Implementing Rapid Real-time Process Defect Collection to Optimize Anatomic Pathology Workflow: A Two Pronged Approach Based on End-user Work Setting
Michael W. Riben ; M.D. Anderson Cancer Center;
Content:
Our workflow optimization project leverages manufacturing based quality improvement methods, such as Lean and Six Sigma, which strive for zero defects as a measure of quality. We have implemented a change management infrastructure that utilizes data collection and analysis to aid decision making, targeting sources of waste and process defects that affect efficiency and quality. We define defect using a published definition. (DAngelo et al., Am J Clin Pathol. 2007;128:423-429), Like these authors, we developed a defect collection system that met several criteria: easy to use, real-time data capture, equal access to all, standardized, menu-driven, defect capture closest to discovery, visual presentation and public exposure, blameless participation, compliance with participation, and reusability.
Technology:
We utilized paper-based customized Post-it® (3M) notes with a 4 quadrant design, and developed a custom data entry form in PathStation, our VB.Net/SQL based workflow integration software application.
Design:
A coded defect classification and location/process list was developed and distributed to all employees. The data collection event lasted for 12 working days. For non-computer based workstations, defects were captured in real-time and completed Post-it® notes were posted in each lab at designated wall locations. Notes were collected every other day for data entry into the electronic module. For computer based settings, an integrated defect collection module automatically set user context, case context, date/time, user location, and utilized an identical defect classification. A running total was always visible in the module. All entered defects were visible on a display tab. Ultimately, all defects were recorded into the electronic module to facilitate visibility to the widest possible audience and allow for data analysis.
Results:
We collected 1291 defects. The range of defects were then analyzed and classified by multiple schemes, including location, process steps, reporting locations, staff type, and workflow (pre-analytic, analytic, post analytic.)
Conclusion:
The ability to document defects in real-time enhances reporting opportunities and increases compliance with data gathering events, critical to designing improvements that optimize efficiency and quality. We demonstrate the ability to document the defect identified in less than 5 seconds in settings with, and without, a computer workstation.
