LTU Six Sigma Group Project

TRI-CORE MEDICAL LABORATORIES

Six Sigma Black Belt Candidates:

Sample Project

Lawrence Technological University

April 14-15th , 2012
 Tri-Core Medical Background
Founded: 1998

Number of Employees: Approximately 1,100

Headquarters: Albuquerque, New Mexico

Revenue: Approximately $2.3B

Areas of Focus: Blood Bank / Transfusion Medicine,

Chemistry, Coagulation, Cytogenetics, Cytopathology,
Dermatopathology, Endocrinology, General Surgical
Pathology, Genetics, Hematology, Hematopathology,
Immunogenetics, Immunohistochemistry, Oncology,
Immunology/Autoimmune, Infectious Diseases, Toxicology,
Renal Pathology, Transplantation
2
 Tri-Core Medical Background
Vision:
 To be the laboratory of choice through personal
commitment to excellence in patient care.
Mission:
 Tri-Core leads the region in providing comprehensive
laboratory information of exceptional quality and value.
Leadership is achieved by dedicated people who support
innovation, advanced technology, customer service,
education and research.
Values:
 Integrity, Compassion, Accountability, Respect,
Excellence
3
Mr. Antonis - Tri-Core Medical - Director of Laboratory Services
offered the following comments:

 “We do not have a good way to schedule appointments.”

 “Many of our draws take too long and back us up.”

Project Goals:

(1) To understand and improve blood draw

operations and eliminate the high amount of
variance.

(2) To improve patient/doctor delivery time for

results .

4
 The Problem Statement
Tri-Core operates twelve laboratories with
identical equipment, personnel, and runs nearly
identical blood testing on a near-identical
patient population. Though designed to perform
at similar levels, there is a variance of as many
as 401 fewer blood draws per month from the
lowest producing lab to the highest. Annually,
this is creating a potential loss of approximately
31,092 blood draws overall.

Lab 5

Other
11 Labs

5
Key Laboratory Operations Data
 Tri-Core Labs are conducting three different levels of
tests. These tests pay between $150-$250/test. For
the purposes of our calculations we used an average
of $200/test.
 All labs run ten hours for six days a week, with one
hour for lunch and two fifteen minute breaks. This
equals 8½ hours/day of working time. With three lab
personnel (receptionist/two lab technicians) a total of
1530 minutes/day.
 Average blood draw process time used is 23 minutes
– Upper Specification Limit (USL).
 Labs on average operate 24 days/month; resulting
288 days/year/lab.
6
 Financial Impact
Lost Revenue:
 The current operation yields 141,708 blood draws/year
across all twelve laboratories, this is resulting in
$28,341,600/year.
 If all twelve laboratories were performing at the level
of laboratory five (172,800 blood draws/year), revenue
would increase to $34,560,000/year.
Bottom Line: A potential loss of $6,218,400/year.

Note: A 50% improvement in blood draw throughput will

yield an increase in revenue of $3,109,200 / year.

7
Key Six Sigma Project Tools

8
 Historical Data
 Tri-Core Medical provided us with data based on sign-in
sheets for 2010.
 This data was verified against weekly lab output studies.
 No significant difference was observed between weekly
detail data and monthly high level data.
 Monthly high level data accurately represents output of all
laboratories.
ACTUALS SAMPLE DATA (Count is based on sign-in sheets for 2010)

Labs (level 1 & 2 blood draws) Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Averages
Lab 5 1188 1200 1209 1204 1210 1200 1196 1212 1206 1194 1190 1191 1200
Lab 8 890 882 880 882 882 870 876 880 885 878 880 875 880
Lab 12 1089 1088 1089 1087 1088 1089 1089 1091 1091 1089 1089 1089 1089

WEEKLY DATA

Weekly May Sept Nov

data Lab 5 Lab 8 Lab 12 Lab 5 Lab 8 Lab 12 Lab 5 Lab 8 Lab 12
Week 1 308 221 299 308 217 287 328 223 297
Week 2 289 216 260 296 223 266 292 221 260
Week 3 311 227 251 293 225 260 280 226 254
Week 4 302 218 278 309 220 278 290 210 278
Total 1210 882 1088 1206 885 1091 1190 880 1089
9
 Measurement System
Things that were not considered relevant to the measurement system
included - laboratory layout and patient demographics. The following
Cause & Effect Matrix was created and used to identify those
variables important for further review and analysis.
Tri-Core Cause & Effect Matrix
Rating of Importance to
5 7 9 9 3 3
Customer →

