Finding Opportunities For Service Improvements

Published Date: 02 Nov 2017

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Contents

Table of Figures

Part A: Finding opportunities for Service Improvements

The hospital selected for this project is Al Gharbia Hospitals, with 7 branches and the branch understudy is Almirfa Hospital where management has already received a complaint on the number of specimen collections were being repeated due to process error.

The room for improvement exists in Laboratory services, laboratory services are a vital part of any health care organization. Therefore it is very important to have an effective patient assessment and treatment processes to effectively manage the large number of results produce by laboratories in a 24 hour setup. The specimen collected must be labelled, to be able to track them at all times while they are under analysis in the laboratory. Al Gharbia Hospital has a system in place to avoid repeat collections of laboratory samples across all the 7 branches of the Hospital.

Laboratory services are challenging in health services because of the huge numbers of tests involved and on day and night basis. In UAE the workforces are being multiplied by additions of workers from all over the world, which increases pressure on the laboratories to operate 24 hours with loads of specimen to administer and track during the test at the lab.

Room for improvement in Specimen Collection

More specifically the room for improvement in laboratory services exists in collection of samples from patients for tests, the management needs to make sure that none of the laboratory staff makes an error in receiving and then sending it to the laboratory for tests and finally presenting the test results to the patient without any error specially repeat collection.

Specimen collection is a safety issue but at Almirfa Hospital it is considered as an important patient satisfaction issue to make sure the specimen collected were tested properly and the management doesnot have to ask the patient for a second specimen.

Room for improvement in Allotment of resources

The inefficiency in the collection results in loss of staff time, lab time, and physical resources also the blood sample for a second test for the same patient is also an issue. Therefore room for improvement also exists in allotment of resources.

The system must be improved so that the staff do not have to repeat the same task again because of an error in collection of specimen increasing inefficiency in utilizing the resources available at the laboratory.

To make the required improvements the hospital has set its goal for the first quarter of 2012 as follows:

Goal: Performance improvement in Laboratory Service

Therefore the Laboratory Collection services are a major target for improvements for the management. Even after the already in place system for the laboratory specimen collection and analysis there are errors in collection and processing of the specimen.

The already in placed system at the hospital does not have a LIS (Laboratory Information System) due to which the staffs at the laboratory are not able to administer the specimen taken for test. If the specimen taken for test has a barcode and a picture of the patient on the specimen the chances of losing a specimen will reduce to zero. Also the ERM (Electronic Medical Records) data base will enable the staff to access the patient information belonging to a particular specimen at any required time by simply scanning the barcode of the specimen.

Part B – Organising a Team

Organising a team is one of the major challenges to achieve the required improvements. Therefore in a health organization the team must be formed with due diligence and use of all the expertise because any inefficiency arose will have serious human implications. As Almirfa Hospital is dedicated to become the industry leader and also the best customer service provider it is vital for the hospital to have best team operating at the laboratory. To obtain best results after the implementation the team will be trained with respect to their personalities so the new system could produce the desired results. MBIT is been used by managers to effectively lead a team to become an effective team.

Therefore in a health organization it is very vital that the team is effective because only an effective team will be able to work on 24 hour basis and produce the desired results as required by the patients and the doctors. Especially in health organization different health agencies and other government institutions require the health organizations to operate at a required level of standards. Myers-Briggs Type Indicator (MBTI) has been used to identify the personalities of the staff and for the purpose to achieve the required goal as shown in the following table-1 (Stanberry, 2013).

Table - Personality Style and Personal Interactions

Personality Types and Personal Interactions.png

To resolve communication problems the management must be aware of the personality types of all the staff, enabling them to avoid communication problems, in the multicultural work force of UAE communication problems are behind most of the inefficiency reasons in the process.

Challenges to be faced

Some of the challenges faced during improvements in the laboratory collection services of the hospital are:

Conducting MBTI analysis of the staff by filling the questionnaire

Developing a team

Taking stakeholders in confidence

Introducing and conducting MBTI assessment is a process requiring attention to detail and the staff must be made aware of the consequences of not answering the questions properly and tweaking their answers to appear to be a certain sort of a personality (quenk, 2009, p. 31). Therefore in order to make a good team all the available staff must be assessed on the basis of MBTI to achieve required results.

