Powerpoint template for scientific posters (Swarthmore College)

1
Effective Use of Process Analysis and Lean
Principles to Improve Processes within the
Gynecologic Cytopathology Testing Cycle
Kent Becker, Jeanne Myers, Cheryl Lown, Tanika
Moreland, Rose Meyer, Chad HoffmanAnatomic
Pathology, Department of Pathology, University of
Iowa Hospitals and Clinics, Iowa City, Iowa 52242
Results

• Methods (cont.)
• Investigation and measurements of specimens held
  in waiting because accessioning workstations
  could not accession concurrently.
• Defined the customers of these processes and
  identified their requirements.
• Phase 3 Process redesign and trials.
• The team collectively developed first-cut
  redesigns of the process maps.
• The information assembled during Phase 2 was
  crucial in developing proposed process changes.
• The diverse experience and collective expertise
  of the project team members facilitated a rapid
  feasibility assessment of proposed changes.
• The redesigned processes were trialed for
  feasibility.
• Some minor adjustments were necessary to make the
  redesigned processes operationally feasible, but
  the Lean principles driving the changes remained.
• Phase 4 Implementation of redesign.

Abstract Staff members of the Department of
Pathology, University of Iowa Hospitals and
Clinics set forth to redesign and improve the
pre-analytical and post-analytical process phases
of the gynecologic cytopathology testing cycle
through the utilization of process analysis tools
and the application of Lean methodology. The
project team developed detailed process maps and
why-why tree diagrams of the reasoning for
certain steps or constraints within the current
process. These process analysis tools
effectively served to establish a common
understanding of the current process. The team
was then able to thoroughly assess the current
process for deviations from Lean principles and
identified various sources of waste and process
defects. Process redesigns were drafted and
trialed for feasibility prior to implementation.
The redesigns effectively reduced the total
number of steps within these processes by 40
versus the number of steps being performed at
project inception. The redesigns applied to
gynecologic specimen receipt and accessioning
processes 1) effectively transformed the process
from a batch-and-queue workflow to single piece
flow, 2) eliminated a significant process
constraint, and 3) provided a systematic means
for reducing specimen labeling errors. The
teams assessments also identified inefficiencies
in billing processes that were eliminated by
process redesign. Overall, the teams
improvement project demonstrated that a
process-focused analysis governed by the
application of Lean principles can effectively
improve laboratory operations, reduce the
potential for error, and identify many other
opportunities for improvements in tangential
processes.

• Methods (cont.)
• Phase 2 As-is process analysis and
  measurements.
• Process mapping the current processes. (Figures
  1a,b 2).
• Process maps were developed by directly observing
  the primary operators performing the current
  processes.
• The process maps established a baseline
  representation and facilitated a common
  understanding of the current state.

Table 1 Measurement of the wait effect.
Cytopathology could not begin accessioning
specimens until outreach had completed their
specimens.
Chart 1 Breakdown of a sampling of specimen
wait times in Outreach. Elapsed time was
measured from time of receipt to time
accessioned. (N49)
Figure 4. Avoid keys that force readers to labor
through complicated graphs just label all the
lines (or bars) and then delete the silly key
altogether (as above). The above figure would
also be greatly improved if I had the ability to
draw mini rats with and without brains. I would
then put these really cute little illustrations
next to the lines they represent.
Figures 1a,b As-is process maps under
development. Figure 1a was the labs
pre-accessioning process Figure 1b was the
accessioning process. These process maps were
initially constructed using a combination of
self-stick notes, whiteboards, poster paper, etc.
These materials made it easy to edit the details
and reconfigure the process steps during
construction.

• Background
• The Cytopathology Laboratory receives and
  accessions roughly 18,000 gynecologic cytology
  specimens annually.
• A lack of a consensus understanding of the
  current workflows and the relevant history that
  lead to the current state created frustrations.
  Consequently, it was difficult to manage this
  area.
• Ultimately, management decided the pre and post
  analytical workflows of this laboratory were
  prime candidates for a formalized process
  improvement project.