Process Outputs (Effects) → 1 2 3 4 5 6

prepped for next day

Lab cleaned for next
Confirm tTest / Pull

Lab re-stocked and

Next day schedule

Testing report
patient chart

Blood draw

patient
Process Inputs (Causes) ↓ Total
Receptionist duties 9 9 3 7 7 9 246
3 Different lab processes 7 3 7 5 7 7 206
Receptionist's skill set & education 5 7 3 3 5 5 158
Patient demographics 3 3 5 3 3 3 126
Laboratory layout 3 3 3 3 3 3 108

Note: scoring scale using 3, 5, 7, and 9.

10
 Graphical Analysis
 Different types of analysis tools were used to help
determine which variables (X’s of interest) should be
pursued and data collected. The following chart shows in
those input variables (X’s) and their respective order of
importance .

11
Graphical Analysis

12
 Statistical Approach
 Several different types of statistical methods were used to
determine critical inputs and root causes. The results from
an ANOVA is highlighted below.
 ANOVA was used to determine if a difference existed
between the three different blood draw processes. Actual
sample data was used.

Since Fobs (9957) is > Fcrit (3.29) [p=0], reject Ho and conclude that the
differences in blood draw processes does increase total blood draw
throughput.

The Result: we accept Ha and reject Ho

13
 Analyses Summary
 It was determined through observation, FMEA and Takt
time analysis that the Receptionist /Lab Technician
duties in laboratory five played a significant role in the
blood draw throughput.
 The balance of our time was spent on the following
activities:
 Establishing daily blood draw targets
 Developing a Pilot Test program
 Implementing Process Control procedures, including control charts
 Review all recommended changes with Mr. Antonis –Director of
Laboratory Services

14
 Establishing The Targets
Blood Draw Target:

 The target for the lab processes is to increase the blood

draws performance from 11,809 / month to 14,400 / month
(theoretical max. 19,152 / month), while increasing the
number of personnel active in the process from two to three
persons (Receptionist will help the Lab technicians in the
overall blood draw process).
 The blood draws/day values are the following:
- Other 11 Labs: 40.1
- Lab 5: 50.0
- Ideal Lab: 66.5
An initial goal of 45 blood draws/day/lab; results in a
50% improvement !
15
Improve Laboratories Performance
ESTABLISHING THE TARGETS
The initial goal is to move
the average daily blood
draw to 45 resulting in a
50% improvement 66.5
70

60
50
50
40.1

40 Blood draws / day

Number of personnel
30

20

10
2 3 3

0
Other 11 Labs Lab 5 Ideal Lab

16
 Developing Potential Solutions
Pilot Program
 Pick one lab other than Lab 5 (e.g. Lab 9), for a pilot program
and ask the Receptionist/Lab tech to shadow the Lab 5
Receptionist /Lab tech for one week to observe their day-to-
day operation.
 This enhanced role for the Receptionist/Lab tech should be
put into practice for one month to determine the change in
blood draw throughput.
 Chart the number of daily blood draws for one month in the
pilot lab.
 If pilot program is successful, implement this new process in
the other 10 laboratories and chart the results for 3 months.
 Review results with Tri-Core Medical Director and Six Sigma
Black Belt team to determine rate of improvement and
compare to baseline. 17
 Process Control Plan
1. Observe and document Lab 5 Receptionist and Lab
technician duties/responsibilities. Update employee
handbook and job description with these improvements.

2. Train all receptionists and lab technicians from the other

10 labs with these enhanced duties, and monitor blood
draw throughput (see page 68 for detailed receptionist’s
work instructions).

3. Standardize all lab operating procedures for Tri-Core

Medical on a company wide basis.

4. Create a daily patient blood draw completions database

system to monitor performance. 18
 Process Control Plan (continued)
5. Monitor all Labs utilizing a control chart (see example
page 64).

6. Implement quarterly meetings (Kaizen), to determine if

other cost saving/employee efficiency suggestions should
be added to Tri-Core Medical processes/procedures
manual.

7. Reward top 2 Labs (e.g. small bonus, vacation time, etc.)

every month based on superior performance.

8. If necessary, change the Receptionist position description

to include medical assistant training and/or experience.
19
 Tri-Core Medical Project Summary
1. Improve as quickly as possible 11 Tri-Core Medical Laboratories with
reduced blood draw throughput.

