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Introduction Our hospital Cairo University Hospital serves about
600,000 students in all faculties and more than10000 staff members and employees.
It lies in Giza square surrounded by differentfaculties of Cairo University , being in such awonderful place it serves many people other thanthose getting benefit from the insurance .
As regard the emergency room it serves the wholepopulation of the university and the neighboringarea.
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The laboratory Department contains 4 units and a
specialized ER lab.
The ER lab plays a vital role in the process of rapiddiagnosis of the critically ill patients especially thosesuffering from suspected myocardial infarction.
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Introduction
of new Chemical Analyzerto ER lab
By:Noura Mohammad Nagib
Sara Ahmad Tarek
Sarah Omar Tawfik
Quality planning project
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Step 1
Step 2
Step 3
Establish the project.
Identify customers.
Discover customer needs.
Develop service.
Develop process.
Steps of quality improvement project :
Step 4
Step 5
Step 6 Develop process controls / transfer to operations.
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Step 1: Establish Project
Step 1
A. Identify project.
B. Establish project mission.
C. Establish team.
D. Verify mission.
E. Plan the project.
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A-Identify Project.
Step 1Step 1
The basis for identifying the project is to establish a
new chemical analyzer in the ER Lab for rapid
diagnosis of the critically ill patients and to
increase the service provided by the hospital Lab
Step 1 : Establish project
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Introduction of a new Chemical Analyzer
Machine in the ER Lab in the span of 7 months.This device will serve the E.R patients, rapidly doing
the urgent Chemical lab tests. The machine will be
able to analyze all the basic Clinical Chemistry tests
quickly, using recent technology in the industry. It will accomplish a rapid , accurate, safe , precise
service for ER patients
B- Mission statement
Step 1 : Establish projectStep 1 : Establish project
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1. To reduce the Central lab turn around time for getting the ClinicalChemistry result from 45 minutes to 20 minutes.
2. To manage the ER cases faster, reducing patient related mortality toless than 3%.
3. To capture 40% of the market share in the field of Emergencymanagement.
4. Increase customer satisfaction by at least 15%.
5. To increase the revenue of hospital as the project is expected to gainnot less than 100,000 LE by the first year of operation.
Goals
Step 1 : Establish projectStep 1 : Establish project
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C-Establishing a team
It is a cross-functional team formed of Chief Executive officer (CEO)
,the quality director and a representatives from the followingdepartments:-
ER department
Lab department
Nursing staff
Reception
Finance
Purchasing department
Supplier company
Maintenance department
Step 1 : Establish project
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Team Charter:
The team is expected to apply the steps of the qualityplanning process.
Team members are to spend a 5 hours each week. The team will have access to resources.
The ER nurses will be responsible for preparing the meetingagenda
The team is supported and authorized from the highermanagement , arrangements are agreed upon for obtainingany additional resources if needed .
Step 1 : Establish project
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D-Verify mission :Our quality planning goal respects the five characteristics
of the 'SMART' method as it is:
Specific as it deals with service provided to ER patientwho will need Chemical tests.
Measurable to perform 3000 lab analysis/month=3%market share.
Agreed upon after taking into account primary and
secondary research and facts from our market share data,we do believe that the objectives set are achievable
Realistic considering financial resources availably andmanpower expertise
Time phased it will be achieved in span of 7months .
Step 1 : Establish project
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1- Tree Diagram
In tree diagram each step is further defined bykey activities and tasks to be done.
The primary goals are subdivided to secondary
project goals or activities and activities are
subdivided to the major tasks that are most
related to the first level goals.
After the Team finished the Brain storming ,they
began using their tools for planning the project .