Project Team

Developing effectiveness starts from developing the team responsible for the implementation of the new process. Developing team effectiveness could be achieved by developing individual effectiveness. The team with following section explains the required skills for the tam to implement the new system.

The three levels which must be used informing a team especially in a health institution are classified as primary, secondary and tertiary. The areas requiring attention are issues aroused in high volume and high risk times of operation at the lab. The organizational priorities are also kept at front while selecting the team along with regulatory agencies and the statutory compliance with these agencies. One of the major factors to be competitive in UAE market is to collect competitor data the results of which will also be incorporated in the benchmark strategy for the hospital. Patient and family need expectations are at the core of hospital goal, vision and mission therefore to increase customer satisfaction the new system will remove the complaints from patients and families. Cost effectiveness of resources by introducing an effective system for allotment of resources at the lab is also an important part to improve the services at the laboratory. The selection criteria for the project team are done on the following format as shown in table-2:

Table - Selection Criteria

Selection Criteria

Primary

1. High Volume

2. High Risk

3. Problem prone

Primary Tool

Secondary

4. Organizational Priorities

5. Regulatory agencies

6. Benchmarking data

Secondary Tool

Tertiary

7. Patient and family needs expectations

8. Risk Management

9. Cost-effectiveness or resources required

Tertiary Total

Grand Total

In order to successfully implement the new Cerner System the team must be trained and well equipped to make sure that the system is implemented and produces desired results.

Mix of skills, personalities and styles

According to MBTI the team to implement the new Cerner System must have following personality according to table 1.

INTJ (Most Independent)

INTP (Most Conceptual)

ENTP (Most Inventive)

ENFP (Most Optimistic)

Stakeholders

The higher management of the hospital must be taken in confidence for to successfully update the current systems in order to avoid repeat collection error. The stake holders involved and the values in conflict with respect to the two areas requiring improvement are shown in table 3.

Table - Stakeholders and values in conflict

Values Conflict

Stakeholder(s)

Value in Conflict

Solution

1. Double collection error in specimen collection

Finance

Increases Cost

Implement Cerner System

Regional Medical Officer

Use of human resources

Quality Manager

Inefficiency in operations

2. Allotment of Resources

Medical Director

Loss of staff hours

Staff training and guidance on all policies and regulations

Lab Staff

Fatigue retest of the same sample

Biomedical Engineer

Loss of labour hours

Physicians and Patients

Problems in customer services

The area of improvement for removing errors in specimen collection has increased cost value conflict with the Finance Manager, and also for the Regional Medical Officer it is a cause of use of human resources twice for the same job hence increases in efficiency in resources employed. To resolve these issues the Cerner System will be implemented. The Cerner System are proven to streamline administration and also reduces cost while enhancing patient safety (Cerner , n.d.). Cerner System will also provide Laboratory Information System (LIS) which is founded after more than 30 years of research in the laboratory information technology. LIS is equipped to do following:

Verification of Key patient demographics, test results and Quality Controls at all time while the specimen is at the lab for testing.

Processing large quantities of specimen 24 hours without error.

Using Bar Coding, Synoptic Reporting and Image Management to track and detect every specimen at all times.

Providing courier services for the results to be sent to different locations

Compiling EMR (Electronic Medical Records)

The Cerner system is a very comprehensive system which has a LIS which will resolve issues like error in collection by introducing barcodes and pictures of the patients on the specimen.

Part C – Clarifying Current Knowledge

This part will provide information on the current performance of the system which is already in place at the Laboratory of Almirfa Hospital. The following tools were considered to be most efficient in collecting information on the current system.

Most Appropriate Tools

The first tool is the communication with different shareholders and collecting information on the current system.

Communications with Stake holders

The following Table 4 shows the communication method adopted and the influence of each stakeholder in the current system.

Table - Communications with stake holders

Stake holder Group

Influence (H/M/L)

Support (H/M/L)

Relationship

Communication Method

Communication Frequency

Finance

H

H

Professional

Emails

Daily

Regional Medical Officer

M

H

Professional

Meeting

Weekly

Lab Staff

L

H

Doctor Patient

Visits

Daily

Quality Manager

H

H

NA

Records

Daily

Biomedical Engineer

L

H

Doctor Patient

Reports

Daily

Physicians and Patients

L

H

N.A.

