A hospital had implemented total quality management (TQM) to improve customer happiness in its diagnostic clinics. The other issue that was addressed was delay in receiving test reports for patients in the intensive care unit (ICU). The process improvement team went through two-day training and addressed the delays in turnaround time (TAT) by implementing total quality management.Process quality improvement experts at the hospital followed the seven steps of problem solving.
The first step was to define the problem and measure it. The ICU doctors were told to present their preferred TAT for the usual lab tests. The average + 3σ of the delay should be less than 0 for 99.7 percent of the tests to be within preferred levels.
The second step was Root cause analysis of 5 Whys. When it come to TAT problems, the root causes are typically found by mapping the process and identifying all non-value added activities, levels and work on the one hand, and by correcting and batching imbalanced workloads that are holding back workflow on the other.
The third step was to produce countermeasure ideas. The quality improvement project was conducted in two phases, each area of the process:
1. Process steps supporting, but taking place majorly outside the laboratory.
2. Process steps occurring in the laboratory
The fourth step was to test the idea. The now 16-step process was then tested – the team was alerted that samples were to be run without delay at any step during this trial.
The fifth step was to verify the result. After further streamlining the process, the average + 3σ was reduced by another 50 percent, from 106 minutes to 53 minutes. During this process, steps that occurred outside of the laboratory proceeded along with the necessary information technology changes and updated. At the same time, the project team was dealing with what was happening inside of the laboratory to reduce TAT to less than 56 minutes.
At the start of this project, the doctors set a desired time of 20 minutes per test. When the doctors were asked for targets for individual tests, the figures for desired TAT ranged from 5 minutes to 120 minutes. The average delay led to 50 percent completed on time and a maximum delay of 40 minutes per test.
The sixth step was to standardize the results. Team members were given the training to draw the control charts, frequently evaluate performance and remove the causes of any deviation.
The seventh and the last step was quality improvement story. It was prepared and presented to management.