Step 1 : Establish project
bli h j
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B. Quality tool: Tree Diagram:-
Establish Newchemical analyzer in
ER lab
Establish the project
Establish the team
Verify the
mission
Plan the project
Identify customers
Create a flow diagram
List customers
and prioritize
Establish project
mission
Discover customer
needs
survey/interview key
customers
Complete needs
analysis
Determine unit of
measure and sensors
translate
Plan more data
collection
Design questions
Send questionnaires/
arrange interviews
Select sample s
List singledimension
needs
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Develop the service
Develop the
process
Optimize features
and goals
Select general
process design
Develop features
and goals
Identify operating
conditions
Identify process
features and goals
Publish final product
features and goals
Publish final product
design
Develop detailedfeatures and goals
Develop high level
features and goals
Determine methods
Optimize
Determine method
Identify process
anatomy
Design process
flow diagram
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Develop process
controls / transfer
to operations
Identify controlsneeded
Design feedback
loop
Plan for transfer to
operations
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It is a highly useful tool for taking a complex or long
term project and dividing it into specific tasks . Some tasks are performed sequentially while other
tasks on different paths do not depend on each otherand can be performed simultaneously.
It is often developed based on a tree diagram
2- Planning network
Step 1 : Establish project
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1/1-20/1
20days
Create flow
diagram
6/2-6/3
30days
Design
questionnaire
6/2-13/2
8days
Select sample21/1-5/2
16days
List
customer
&prioritize
7/3-22/3
16days
interview
7/3-10/3
4days
Sendquestionnaire
7/3-22/3
16days
Plan more
data
collection
23/3-22/4
31days
List single
dimension
needs
Planning Network
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23/5-7/6
16days
Determine unit
of measure &
sensor
23/4-22/5
30days
Place on service
design
spreadsheet
23/4-8/55
16days
translate
8/6-12/6
5days
Select high
level service
features &
goals
13/6-17/6
5days
Developed
detailed
service
features &
goals
18/6-22/6
5days
Determine
the design of
process
anatomy
CRITICAL PATH: The path with the largest total elapse time labeled by blue colors
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23/6-27/6
5days
Develop
process flow
diagram
28/6-4/7
7days
Construct
detailed
process
features &
goals
spreadsheet
5/7-7/7
3days
Develop
feedback loop
8/7-10/7
3days
Develop
process
control
spreadsheet
The overall project days = 192 days
CRITICAL PATH: The path with the largest total elapse time labeled by blue colors.Lost time for any of these tasks would put the entire project behind schedule
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Step 2: Identify customers
A. Construct a high level flow diagram
B. Construct a detailed flow diagramC. Create a list of all external customers
D. Create a list of all internal customers
E. Prioritize customers lists
F. Vital few customers
S 2 Id if
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ER physician making a lab request
ER nurse takes the suitable sample for the requested test
Porter delivers sample to the ER lab
Sample taken correctlyand suitable for testing?NO
yes
Lab chemist records the requested test and related information
in the ER lab register
Lab chemist performs the test on the sample and reads the
result
ER lab
reg
ER lab
req
A
D
etailedflowdiagram
Step 2 : Identify customers
St 2 Id tif t
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Lab chemist delivers the result to the lab dr
Lab dr interprit the result and write the report ER labreport
Lab porter takes the reportand deliver it to the ER phys
B
Step 2 : Identify customers
Is the
resultcritical?
NO
yesLab DR calls the
ER phys and report
him
St 2 Id tif t
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Internal Customers External Customers
ER physician ER patients
Porters. Families of patients.
ER nurse. Supplier of medical equipments
Administration staff. Ministry of health.
ER lab doctor. Health insurance organization.
Financial staff Market.
Purchasing,.
Lab chemist
Infection control team
Customerch
icklist
Step 2 : Identify customers
St 2 Id tif t
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It organizes data into sets of items to be
compared. The diagram graphically shows
relationships and/ or evaluates the strengths of
relationships between the items in each set.