Quality Questionnaires

Daily

Stake Matrix

With the help of the following Stake Matrix the obstacles, grumblers, champions and friends were detected.

Stake Matrix 1.png

Figure - Stake Matrix

Figure 1 above shows the obstacles and grumblers to be faced while implementing the new Cerner System and also shows the champions and friends which could be used to apply the new system efficiently.

Training of the staff is a necessary component at a health institution and the new system will incorporate the training of the staff on all the rules, policies and procedures. The error in specimen testing will be removed by the help of the barcode and image of the patient on every specimen.

Current performance

The current performance of the hospital is been very poor with regards to the laboratory operations. The error in collection of samples from patient has serious implications for the hospital and is increasing the complaints and customer dissatisfaction in the patients and their families. The current Mission and Vision of the Al Gharbia Hospital are as follows:

MISSION:

The Laboratory Department at Al Gharbia Hospitals is committed to Al Gharbia Hospitals mission to be a leader in promoting laboratory service within acceptable turnaround time to all patients, staff and the community.

VISION:

The Laboratory Department, through continuous quality improvement measures will provide high standard laboratory services to all patients, and will go towards national recognition and accreditation from certified laboratories and organizations outside the United Arab Emirates.

Therefore the improvement in laboratory services is very necessary for the organization to be in line with the mission and to become the leader of laboratory service provider in UAE. Gathering important benchmarking information is also at the core of the new system, which will update the hospital management with policies and procedures followed by other organization in the industry.

The current system used for processing records at the laboratory of Almirfa Hospital is not using bar codes, due to which there is a room for error in managing the specimen arriving at the lab for test. The Cerner System will also help to achieve the current mission, vision and goal of the Almirfa Hospital.

The vision of the hospital to increase customer satisfaction and acquire accreditations from all the medical institutions in UAE requires the hospital to urgently update the laboratory services in order to reduce customer complaints. For a laboratory customer satisfaction must be at the heart of its operations because if the results produced by the laboratory are not satisfactory the patients will move to other laboratories hence losing business and damaging the good will of Almirfa Hospital.

The results acquired using the most appropriate tools i.e. communications with stake holders and stake matrix imply that the old system has failed to provide an effective laboratory management system (LIS) due to which the complaints in the services of the laboratory have increased and they must be stopped with the help of the introduction of an effective LIS.

LIS will enable the staff to access the patient information by simply scanning the barcode on the specimen. These barcodes will be issued by the system inform of prints which could be pasted on the specimen enabling the staff to track the specimen and access information on the status of a particular specimen when ever requested by the customer.

LIS will also have the delivery system enabling the staff to post any results as requested by the patients and to track the delivery after the results were posted. On implementation of the LIS it will also assist in acquiring accreditations as part of the objectives of the hospital. Electronic database management is also at the heart of a health organization as it assists the doctors and the patients with vital information in tracking health records and status on the records of a particular patient.

The staff will be accessed on MBTI and the training will be planned as per the results of MBTI in order to achieve maximum results of the training. The system in a health organization must have the process of identifying, understanding, applying and recognising problems to make the system efficient. To develop the effectiveness of the team it must start from developing effectiveness on individual level and then moving on to team level, the handling of issues with team members plays an important role in maintaining the motivation level of the team. To make individuals effective all the individuals must be made aware of their responsibilities and the ways they could perform the duties assigned to them efficiently.

Developing skills while working with the team will be at the heart of the training for the staff and informing them about increase in output if working in a team. UAE has a multicultural work force therefore understanding values play an important role in managing a team effectively.

The health policies of the hospital are customer oriented and customer satisfaction is taken as the most important aspect, therefore the patient satisfaction must be at the heart of every strategy made at the hospital. The new system will make the operations customer oriented by introducing centrally accessed ERM database.

Part D – Understanding the Causes of Variation

The following table 5 identify the issues in the current services:

Table - Performance Improvement in Lab Service

Issue

Performance improvement in laboratory service.

