Pit stop system

From HMCwiki

A pit stop system tool can be used to apply the concepts of quick changeover and the theory of constraints to knock out every nickel of delay in lab results turnaround.

Equipment: knock out variation

• is equipment uptime optimized
• is it PM’d at non crucial times
• are preventive measures for equipment service keeping equipment up
• are unnecessary standards runs eliminated
• are slow service calls questioned and minimized
• are there contingency plans for equipment failure, backup
• are supplies for running equipment in abundance
• are techs cross-trained to run various equipment: are demands met by shift
• are their plenty visuals on equipment - standards, what next, how to’s,
• when delays are beyond limit - are requesters notified in broadcast fashion
• are loggings, controls used as defensive measures or for monitoring/preventive measures
• how often is the preventive measure used, what does it displace
• do staff know when unusual demand of STATs arrive
• do they know how to SWAT the STATs (can they run upstream to open up the flow of critical specimens
• is tele equipment available to allow conversation and hands free work
• is equipment/supplies ready at hand
• are they in proximity to minimize travel
• are ordering/repair instructions, numbers built into the workplace so anyone can pick up the ball
• are there par levels set so with lead times to keep times from running out -- are they monitored accordingly

Communication: keep it clear and flowing

• are there ongoing measuring showing STAT capacity turnaround
• can known delay STAT notification take less time than the incoming of calls searching progress of delays
• can we intercept status/ easy answers with some blocking/tackling service (retired tech who knows the system)
• how do sections call for help, can demand be balanced by SWAT type help
• can the floors be notified of a ready test result instead of the trial and error or a look and see process
• can we gain from feed-forward (how to do it right) and feedback (what you need to do better)
• do staff causing delay know and own the results
• do upstream departments/doctors know how to give correct instructions so patient is correctly scheduled and has correct information upon arrival
• are there sufficient tele lines coming in to the area

Staffing: set it to achieve service levels

• are productive hours or service hours aligned
• does the workload to staffing pattern overlay on each other
• do we know how unfilled positions effect turnaround
• is there clear understanding as to which positions have the greatest impact on quality and service turnaround
• do we hire to optimize for service (turnaround) or do we hire for high productivity or a known mix of the two
• are staff of the mind to cross over to secondary jobs to keep the flow at peak
• do they know when this is needed and where to go to reduce the bottleneck
• are there ways to predict where this will happen
• do struggling areas call for help, are areas that cry “wolf” coached
• are there mid-shift huddles to adjust for the dynamics of the day
• are vacations/holidays balanced not only by FTE but by STAT/equipment coverage
• are all presumptuous instructions knocked out
• can downstream areas who will incur delay because of bottleneck, systematically come help relieve the bottleneck
• do we have a mechanism to detect when additional staff is needed and can it happen such that they are up and running when the need is there

Minimizing wait: idle/non value-added time

• is there a known limit on batches or time cycles to run equipment. Is it time based, does it relate to the urgency of the consequence of the delay
• what is the cost of delay (potential downstream effect)
• can smaller batches be used
• can one piece flow (one person does all be effective)
• can point of service equipment be used, and can staff at hand run and maintain standards
• can the capacity of STAT runs be determined: minimum lots given the setup requirements
• do we know the capacity of the true routine/STAT mix and can we calculate the average wait time of the two and use it as order practice change ammunition
• can we add transporters to reduce wait time from one process to the next
• can the end of one point be the beginning of the next
• is the destination/what to do next in the process readily known (obvious to the user)
• can better computers speed the interface between systems
• what preventive measures are in place to keep from overloading systems

Externalize activities- do ahead, in parallel or best yet, not at all

• can preparation be done in anticipation of an onslaught of STAT
• can pre-loading/sorting be done more on a continuous basis than a batch basis
• are there jigs, tools, racks, whatever that can make it easier for the next station
• can pre-measuring, pre-pulling, pre-assembly be used for advantage
• do we have to wait on a specialized skill if it can be readily transferred (nursing calling for phlebotomy (build phlebotomy into the unit workforce

Properly prioritize: incoming work has varying needs

• can trouble transaction encounters (usually 3 to 5 times longer) be pulled outside the mainstream of the clean transactions. (queue of 5 transaction: 4 routine 3 min and 1 problem 12 min -- if problem is processed at front of queue average wait is 18 min, if at end of queue it is 8 min)
• if true STATs were known and done accordingly and rest done as routine what would average wait be
• can a separate STAT classification help distinguish between medical and operation urgency
• have we tested all standing STAT orders by area for reasonableness, can we alter practice without consequence
• can there be a Robocop (leadership) for order abuse for doctors for nurses

Controlling demand- slow or match the peaks

• can upstream instructions get patients here closer to their appointment times
• can appointments be set at a frequency to not exceed the ability to meet the demand. If emergent or service contingencies are needed, leave a portion of the slots available (15 to 20%) to insure service levels met
• hold off servicing those arriving greater than an hour early as long until on-time folks are finished. Ample signage, warning, mail-outs done stating this new practice
• alter or offer incentives for physicians to change their hours given a promise of a turnaround

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