The team brainstormed a list of possible criteria
to use in prioritization the external and internalcustomer
Impact (Prioritization) Matrix
Step 2 : Identify customers
St 2 Id tif t
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SELECTION MATRIX FOR PRIORITIZATION OF
EXTERNAL CUSTOMERS
Customer Revenue Impact
on our
image
Shut us
down
Decrease
morbidity
& mortality
Bring
new
business
Total
Patient 9 9 1 9 9 37
Suppliers 9 3 1 3 3 19
Patients
families
9 9 1 1 9 29
MOH 3 1 9 1 1 15
Market 9 9 1 1 3 23
Insurance 9 9 1 1 9 29
Scale : 9 ( very strong ) 3 ( strong) 1 ( weak)
Step 2 : Identify customers
Step 2 Identif c stomers
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SELECTION MATRIX FOR PRIORITIZATION OF INTERNAL
CUSTOMERSCustomer Revenue Impact on
our image
Shut us
down
Decrease
morbidity
Bring new
business
Total
ER physicians. 9 9 1 9 3 31
porters 1 3 1 3 3 11
ER lab
physician
9 3 1 3 3 19
Admission
staff
3 3 1 3 3 13
ER nurse 9 9 1 3 3 25
Finance staff 9 1 1 1 1 13
purchasing 9 1 1 1 1 13
Lab chemist 9 9 3 1 1 23
Lab clerk 3 3 1 1 1 9
Inf. cont team 3 3 3 9 1 19
Scale : 9 ( very strong ) 3 ( strong) 1 ( weak)
Step 2 : Identify customers
Step 2 : Identify customers
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Vital few customers were identified as follows:
Patient ( ext.)
Patient families ( ext.)
Insurance (ext)
ER physicians ( int.)
Lab chemist (int) ER nurse(int)
Vitalfewcustomers
Step 2 : Identify customers
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Step 3: Discover customer needs
A. Plan to collect customer needsB. Collect list of customer needs in their language
C. Examine and prioritize customer needs
D. Translate their needs into your language
E. Establish unit of measurement and sensors
Step 3 : Discover customer needs
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Understanding customer needs
The team decided to collect the needs of the
vital few external and internal customers. They
prepared different customer questionnaires and
conducted face to face interviews with the
customers.
Step 3 : Discover customer needs
Step 3 : Discover customer needs
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Questionnaire(for external customers)
Name: Sex: Occupation:
Please check your answers & explain when needed:
1- How often do you visit the Cairo university hospital?
2. How many times did you come to our ER ?3. Are you satisfied with our waiting time for results of our ER
laboratory?
satisfied Neutral Dissatisfied.
4. If you are not satisfied , please tell us why do u feel that way ?
5. How satisfied are you with our ER lab. Service?
6. How do you compare us with other similar hospitals providing ER
lab. Service?
7. What suggestions do u have to improve our ER lab service?
Step 3 : Discover customer needs
Step 3 : Discover customer needs
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Some answers were as following :
4. If you are not satisfied, please tell us why do you feel that way?
Delayed results of ER tests.
Multiple sampling trials.
Sometimes, there are errors in the reports.
ER devices look somehow old, not recent.
Delay in transporting samples to ER lab.
Re-analysis due to lab mistakes or sampling mistakes.
Painful, uneasy sampling. Unfriendly behavior of the personnel at the ER.
Not all the ER tests are always available at the ER lab.
Step 3 : Discover customer needs
Step 3 : Discover customer needs
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5. How satisfied are you with our ER lab service?
Its location is easy to reach.
Many ER lab residents available at the place.
7.How do you compare us with other similar hospital providing ER lab
service?
Same.
8. What suggestions do you have to improve our ER lab service?
Updating the ER lab service.
Step 3 : Discover customer needs
Step 3 : Discover customer needs
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Questionnaire ( for internal customers)Name: Sex: Occupation:
Please check your answers & explain when needed:1- Do you think that applying a new chemical analyzer in ER lab to avoid sending
sample to the central lab is a good idea and why?
2- Do you prefer a nurse to take the sample or a Lab technician and why?
3- Do you think the presence of work instruction attached to any device is a good
idea?
Yes No Somehow
4- What are your requirements for a new chemical analyzer device?
5- Do you think a 24 hour,7 days week availability of this service is a must?
Step 3 : Discover customer needs
6- Do you think explaining what goes on to the patient is important, why?7- Do you have any suggestion for a better lab service?
8- Do you need easy, rapid communication between ER dep and lab dep when
there is a critical values?