2. Investigate 3 different laboratory blood draw processes for takt time

and operational efficiency.

3. Identify all reasons that cause Lab 5 throughput to be significantly

higher than the other laboratories.

4. Quickly standardize Lab 5 Receptionist/Lab technician duties and

responsibilities for all other labs.

5. Develop new monthly blood draw baseline for all labs to achieve, and
monitor their behavior with new control chart.

6. Document and standardize Tri-Core Medical employee handbook

with new Receptionist/Lab technician enhanced duties and
responsibilities, and hiring requirements if necessary. 20
Back-up Slides: Tri-Core Medical
Six Sigma Project

 DEFINE Phase: slides 22 - 30

 MEASURE Phase: slides 31 - 46
 ANALYZE Phase: slides 47 - 54
 IMPROVE Phase: slides 55 - 62
 CONTROL Phase: slides 63 - 68

21
 Project Charter
Project Name Tri-Core Medical Laboratories Business / Location Albuquerque, NM
Green Belt Jim Steiger Telephone Number 810-227-1638
Black Belt Telephone Number
Champion Yolanda Ntseful Telephone Number 248-204-4050
Start Date: July 25, 2011 Target End Date: Dec 6, 2011

Project Details
Project Description To improve the throughput in monthly blood draw performance by determining the cause of the differences among laboratories.
This will improve the overall blood draw process and patient/doctor delivery time. This project is Critical To Delivery (CTD).
Business Case Tri-Core Medical Labs is losing on average $200 per blood draw in lost opportunities across 11 of their 12 laboratories. If all labs
were performing at the rate of Lab 5, the increase in revenue $11,404,800/year.
Problem Statement Tri-Core Laboratories is conducting 141,708 blood draws/year out of 172,800 blood draws/year, leading to a loss of 31,092 blood
draws/year, costing an average of $6,218,400/year.
Process & Owner Blood Draw Operational process – Laboratory Director – Mr. Antonis
Scope Start: Pre-24 hour advance call to patient
Stop: Next day’s lab preparation
Includes: Patient arrival and check-in; Blood draw completion (Level 1, Level 2); Blood
sample processing
Excludes: Blood draw completion (Level 3), performed by two external labs (at hospital
facilities)

Project Goals Metric Baseline Current Goal Theoretical Max.

Increase blood draw Blood Draws /month 11,809 blood 11,809 blood 14,400 blood 19,152 blood
performance draws/month draws/month draws/month draws/month across
across 12 labs across 12 labs across 12 labs 12 labs
Expected Business Increase blood Increase blood
Results draws by 50% draws by 90%
Expected Customer Improve the patient/doctor delivery time for results.
Benefits
Team members Radu Muresan
Support Required Tri-Core Medical HR Manager/Director, along with Mr. Antonis – Lab Director
Lab 5 Receptionist
Risks or Constraints The fear of change by some receptionists with enhanced duties.
22
 Findings and Action Plan
Tri-Core Medical Six Sigma Project
Title: JPS
Background Recommendations
Tri-Core Medical Laboratories is experiencing
significantly different monthly blood draw 1st – Expand the roles & responsibilities of the
throughput among its 12 labs. Receptionist/Lab tech in the other 11 labs.
2nd - Explore streamlining the Lab tech’s duties to
Current Situation determine if the overall laboratory process can be
improved.
The Laboratory Director wants us to investigate
the cause for the laboratory variance.

Tri-Core Medical Labs has identified 3 different Plan

operational processes being used among their labs.
Pick one lab Receptionist (other than lab 5) in a pilot
Goal Bring the other 11 labs in-line with Lab 5. program and ask the Receptionist/Lab tech to shadow
the Lab 5 Receptionist/Lab tech for one week to
Identify possible causes and determine how best to observe their day-to-day operation. Then this
correct the problem quickly. enhanced role for the Receptionist/Lab tech needs to
be put into practice for one month to determine the
change in results.
Analysis
It was determined through our analyses that the
Receptionist duties and responsibilities are the Follow - up
leading cause for differences in blood draw After one month, analyze the data for improvements. If
throughput among Tri-Core Medical Labs. successful, implement this process among the other 10
labs as quickly as possible. After 3 months, re-analyze
the data from the other 11 labs to determine the
improvement. Personnel changes may be necessary if
desired results are not meeting expectations. 23
 Key Assumptions and COPQ
Key Assumptions:
1. Labs run at 6 days/week; 10 hours /day. 1 hour for lunch, and two15 min
breaks = 8.5 hours/day of working time. With 3 lab personnel = 1530
minutes/day.
2. Average blood draw process time used is 23 minutes.
3. Labs on average operate 24 days/month (taking into account
longer/shorter months & holidays)
4. Total working days/year/lab = 288.
5. Average lab test pays $200.

