Improvement in the TAT of laboratory reports using six sigma
methodology
Dr Khalida Parveen Basha N
Lean six sigma black belt
NABL assessor
Certified CAP team lead
DEFINE PHASE
PROJECT NAME
Improvement in the turn around time of laboratory reports
PROBLEM STATEMENT
In the FY 2014-2015 11% of the laboratory reports had TAT
outliers(>240 mins) ) impacting patient clinical care.
GOAL STATEMENT
CONSTRAINTS
Reduce the TAT outlier to < 5 %
- Patient care service/general duty assistant not under direct
control
- No audit trail for transport time from collection to
accession and from accession to the biochemistry
department.
- No audit trail for report dispatch
- HIS not user friendly
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Project objective
Status at the start of the project
Status aimed at the end of the project
(April 2015)
(Nov 2015)
 9.1 % TAT outlier (defects)
 < 5% TAT outlier (defects)
 Test load : 172 tests per day
 To increase the number of tests per day
by 36 tests
 Increase in the financial benefit between
Rs 3960 /day to Rs. 86,400/day
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Scope: All biochemistry reports
Out of bounds:
- IP and outsourced tests
- samples billed before 6AM and after 4PM
- National holidays and Sundays
- Timed samples
- Urine and other fluid samples
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SCHEDULE
Define
Measure
Analyse
Implement
Control
11th May -25th May
2015
Aug 7th- Sept 5th
2015
Oct 1st - 30th Oct
2015
Dr Khalida Parveen
Dr Shabnam Roohi
Nov 2nd- Nov 10th
2015
Dr Khalida Parveen
Dr Shabnam Roohi
4th May 2015
Dr Khalida Parveen
Dr Shabnam Roohi Dr Khalida Parveen
Mr Deepak Agarkhed
PRIMARY CUSTOMER
Dr Khalida Parveen
Patient/Requesting doctors
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MEASURE PHASE
Turn around time from billing to report
verification
TYPE OF MEASURE
DATA COLLECTION
STRATEGY
OUTLIER
-
HIS biochemistry data of two weeks
Sample audit, time and motion study of
two days (Gemba)
TAT more than target time i.e
4 hours (240 minutes)
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PROCESS MAP
Target time from
billing to collection:
10 mins
Billing of the tests
Sample collection
Phlebotomy
Sample transport
Accession
Sample
acknowledgement
Target time from
collection to
acknowledgment:
45 mins
Sample receipt
Biochemistry
Department
Result entry
Target time from
acknowledgment to
verification :
120 mins
Result verification
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Cause and effect diagram (Ishikawa)
Report
delay
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Prioritisation of Xs: Control / Impact Matrix
IMPACT
IN OUR
CONTROL
C
O
N
T
R
O
L
OUT OF
OUR
CONTROL
LOW
MEDIUM
HIGH
- Shortage of staff
- Delay in sample transport
- Sample rejection & follow up
- Delay in sample receipt in the
department
- Equipment breakdown
- Equipment sample process
time
- Wrong billing correction
- Improper information about
the change in the billing
- Improper information about
the samples billed earlier &
collected late
- GDA unavailable
- Bar code alignment issue
- IP sample collections in HIS
without collecting the sample
- Preventive maintenance
- One PCS staff in the 7AM11:30AM shift
-
- Difficult vein
- Patient's queries
- Bar codes not read by the
equipment
- EI worklist delay
- Equipment not interfaced
- All investigations not mapped
- Power failure
- Temperature not maintained
- HIS not working
- No reagent supply
-
- Increased sample load
Tight full sleeves dress
Telephonic queries
Patient queries
Latest billing not reflecting
on the first page
- Pending worklist not
available
Delay from phlebotomists
Inexperienced GDA
Inexperienced PCS
Inexperienced accession
personnel
- Delay from GDA
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HIS data
ANALYSE PHASE
Gemba-time
and motion
study
Target time:10 mins
Source: 1. HIS 2.Gembatime and motion study
Data: Population
Area: Phlebotomy
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HIS data
Gemba-time
and motion
study
Target time: 45 mins
Source: 1. HIS 2.Gembatime and motion study
Data: Population
Area: Accession
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HIS data
Gemba-time
and motion
study
Target time: 120 mins
Source: 1. HIS 2.Gembatime and motion study
Data: Population
Area: Biochemistry
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Improvement strategy
Phlebotomy:
• Non value added steps reduced in the sample collection process
• Takt time analysis done and staff allotted for sample collection during the peak
time and back up provided for sample collection when there are more three
patients waiting
• Two dedicated GDA staff & their back up trained for sample transport and time
management
Accession:
• GDA training for the transport of samples from accession to the biochemistry
department
• Specific time to be allotted for outsource report dispatch
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Improvement strategy
Biochemistry department:
• Pending lists monitored at frequent intervals
• The unresolved IT issues were compensated to some level by the technical staff
suggestions in the brainstorming session: 1. Manual dilution programming for
auto calculation (manual calculation step was skipped) 2. Manual assignment of
the position and rack ID (helped in the reduction of number of steps in the
manual process)
Suggestions that were not implemented Two dedicated staff to be provided covering 7AM-5:30PM
 Target time of the transport time to be revised to 10mins from 45mins as we
have pneumatic chute system for sample transport
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Performance measurement
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Project objective
Status aimed at the end of the project
Achievement at the end of the project
 < 5% TAT outlier (defects)
 4.6 % TAT outlier (defects)
 To increase the number of tests per
day by 36 tests
 Increased the number of tests per day
by 76 tests
 Increase in the financial benefit
between Rs 3960 /day to
Rs. 86,400/day
 Financial benefit achieved between
Rs 8360 /day to Rs. 1,82,400/day
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CONTROL PHASE
For the sustenance of the TAT
• The pending tests list is monitored twice daily at 11 AM and 4 PM by the
biochemistry department to control the TAT of the tests.
• Monthly TAT review in the laboratory quality meeting and quarterly TAT review
by the hospital quality department.
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Conclusion
Lean six sigma methodology has helped in the achievement of the following:
 increasing productivity without any additional resources;
 improving quality by reducing the opportunities for error; and
 ensuring the improvements are maintained through systematic and timely
monitoring.
 The stakeholders have noticed the change and improvement in the turnaround
time of biochemistry reports.
 Staff feel appreciated and motivated as their suggestions has played a vital role
in the success of this project.
 Furthermore, this project has served as a model that launched other quality
improvement programs in the hospital
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