
The goals of our improvement efforts were achieved through increased reliability of positive healthcare outcomes. We achieved this by decreasing footsteps to navigate the working environment in order to accession a body fluid specimen by 30% from 92 steps to 64 steps, and by reducing the average sample processing time for a body fluid specimen by 12.5% from 24 minutes to 19 minutes. Further analysis revealed the average time reduction was attributed to random variation when the data was plotted on a control chart. Standardized workflows for reading urine, blood, body fluid, stool and wound cultures will be implemented on April 3, 2017.

Eric W. Branning

Enterprise Improvement Advisor, Office of Safety and Medical Operations
Children's Hospital of Philadelphia
Philadelphia, Pennsylvania

Eric W. Branning is currently an Enterprise Improvement Advisor. He has 4 years of healthcare experience which includes change management, internal healthcare consulting, process re-engineering, quality improvement, and systems implementation. Eric is Lean Six Sigma Green Belt certified and a MBA candidate at Temple University's Fox School of Business in Philadelphia, PA. He has a BA and MA from Rutgers, the State University of New Jersey in Psychology.

Edward J. Hopkins is currently an Enterprise Improvement Analyst II. He has 4 years of healthcare experience which includes change management, internal healthcare consulting, process re-engineering, quality improvement, and systems implementation. Ed is Lean Six Sigma Green Belt certified from Rutgers, the State University of New Jersey. He has a BS in Biology from Muhlenberg College in Allentown, PA.

Michael Anne Kell

Senior Enterprise Improvement Advisor, Office of Safety and Medical Operations
Children's Hospital of Philadelphia
Philadelphia, Pennsylvania

Michael Anne is currently a Sr Enterprise Improvement Advisor. She has 17 years of healthcare experience which includes change management consulting, outpatient practice management, process/quality improvement implementation using a variety of methodologies, and clinical nutrition counseling and education. Michael Anne is Lean Six Sigma Green Belt certified, and has a Master’s degree in Healthcare Administration from the University of Alabama at Birmingham.