0 =No Application

1 = Minimal Application

2 = Weak Application

3 = Moderate Application

4 = Strong Application

5 = Maximum Application

Result delay

Lack Backup analyzer

increased infection rate

Lack safe environment

Lack reagent

Primary

1. High volume

5

4

4

3

2

2. High risk

5

4

5

3

5

3. Problem prone

5

4

5

4

5

Primary Total

15

12

14

10

12

As we can see at the time of high volumes the result delays increase and the probability if result delays is maximum at high volumes, high risk and high problem prone.

The Cause and Effect Diagram:

Using the cause and effect diagram also known as fish bone diagram, which was adopted by Dr. Deming and is been a great tool to quickly help identify all possible causes of Labour error, improving which can lead to a better implementation of solutions (Dr. Deming, 1900-1993).

ENVIRONMENT

METHODS

EQUIPMENT

Small space

No system (Cerner)

Lack of safe environment

Lack of commitment

Low quality service at lab

Policy and procedure

lack of backup machine

short staff

Poor equipment maintenance

No pathologist lack Training

PEOPLE lack Teamwork Lack of teamwork

The above fish bone diagram reveals vital information about the problems in the current process followed by the hospital and shows certain in capabilities of the hospital in the following:

Small Space for the Laboratory

Lack of Safe Environment

Lack of backup machines

Poor equipment Maintenance

Small space for the operation is also a reason which is leading to error in collection of specimen, because the process of lab testing is 24 hours and at times the work pressures increases due to which the space becomes an issue this also adds in the working environment not being safe because of small space. Backup and maintenance are also two important functions of a laboratory in a health organization, if the equipment not maintained properly will definitely lead to error in the services. All of these factors listed above lead to the following:

No System Centre

Lack of commitment policy and procedure

Short Staff

No pathologist

Lack of Training

Lack of Team work

A central database for a laboratory is a must which enables the staff to access the information of the specimen belonging to a particular patient. The old system increases the work load an administration of the specimen due to which the staff end up making errors in collection of specimen and it also results in loss of staff hours. At a 24 hour operative laboratory the shortage of staff could be vital for the functioning of the laboratory and the new system will make enough staff resources available including pathologist. The lack of team work and training must be coped with the introduction of a staff training program. Summarising the above table 5 explains the causes of variations:

Result Delay

Lack of Backup analyzer

Increased infection Rates

Lack of Safe Environment

Lack of Reagent

Above five are the major issues faced at the laboratory of the hospital arising due to error in collection of specimen. Due to all the inefficiencies just explained above the laboratory ends up producing delays in results. Because of no backup facility the issue of backup analyzer arises and the shortage of human resources adds up to this, the new system will also make the required human resources available. Due to small space and the safety issues the risk of infections is also arising at the laboratory, which will be tackled by the new system by increasing the space for the laboratory and removing work hazards from the laboratory. Another reason for the safety issues to be more frequent is the lack of reagent, the new LIS will also have the capability to maintain stock levels of the reagent.

Part E – Selecting Improvements

This part of the report discusses the suggested improvements for the hospital laboratory information system (LIS).

To accomplish the goals as shown in table 6 staff training will be started by Dec, 2012 and the Cerner System will be implemented by Fem 2013. To accomplish these two goals the resources acquired will be manpower, medical equipment and budget.

Table - Selecting Improvements

Accomplishing Goals

(SMART Objectives)

1. Staff training and guidance on all policies and regulations on laboratory DEC 2012

2. Implement Cerner system starting Feb 2013

Acquiring Resources

Manpower: Admin & Medical

Medical equipment

Budget

Satisfying stakeholders

Finance

Regional Medical Office- RMO

Medical director

Lab Staff

Quality manager

Biomedical Engineer

Physicians and patients

Having Healthy Process

Building strong relationship based on trust, honesty and good will among staff.

Eliminate stress

Motivate the staff

Implementation of the new system will satisfy the stake holders including Finance, Regional Medical Officer (RMO), Medical Director, Lab Staff, Quality Manager, Biomedical Engineer, Physicians and Patients. Once the new Cerner System is implemented it will make the processes at the laboratory healthier by building strong relationship based on trust, honesty and good will among staff. It will also help to eliminate stress for the staff working at the lab which will eventually motivate the staff to achieve the required foal.