Lost Opportunities:
1. 1530 min/day (3 lab personnel) divided by 23 minutes/blood draw
process = 66.5 blood draws/day “in a perfect world “= 1596/month
(Theoretical Maximum).
2. Currently Lab 5 is operating at 50 blood draws/day = 1200/month
(Pacesetter).
3. Other 11 Labs are averaging 40 blood draws/day = 960/month (Current
Level)
4. Lost opportunities vs. Pacesetter = 1596 – 1200 = 396/month
5. Lost opportunities vs. current (except Lab 5) = 1596 – 960 =
636/month/lab 24
 Key Assumptions and COPQ
Cost of Poor Quality (COPQ):
1. Lab 5 – 396/month x 12 months x 1 lab x $200/test = $950,400/year
2. Other 11 Labs – 636/month x 12 months x 11 labs x $200/test =
$16,790,400/year
3. Total COPQ under current conditions = $950,400 + $16,790,400 =
$17,740,800/year

The COPQ from lost opportunities = $17,740,800/year

Note: If all Labs were running like Lab 5 the COPQ would be
reduced to $11,404,800/year

25
 DEFINE
Define the Process
Who What is What STEPS are Included WHAT does the WHO are your
PROVIDES provided to in the Process today? customer primary
the input? START the (high level) receive? (Think of customers?
process? their CTD’s)
Supplier Input Process Output Customer
(Who) (Nouns) (Verbs) (Nouns) (Who)

Instrument 24 hour advance call to patients Completed

Analysis Instruments Analyses Lab Technicians
Manufacturers
Computers & Patient arrival & check-in by Electronic
Computer receptionist Reporting
Printers All Lab Personnel
Manufacturers

Syringes, Alcohol, Filled Blood Vials

Patient blood draw by lab tech1
Medical Supply Cotton Swabs All Lab Personnel
Company Patient
Phones, Answering Communication
Machine Analyses of Blood by lab tech 2
Phone Company & report sent to Doctor Patients & Lab
Removal of Medical
Waste Bins Personnel
Medical Disposal Medical Waste Bins
All Lab Personnel
Company Lab area prepared for next Prepare Lab for
patient by lab tech 1 next Days’
Patient Scheduling Schedule
Receptionist Patients
and Log-in

Prep for next days patients by Blood Analyses

Blood Draws, Reports; prep for Patients & Doctors
Lab Technicians all lab personnel
Specimen Vials next day
26
DEFINE

27
DEFINE

28
DEFINE

29
DEFINE

30
 MEASURE
Tri-Core Cause & Effect Matrix
Rating of Importance to
5 7 9 9 3 3
Customer →

Process Outputs (Effects) → 1 2 3 4 5 6

prepped for next day

Lab cleaned for next
Confirm tTest / Pull

Lab re-stocked and

Next day schedule

Testing report
patient chart

Blood draw

patient
Process Inputs (Causes) ↓ Total
Receptionist duties 9 9 3 7 7 9 246
3 Different lab processes 7 3 7 5 7 7 206
Receptionist's skill set & education 5 7 3 3 5 5 158
Patient demographics 3 3 5 3 3 3 126
Laboratory layout 3 3 3 3 3 3 108

Note: scoring scale using 3, 5, 7, and 9.

31
MEASURE

32
 MEASURE

RPN Scoring used for PFMEA

Example of a scoring scale using 1, 3, 6, and 9.

Designed to achieve a greater spread when rating severity, occurrences
and detection categories of a Failure Modes & Effects Analysis.