Figure 2 Process map of the as-is
pre-accessioning process (Figure 1a) once
translated into a Visio diagram (Microsoft,
Redmond, WA). This process map detailed the
steps involved in specimen receipt, unpackaging,
assessment and batching steps occurring before
a subsequent acccessioning process. Process
mapping proved to be a key tool as it facilitated
a consensus understanding and a thorough
assessment of the as-is process.

• Conclusions
• A process-focused, employee-involved approach to
  operational management can effectively identify
  and address problems and inefficiencies within a
  laboratorys workflows.
• Process analysis tools facilitate a thorough
  analysis and a mutual understanding of the
  laboratorys existing processes. The information
  yielded by the use of these tools is key to the
  teams success in objectively assessing the
  current state for opportunities for improvement.
• Application of Lean principles effectively
  reduced waste within the laboratorys processes
  and is proof that manufacturing-based quality
  improvement methods can be used to effectively
  improve operational efficiency and effectiveness.
• These process changes have yielded opportunities
  for improvements in related processes. The staff
  involved in this project have produced
  recommendations for other process improvements in
  other laboratories and work areas. Improvement
  projects such as this one create momentum for
  continuous improvements throughout the
  laboratory.

• Results
• Pre-accessioning process after redesign
• Process for pre-analytical technical billing
  entry
• Process for post-analytical professional billing

• Objectives
• Utilize a team approach and process analysis
  tools to thoroughly investigate the current state
  of the laboratorys pre-analytical and
  post-analytical workflows create a consensus
  understanding of these workflows.
• Assess the current state for whether these
  processes adhere to Lean principles identify
  opportunities for process improvements.
• Streamline the existing processes by removing
  non-value added process steps, by standardizing
  the workflows, and by reducing opportunities for
  error.

Figure 5 The final version of the
pre-accessioning process map after process
redesign and feasibility trial. For comparison,
Figure 2 is the corresponding before map.
Redesign removed 8 decision steps and 32 action
steps reductions of 73 and 86 respectively.
Figure 3 Example of a 5-whys tree-diagram
developed during the analysis of the as-is
pre-accessing process map (represented in Figure
2). This tool helped the project team to
understand the rationale behind certain aspects
of the current process in this case, why the
work was batch accessioned and why worklists were
being produced at accessioning. It also served
to remind the team of key issues to consider when
proposing process changes.

• Methods
• Phase 1 Getting started.
• Meeting with management.
• Defined scope and established project objectives.
• Formation of the process improvement project
  team
• Quality assurance representative and division
  manager serving as co-project facilitators
  primary operators within the specimen receipt,
  accessioning, and preparation areas a
  cytotechnologist a financial manager.
• Communication of the team charter to the team
  members.
• Outlined the project objectives and scope.
• Provided the team with a basic introduction to
  process analysis, process redesign, and Lean
  principles.

After 1 decision step Select
from 2 billing codes
Before 4 decision steps
Select from 5 billing codes

• References
• Madison, D. Process Mapping, Process Improvement,
  and Process Management A Practical Guide to
  Enhancing Work and Information Flow. Chico, CA
  Paton Press LLC 2005.
• Liker JK. The Toyota Way 14 Management
  Principles from the Worlds Greatest
  Manufacturer. New York, NY McGraw-Hill 2004
• Persoon TJ, Zaleski M, Cohen M. Improving pap
  test turnaround time using external benchmark
  data and engineering process improvement tools.
  Anatomic Am J Clin Pathol. 2002 118527-533.
• Zarbo RJ, DAngelo R. Transforming to a quality
  culture the Henry Ford Production System. Am J
  Clin Pathol. 2006126(suppl 1)S21-29.
• Contact Information kent-becker_at_uiowa.edu

Before 7 decision steps 5 different billing
codes.
After 2 decision steps 2 different billing
codes.
Figure 4 Examples of some of the steps and
decision trees found in the as-is process maps.
Each step (or a combination of steps) of the
as-is process map could be evaluated for
deviation from Lean principles.