Step 3 : Discover customer needs
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Some answers were as following
1- Do you think that applying a new chemical analyzer in ER lab to avoid sending
sample to the central lab is a good idea and why?Yes it will decrease the TAT for central lab and will increase ability to rapidly
diagnose and management
2- Do you prefer a nurse to take the sample or a Lab technician and why?
A well , trained nurse
4- What are your requirements for this device?
Reliable, results , safe , rapid , user friendly ,calibrated , regular maintenance.
5- Do you think a 24 hour,7 days week availability of this service is a must?
Yes
Step 3 : Discover customer needs
6- Do you think explaining what goes on to the patient is important, why?
Yes
8- Do you need easy, rapid communication with the doctor when there is a
critical values?
Yes
Step 3 : Discover customer needs
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List of Customer Needs(ext. & int. customers)
Short TAT for test result
Accurate results with low error rate.
Skilled lab chemist
Taking suitable sample to prevent re sampling .
Availability of all ER tests.
Friendly device.
Using latest, easier & updated technology.
24 h/7 days week ER device service.
Safety.
Enough training on ER lab chemical devices.
Step 3 : Discover customer needs
Step 3 : Discover customer needs
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Privacy & security.
Written work instructions.
Contact with ER device supplier specialist in case of anyproblem.
Easy & rapid communication between ER dep and ER lab in
case of critical values.
Clarified criteria of ER device. Comfortable working environment ( availability of reagents
& materials)
Step 3 : Discover customer needs
List of Customer Needs(ext. & int. customers)
Step 3 : Discover customer needs
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Translation of customer needs:
Needs expressed asfeatures
Needs expressed as benefits
Using latest, easier & updated
technology.
Rapid, accurate & user friendly equipment.
Short waiting for ER testresults.
Lab. results arrive on time.
Accurate results with low error
rate.
The No. of reports repeated for not being
accurate in relation to total No. of delivered
reports per month.
Safety Provide manual for infection control.
Following the instructions in this manual.
Easy & rapid communication
between ER lab and ER dep in
case of critical values.
Lab DR have to call immediately ER doctors
in case of critical value.
Step 3 : Discover customer needs
Step 3 : Discover customer needs
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Translation of customer needs:
Needs expressed as
features
Needs expressed as
benefits
Availability of all ER tests. All are ER test kits and devices
should be available in the lab.
Contact with ER device/
supplier specialist in case of
any problem.
Calibrate before starting work.
Maintenance contract with supplier.
Customer satisfaction. No. of repeated customer/relatives
visits/ year for the same or other
service.
Step 3 : Discover customer needs
Step 3 : Discover customer needs
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Customer Needs Spreadsheet:
Step 3 : Discover customer needs
Step 3 : Discover customer needs
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Customer
Vital few
Using
latest,
technol
ogy
Short
waiti
ng
time
accurate
results
Commu
nic. for
critical
values
Availabilit
y of all ER
tests
24 hrs,7
days
week ER
device
service
safety written
work
instructi
ons
Patient 1 9 9 3 9 9 9 1
Lab
chemist
9 1 9 9 3 3 9 9
Patientfamilies
9 9 9 3 9 9 9 1
ER nurse 3 9 3 9 1 1 9 9
ER
physician3
9 9 9 9 9 1 1
insurance 1 3 3 1 3 3 3 1
Total 26 40 42 34 34 34 40 22
Scale : 9 (strong) 3( medium ) 1 ( week)
Step 3 : Discover customer needs
Step 3 : Discover customer needs
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Prioritized list of needsof external and internal customers
1- Using latest, easier, updated technology
2- Short waiting time for test results
3- accurate results with low error rate
4- safety
5-Easy,rapid communication with the ER physician in case of
critical values
6- 24 hrs,7 days week ER device service
7-written work instructions
8- contact with the device supplier specialist in case of any
problem.
Step 3 : Discover customer needs
Step 3 : Discover customer needs
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The team recognized that some of the needscollected from customers were broad and
required further definition in order to be
addressed.