Rating Severity of Effect Likelihood of Occurrence Ability to Detect

9 Hazardous defect noticed by all customers Failure is inevitable Can not detect
6 Major defect noticed by most customers Frequent failures Moderate chance of detection
3 Minor defect noticed by some customers Relatively few failures High chance of detection
1 No effect Failure is unlikely Certain detection

33
 MEASURE

HISTORICAL DATA (YEAR 2010)

Labs (level 1 & 2 blood draws) Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Process
Lab 1 1100 1100 1100 1100 1100 1100 1100 1100 1100 1100 1100 1100 B
Lab 2 900 900 900 900 900 900 900 900 900 900 900 900 A
Lab 3 910 910 910 910 910 910 910 910 910 910 910 910 A
Lab 4 800 800 800 800 800 800 800 800 800 800 800 800 A
Lab 5 1200 1200 1200 1200 1200 1200 1200 1200 1200 1200 1200 1200 C
Lab 6 1114 1114 1114 1114 1114 1114 1114 1114 1114 1114 1114 1114 B
Lab 7 900 900 900 900 900 900 900 900 900 900 900 900 A
Lab 8 880 880 880 880 880 880 880 880 880 880 880 880 A
Lab 9 799 799 799 799 799 799 799 799 799 799 799 799 A
Lab 10 1008 1008 1008 1008 1008 1008 1008 1008 1008 1008 1008 1008 B
Lab 11 1109 1109 1109 1109 1109 1109 1109 1109 1109 1109 1109 1109 B
Lab 12 1089 1089 1089 1089 1089 1089 1089 1089 1089 1089 1089 1089 B

34
 MEASURE

ACTUALS SAMPLE DATA (Count is based on sign-in sheets for 2010)

Labs (level 1 & 2 blood draws) Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Averages
Lab 5 1188 1200 1209 1204 1210 1200 1196 1212 1206 1194 1190 1191 1200
Lab 8 890 882 880 882 882 870 876 880 885 878 880 875 880
Lab 12 1089 1088 1089 1087 1088 1089 1089 1091 1091 1089 1089 1089 1089

WEEKLY DATA

Weekly May Sept Nov

data Lab 5 Lab 8 Lab 12 Lab 5 Lab 8 Lab 12 Lab 5 Lab 8 Lab 12
Week 1 308 221 299 308 217 287 328 223 297
Week 2 289 216 260 296 223 266 292 221 260
Week 3 311 227 251 293 225 260 280 226 254
Week 4 302 218 278 309 220 278 290 210 278
Total 1210 882 1088 1206 885 1091 1190 880 1089

35
 MEASURE

Blood Draw Differences

1400
Average Number of Blood Draws per Month

1200

1000

800

600

400

200

0
Process A Process B Process C
Blood Draw Differences 864 1084 1200

36
 MEASURE

PERFORMANCE STANDARDS

The specification:

 Taking into account the initial data received from the

management of Tri-Core Medical Laboratories, we have
the following:
50% Level 1 tests/lab (20 min/test) ;
30% Level 2 tests/lab (30 min/test);
20% Level 3 tests/lab (20 min/test).

 The specification against every improvement will be

compared was calculated at the following value: USL= 23
min/test (for this process there is no LSL).

37
 MEASURE
MSA – GAGE R & R

Discrete (Attribute) Data:

 The Actual Sample Data, from Tri-Core Medical Laboratories

will be used to perform the Gage R&R (Attribute Agreement
Analysis); only a minimum score of 80 % is acceptable.

 The initial set-up conditions:

3 appraisers used (Receptionist, Lab tech 1, Lab tech 2);
3 trials were performed;
36 items were inspected: the monthly data for the Lab 5
Lab 8, and Lab 12 (counting the patients);
2 standards accepted : “Good” (patient have the test);
“Bad”(patient miss the test).

38
MEASURE

39
 MEASURE
Date of study : 09/03/2011
Assessment Agreement
Reported by : Radu Muresan
Name of product: Blood draw process
Misc: TRI-C ORE Medical Laboratories

Within Appraisers Appraiser vs Standard

100 95.0% C I 100 95.0% C I
P ercent P ercent

80 80

60 60
Percent

Percent
40 40

20 20

0 0
Receptionist Lab tech 1 Lab tech 2 Receptionist Lab tech 1 Lab tech 2
Appraiser Appraiser

40
 MEASURE

MSA – GAGE R & R

Conclusions:

 The minimum score of 80 % is acceptable, after performing the

analysis we obtained a score of 92.02 % , and a Kappa
coefficient of 1 (minimum acceptable is 0.9).

 The Gage R&R was successful, therefore we can trust and

use with confidence the historical data from Tri-Core Medical
Laboratories.