The implementation of the new system will remove the error of double collection of specimen and will satisfy all the stake holders as well. In a laboratory setup an error like double collection is very destructive as it destroys the business and also increase the risk of infection arising as taking specimen from patients for the second time for the same test. The new system will also make the allotment of resources efficient by maintaining a Electronic Medical Records data base. This system will assist the Regional Medical Officer in efficiently allotting staff hours and remove inefficiency aroused due to double collection error in specimen.

Therefore by making the system efficient in allotting resources to a specific job and issuance of barcode to every specimen will enable the staff at the lab to reduce work pressures and reduce delay in test results. This will reduce fatigue hours for staff and the motivational levels of the staff will also be raised as a result of ease in operations due to barcode scanner and the picture recognition of every sample with the patient. For successful operations of a health organization it is important that it satisfies the stake holders the families, the management and all the concerned authorities which involve keeping up-to-date with all the stake holders. This involves administration and hard work which could be made easier with the introduction of a database. The database could be accessed centrally by anyone to obtain information, which will certainly reduce pressure on the staff eventually leading to efficiency in operations.

The Cerner System will enable the hospital to have an effective LIS enabling all the stake holders to obtain information they are looking for. The system will have a central data base which will help in removing errors in collection of specimen and will also make the allotment of resources efficient. The error in specimen is a source of pain for patients and their families as the patients resist going for a second specimen which increase risk to health and also stress for the patients.

Part F – Reflecting

The services necessary to be delivered in a laboratory system must have the characteristics of reliability and validity. If the system is not reliable and fails to produce valid results it will eventually increase errors in specimen collection as in the case of Almirfa Hospital. Almirfa hospital requires a LIS which will enable all the stakeholders to access to the required information any time and also remove the error in collection of samples.

After studying and analyzing the whole case we have come to know that the new system must involve improving the small space for the laboratory, due to high number of tests the space becomes a vital issue at times of high workloads. The space issue is very vital as it also restricts the output levels of the laboratory in order which is very vital for becoming the industry leader of a 24 hour service.

The environment of the lab must be safe from all aspects of safety and a safety supervisor will also be formed to avoid any hazards while work at the laboratory. Backup is also very important in a health organization as it has humane implications, therefore the new system will also involve maintaining the backup of the backup.

The laboratory involves using complex machineries which require regular maintenance and if not maintained properly it will increase in efficiency in results produced by the lab, therefore regular maintenance of all the machinery used is also at the core of the new system. The regular maintenance also increase the reliability and validity of the results, in the laboratory the machines must be updated and maintained to be able to operate on 24 hours bais.

The Cerner System will also maintain EMR which will help in centralizing the patient test data. The staff will be provided training on the policies and procedures to be followed in the form of SOP’s, and regular checks will be done to see if the staff are performing on SOP’s. These SOP’s will be continuously developed after gathering data from competitors. UAE has a very competitive health industry and it is necessary to benchmark the competitors to be the industry leader in providing health services.

More staff will also be hired to deal with any sort of staff shortages at the lab, the lab has to be run 24 hours and cannot afford staff shortage at any time of the year. To increase effectiveness and acceptability of the results it is necessary that a Pathologist must also be hired full time to meet the requirements of staff at the lab. To acquire accreditations it will be very helpful to employ a famous pathologist of UAE which will increase good will and will also increase the authenticity of the results produced by the lab.

The staff of the lab must be motivated on team basis and regular feedback on staff motivational levels must be taken to increase motivational level of the staff. The result delays will be removed with the introduction of the bar codes, which will enable the staff at the lab to be more efficient in conducting test and remove delays in test results.

The safety instructions will be issued to control infection rates arising at the lab, the new policy targets to take infection rates at zero by proving reagent and safe environment to operate in the laboratory. The staff will be provided training on all aspects of safety, a new safety supervisor will also be hired for the laboratory and the responsibility of the safety supervisor will be to remove work hazard.

After a detailed analysis it’s been deuced that the Cerner system must be implemented for the laboratory to avoid errors in collection of specimen, as the mission of the hospital is very customer oriented. Therefore increasing patient complaints show that the management is incompetent and in efficient when managing the resources of the hospital. The use of a laboratory management system is necessary in developing society of UAE where population is also growing increasing pressure on health organizations.

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