So, the team decided to review the list of
needs and break them down to a precise
enough that a single response to each need
could be developed.They used a needs analysis spread sheet to do
this.
Step 3 : Discover customer needs
Step 3 : Discover customer needs
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Needs analysis Spreadsheet:
Step 3 : Discover customer needs
Step 3 : Discover customer needs
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Primary needs Secondary needs Tertiary needs
Safety Proper infection control
system
Implementation of infection control system in the
ER lab
Establish policy & procedure for infection controlWell ventilated
Properly cleaned
Implementation of safety measures for taking
sample
Rapid serviceRapid sample withdrawal
by the ER nurse.
Buying a new machine
using the recent updated
technology.
24h/ 7 days available lab
Chemist.
Providing a budget for buying the machine and
vacutainer materials.
Training courses for ER nurses on vacutanier.
Dividing the day to 3 shifts for the chemist
Accurate results Adequate calibration for
the machine.
Well trained lab chemist
Qualified lab doctors.
Checking the machine manual for required QC &
calibration.
Training courses for the Chemist. on the machines.
Choosing doctors with highest qualification & past
experience in ER lab.
Step 3 : Discover customer needs
Step 3 : Discover customer needs
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Primary needs Secondary needs Tertiary needs
Comfortable service
(24hrs,7 days available)
All ER tests are available.
Available kits & reagents.
Sample taking once.
Providing a budget for
buying a new machinedoing all ER chemical tests.
A store for the kits &
reagents inside the ER lab.
Trained ER nurse on takingsample.
Written work instruction Easy operation on the
device
From manual
Customer satisfaction Provided patient with
needed information
Effective treatment.
Education
Accurate result
S ep 3 sco e cus o e eeds
Step 3 : Discover customer needs
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Determine units of measures and sensors:
Customer need Unit of measurement Sensor
Rapid service ER lab T.A.T for chemical
analysis less than 20 min.
Numbers of ER results than took
more than 20 min.
Accurate results Complaints of ER
physicians.
No. of tests repeated.
Monthly questionnaire ER
physician.
No. of tests repeated permonth.
Comfortable service Yes/no Complaints report
Customer satisfaction No. of new patients using
our service.
Customer survey monthly
random.
Direct communication with
customer to view their
satisfaction.
p
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Step 4: Develop the service
A. Group together related customer needs
B. Determine methods for identifying product
featuresC. Select high level product features and goals
D. Develop detailed product features and goals
E. Optimize product features and goals
F. Set and publish final product features andgoals
G. Set and publish final product design
Step 4 : Develop the service
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Group together related customer needs:
The team should prioritize and group
together those needs which relate tosimilar functionality
(clustering the needs)
Tool: Affinity diagram
p p
Step 4 : Develop the service
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ER lab.Staff2
Highqualityneeds
ERchemical
tests
Safetyneeds
Trainingneeds
Reports
Qualified
doctors
Latest
technologyRapid results
Sample taking
once
Qualified lab
doctors.
Provided
patient with
needed
information
Availableporters Rapidresults AccurateresultsAll ER tests areavailable
Well trained lab
chemist Lab report withno errors
Well trained
lab chemist
Accurate
results
Short ER lab
turnaround
time
Accurate results Well trained ERnurse
User
friendly
All test kits
available
Regularly
maintained
Daily
calibration
Affinitydiagram
p p
Step 4 : Develop the service
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Brain storming: to identify product features.
Benchmarking:to make a point of comparison or measure what our
competitors have achieved with their ER lab matched to us.
Basic research:to explore the feasibility of the productand productfeatures
Market experiments:introducing and testing ideas for productfeatures which allow us to analyze our team's recommendations. This is
done through focus groups to compare our expectations with the actual
market requirements.
Determine methods
for identifying service features:
p p
Step 4 : Develop the service
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Select high level
product features & goals:
Available
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Customerneeds
Available
Service
test
Regular
mainten
ance
Calibrate
d
machineMachine
Latest tech
Qualified lab
physicians
Trained
Lab
chemist
199999Safety
999939Rapid
199999accurate
333311comfortable
133319Written workinstruction
933333Customersatisfaction
931911
Availability of
all chemicaltests
Service
available
24/7
Accurate
results
longer
life span
int. & ext
quality
proficien
cy?