41
 MEASURE

PROCESS CAPABILITY (BASELINE)

The initial data:

 For each laboratory there are employed 3 people:

Receptionist, Lab tech 1, Lab tech 2.

 Working schedule is: 6 days / week, with 1 shift of 10

hours / day (1 hour for lunch time, and 2 breaks of 15
minutes / day are allowed).

 The effective time of work: 8.5 hours / day / employee,

25.5 hours / day / lab, 1530 minutes / day / lab.

42
 MEASURE

PROCESS CAPABILITY

Lab Type of Draws / Max. expected Actual Missing DPMO Current

number process month draws / day draws / day opportunities / lab / day per lab σ level
L1 B 1100 66.5 45.8 20.7 311,278.2 1.992
L2 A 900 66.5 37.5 29.0 436,090.2 1.661
L3 A 910 66.5 37.9 28.6 430,075.1 1.676
L4 A 800 66.5 33.3 33.2 499,248.1 1.502
L5 C 1200 66.5 50.0 16.5 248,120.3 2.180
L6 B 1114 66.5 46.4 20.1 302,255.6 2.018
L7 A 900 66.5 37.5 29.0 436,090.2 1.661
L8 A 880 66.5 36.6 29.9 449,624.0 1.627
L9 A 799 66.5 33.2 33.3 500,751.8 1.498
L 10 B 1008 66.5 42.0 24.5 368,421.0 1.836
L 11 B 1109 66.5 46.2 20.3 305,263.1 2.009
L 12 B 1089 66.5 45.3 21.2 318,796.9 1.971

43
MEASURE

44
 MEASURE

COST OF POOR QUALITY (COPQ)

Lab Type of Draws / Max. expected Actual Missing Avg. value COPQ
number process month draws / day draws / day opportunities / lab / day per test [ $ ] [ $ / month ]
L1 B 1100 66.5 45.8 20.7 200 99,360
L2 A 900 66.5 37.5 29.0 200 139,200
L3 A 910 66.5 37.9 28.6 200 137,280
L4 A 800 66.5 33.3 33.2 200 159,360
L5 C 1200 66.5 50.0 16.5 200 79,200
L6 B 1114 66.5 46.4 20.1 200 96,480
L7 A 900 66.5 37.5 29.0 200 139,200
L8 A 880 66.5 36.6 29.9 200 143,520
L9 A 799 66.5 33.2 33.3 200 159,840
L 10 B 1008 66.5 42.0 24.5 200 117,600
L 11 B 1109 66.5 46.2 20.3 200 97,440
L 12 B 1089 66.5 45.3 21.2 200 101,760

45
MEASURE

46
ANALYZE

47
 ANALYZE

SAMPLING PLAN

WEEKLY DATA

Weekly May Sept Nov

data Lab 5 Lab 8 Lab 12 Lab 5 Lab 8 Lab 12 Lab 5 Lab 8 Lab 12
Week 1 308 221 299 308 217 287 328 223 297
Week 2 289 216 260 296 223 266 292 221 260
Week 3 311 227 251 293 225 260 280 226 254
Week 4 302 218 278 309 220 278 290 210 278
Total 1210 882 1088 1206 885 1091 1190 880 1089

48
 ANALYZE

POTENTIAL “X” MATRIX

Key process inputs (X's) Origin Appropriate Result Is input vital ?

test / analysis (Yes / No)

X1 Receptionist duties Fishbone Chart FMEA RPN=729 Yes
X2 Three different lab processes Process Map 2 Sample t-test p-value = 0.0 Yes
X3 Patient scheduling C&E Matrix FMEA RPN=324 Yes
X4 Receptionist's skills set & education Fishbone Chart FMEA RPN=108 Yes
X5 Laboratory layout C&E Matrix FMEA RPN=54 No
X6 Patient demographics Historical Data FMEA RPN=9 No

49
ANALYZE

50
ANALYZE

51
 ANALYZE

HYPOTHESIS TESTING
2 Sample t-Test and CI: Lab 8 - Process “A”, Lab 12 - Process “B”

The 2 sample t-test for Lab 8 - Process A vs. Lab 12 - Process B results:

N Mean St.Dev SE Mean

Lab 8 - Process A 12 880.00 5.06 1.5
Lab 12 - Process B 12 1089.00 1.13 0.33
Difference = µ (Lab 8 - Process A) - µ (Lab 12 - Process B)
Estimate for difference: -209.00
95% CI for difference: (-212.26, -205.74)
H0: µ 1 - µ 2 = δ0 versus H1: µ 1 - µ 2 ≠ δ0
t-test of difference = 0 (vs. not =): T-Value = -139.57 P-Value = 0.000 DF = 12
Power of the test: 1-β = 0.854
Conclusions:
The p-value=0.00   risk=0.05 , the null hypothesis H0 is rejected in favor of
the alternative hypothesis H1 . The mean of data from process type A is
statistically different from the mean of data from process type B.
52
 ANALYZE
HYPOTHESIS TESTING

53
 ANALYZE
HYPOTHESIS TESTING

Boxplot of Lab 8 - Process A, Lab 12 - Process B

1100

1050

1000
Data

950

900

Lab 8 - Process A Lab 12 - Process B

54
IMPROVE

55
 IMPROVE
ANOVA ANALYSIS
In Symbols In Words
HO D5=D8=D12 The differences in Blood Draw processes does not increase blood draws.
HA Not Ho The differences in Blood Draw processes does increase blood draws.

D=Blood Draws from labs 5, 8, & 12

ACTUAL SAMPLE DATA:

LAB 5: Number of items= 12

1188. 1190. 1191. 1194. 1196. 1200. 1200. 1204. 1206. 1209. 1210. 1212.
Mean = 1200
95% confidence interval for Mean: 1197. thru 1203.
Standard Deviation = 8.28
Hi = 1212 Low = 1188
Median = 1200
Average Absolute Deviation from Median = 6.83

LAB 8: Number of items= 12

870. 875. 876. 878. 880. 880. 880. 882. 882. 882. 885. 890.
Mean = 880.
95% confidence interval for Mean: 876.7 thru 883.3
Standard Deviation = 5.06
Hi = 890. Low = 870.
Median = 880.
Average Absolute Deviation from Median = 3.50
56
 IMPROVE
ANOVA ANALYSIS
LAB 12: Number of items= 12
1087. 1088. 1088. 1089. 1089. 1089. 1089. 1089. 1089. 1089. 1091. 1091.

Mean= 1089
95% confidence interval for Mean: 1086. thru 1092.
Standard Deviation = 1.13
Hi = 1091 Low = 1087
Median = 1089
Average Absolute Deviation from Median = 0.667

ANOVA RESULTS:

Source of Sum of d.f. Mean F

Variation Squares Squares

between 633,610 2 316,800 9957.

within 1050. 33 31.82
total 634,660 35
The probability of this result, assuming the null hypothesis (Ho), p is = 0.000

The Decision:

Since Fobs (9957) is > Fcrit (3.29) [p=0], reject Ho and conclude that the differences
in blood draw processes does increase total blood draw throughput.

57
 IMPROVE
ANOVA ANALYSIS

58
 IMPROVE
ANOVA ANALYSIS

59
 IMPROVE
MEASUREMENT SYSTEM ANALYSIS (MSA)

Purpose:
Ensure that the difference in the Laboratory data is due to
actual differences in what is being measured, and not
variation in the measurement methods.
Conclusions:
 The number of blood draws completed is calculated based
on actual Lab study results;
 High level observed data was verified against detailed
weekly Lab output studies;
 No significant difference was observed between weekly detail
data and monthly high level data;
 Monthly high level data accurately represents output of the
Labs.

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 IMPROVE
PROCESS CAPABILITY

The baseline:

Opportunities Total
Tests per test Opportunities Defects DPO DPMO P(good) Z long term Z short term Ppk Cpk
11,809 1 11,809 2,591 0.2194 219,409 0.7806 0.774 2.274 0.258 0.758

The 50% improvement:

Opportunities Total
Tests per test Opportunities Defects DPO DPMO P(good) Z long term Z short term Ppk Cpk
11,809 1 11,809 1295,5 0.1097 109,704 0.8903 1.228 2.728 0.409 0.909

The 90% improvement:

Opportunities Total
Tests per test Opportunities Defects DPO DPMO P(good) Z long term Z short term Ppk Cpk
11,809 1 11,809 259.1 0.0219 21,941 0.9781 2.015 3.515 0.672 1.172