Model 2010-
2011Master Degree
Well
trained
Lab
chemist
Servicefeature goals
333937452741Total
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Step 5:Develop process
A. Review product goals
B. Identify operating conditions
C. Collect known information on alternateprocesses
D. Select general design
E. Identify process features and goals
Step 5 : Develop process
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The main activity:
Process anatomyProcess flow diagram
Process features & goals spreadsheet
Step 5 Step 5 : Develop process
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Process development is the activity which
determines how our lab service will be
delivered, the aim of process development
is to provide the operating forces with
means for meeting operating goals
Step 5 Step 5 : Develop process
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Process anatomy
It is a coherent structure which binds or holds the
process together.
It guides the flow of the work from start to finish.
Shows in schematic form where the various sub-processes reside, how they are linked together, and
where the inputs enter and the outputs go.
Step 5 : Develop process
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Item Process Process anatomy
Macro process Chemical analyzer Assembly tree
Sub process Lab request Assembly tree
Withdraw sample Procession
Performing the test Procession
Report Procession
Processanatomy
Step 5 : Develop process
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Patient
Administration
Admission
Investigation
Labreport
Medical / record
Main lab
Nursing
Physician
Lab register
Finance
Lab chemistProcessanatomy
Assemblytree
Step 5 : Develop process
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Lab request
Withdraw sample
Performing
The test
ReportDelivering the report Writing the report
Calibrate the equipment
Preparing the patientSafety measures
HIGHLEVELFLO
WD
IAGRAM
(PROCESSA
NATOMY)
Step 5 : Develop process
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Process features & goals spreadsheet
The process features can be categorized underprocedures, methods, equipments and supplies,materials, people, training and knowledge and otherresources.
The process goals are like other goals should beSMART
Step 5 : Develop process
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Proces
sfeaturesand
goalsspreads
heet
Process features
Service features Service goals Procedure People equipment Material
Trained Lab
chemist
Well trained for
(2weeks) Lab chemist
O * O O
Qualified lab
physicians
Master Degree # # O O
Machine Latest
technology
Model 2010-2011 * O * *
Calibrated machine int. & ext quality
proficiency
O * * *
Regular
maintenance
Accurate results longer
life span
* * * *
Available
Service test
Service available 24/7 * * # #
Process goals
* Very strong
# strong
O weak
90 % of
results
achieved
95% of
people do
the required
job
95% of
equipment do
the required job
90% of material
r available
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Step 6:Develop process controls
/ transfer to operations
A. Identify controls neededB. Design feedback loop
C. Plan for transfer to operations
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Feedback loop
Feedback loop is the tool for
monitoring the actual performance of
a process and keeping it performing
as it was designed
Step 6 : Develop process controls/transfer to operations
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Step 6 : Develop process controls/transfer to operations
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Process control spreadsheet
This tool will enable the team to identify:-
1. The control subject.
2. The target goal
3. Criteria for taking action
4. Who takes action
5. What action they take
6. Where they do it7. When they do it
8. How they do it
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By phoneimmediately
Mantainence
dep.
Call the
maintenanc
e
Seniornurse
Brock down of
any device
100%accuratedevice
Functioni
ng
device
Formal
request
After 1 m of
completionof initialtraining
Organization
management
More
training tostaff
Head of
lab dep
More than 3%
error
100% ptsatisfaction
Calibrati
on andset
errors
Standard
method
Once
discovered
ER labDiagnoseof the
cause ofdelay
Head ofLab dep
More than 20
min
Max 20min
Long TAT
Formal or
oral request
After one
month of
training
Organizationmanagement
Calls formore
trainingnurse
Head ofER
More than 10 %
of cases need
more than
withdrawal trial
Rapid,Painlesssample
withdrawalfrom thefirst time
% of
multiple
sampling
trials
Process control spreadsheet
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