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 IMPROVE
Modified FMEA
Potential Cause(s) Occurrence Recommended Action(s)
Receptionist training has not been 9 Observe & document duties for
standardized across all labs receptionist in Lab 5 and cross train in the
other 11 labs
Applicant pool for receptionist 6 Raise the minimum required education
position varies level
Receptionist never advised to 6 All lab personnel need to strive for 50
increase patient numbers blood draws/day
No consistent company employee 6 Tri-Core Medical Employee handbooks
established process/procedures need to be developed incorporating
enhanced redeptionist duties &
responsibilities
Commercial space availability & 3 Make sure all labs have a pleasing
cost/sq. ft. environment and are wheel chair
accessible
Labs located closer to Senior 1 Consider a mobile lab to help older
Centers and Assisted Living patients in specific areas of need
facilities

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 CONTROL
PROCESS CONTROL:
1. Maintain two-week control charts for each lab,
and use 50 blood draws/day as a lower spec.
2. Have Monday morning meetings with all lab
personnel to discuss previous weeks results.
Make necessary improvements as needed.
3. Update employee handbooks for current policies
and procedures.
4. Hold quarterly Kaizen events to discuss overall
progress and identify other areas of
improvement.

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 CONTROL

Example Control Chart:

2-Week Laboratory Control Chart
70

Daily Blood Draws 60

Theoretical Maximum
Lab 5 Performance
50

40
Current 11 Labs Performance
30

20

10

DAYS 0
1 2 3 4 5 6 7 8 9 10 11 12
Daily Completed Blood Draws 45 48 41 43 37 49 42 48 39 41 45 50
Level 1 Tests 23 24 21 22 19 25 21 24 20 21 23 25
Level 2 Tests 14 14 12 13 11 15 13 14 12 12 14 15
Level 3 Tests 9 10 8 9 7 10 8 10 8 8 9 10

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 CONTROL
CONTROL PLAN

Process Process Input Output Process Cpk / Measurement % R&R Control Who ? Where ? When ? Reaction
step specification Ppk system method plan

Blood Pre-24 hour Appointment list / Next day's schedule / N/A N/A Visual check N/A Self - Receptionist Schedule Beginning Check

draw advance call Voice mails/E-mails / Wait list / checking list of each per SOP
process to patient Active phone line Reschedule patients day reference
Blood Patient arrival Sign-in lab forms / Confirm test / N/A N/A Visual check N/A Self - Receptionist Patient After Check

draw and check-in ID card (document) / Pull patient chart / checking chart every per SOP
process Med. insurance card Patient prepared sign-in reference

Blood Blood draw 2nd ID verification / Label specimen vials LSL = N/A Cpk=0.5 Syringes, vials, 92.02% Counting Lab Patient After Check
draw completion Triage patient Patient released / USL = 66.5 Ppk=0 test strips technician 1 chart every per SOP

process (weight, general info) Specimens submitted [ draws / day ] draw reference
Blood Blood sample Labeled specimen Specimens grouped, LSL = N/A Cpk=0.5 Microscopes, 92.02% Counting Lab Testing After Check

draw analysis and vials with blood processed, recorded / USL = 66.5 Ppk=0 analysis technician 2 report every per SOP

process processing sample Testing reports out [ draws / day ] instruments recording reference
Blood Lab area Remove the Notify receptionist / N/A N/A Visual check N/A Self - Lab The lab End of Check
draw prepared for medical waste bins / Next patient charts / checking technician 1 area each per SOP
process next patient Prepare instruments Patient prepared and 2 test reference
Blood Next day's lab Dirty lab rooms / Cleaned-up lab / N/A N/A Visual check N/A Self - Receptionist The lab End of Check
draw preparation Empty bins without Replenish the bins / checking and Lab area each per SOP
process medical supplies New appointments technicians day reference

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CONTROL

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CONTROL

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 CONTROL
Receptionist’s Work Instruction:
1. Print patient schedule / appointment list.
2. Clear voice mails from last evening.
3. Remove forwarding to emergency line.
4. Pull patient charts.
5. Confirm appointments for following day (call to confirm date and
time, re-schedule cancellation, start waiting list, update daily
schedule with wait listed patient confirmed).
6. Check-in patients (sign-in, confirm test, insurance card update).
7. Triage patient (weight, general information of visit).
8. Take sample (when possible).
9. Perform test (when possible).
10. Patient release (payment, next schedule, work / school excuse).
11. Clean lab rooms.
12. Call next patient for lab work.
13. Create tomorrow lab work (patient schedule / appointment list).

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