Katie Castree always wanted to work in the healthcare industry. Finding a passion for business and process improvement, she set her sights on a master’s degree in health administration followed by a Six Sigma Black Belt certification. Katie then found success in the simplicity of making things run smoothly, as a Senior Performance Improvement Specialist, and recently as an Operations Excellence Manager focused on the hospital laboratory. HPI met up with Katie to talk about the application of process improvement principles in healthcare and the impact of her work in the midst of the current healthcare crisis.
Process in Practice
Today Katie focuses on delivering measurable improvement for the laboratory in three areas – productivity, quality, and service – by implementing Lean Six Sigma practices, identifying opportunities for improvement, and leading initiatives to deliver the improvements. This involves a lot of facilitating and coaching clients, sharing tools and methods, defining, and measuring new metrics, and analyzing data to improve and also sustain the improvements made. There’s a lot of communication involved as I serve as a change agent, influencing teams and driving results.
Katie manages projects over multiple years beginning with an extensive assessment of each lab department. Over the initial few months of an engagement, there is an intense review of all workflows, including observation of all three shifts. There are some pretty long, odd hours but it’s essential to identify what strengths and best practices are already in place. A dozen or more opportunities might also be noted in the assessment of a single department, varying from easy changes to larger scale initiatives. We prioritize opportunities by the effort required to make a change as well as the impact it will have on the lab. Of course, as new opportunities come to light post-assessment, those can be prioritized and added to the improvement plan as well.
The unique part of Katie’s work is her team’s support of implementation through “boots on the ground” and project management. If we’re going to implement a new process to complete the inpatient morning blood draws in a different way, for example, I’m going to be the one working hand-in-hand with the supervisor – training the staff, making sure that the lab team is collaborating with nursing on the changes, creating communications for the hospital, getting new supplies that they may need, writing Standard Work, and collecting and analyzing data before and after the change. Then, during the implementation week of a new process, I’ll be going with the team on their collections. Day or night.
Katie continues: It’s really important to monitor sustainment after making a process change and initial improvement. To accomplish that, we create a Control Plan. We try to avoid any process deterioration among the team. We identify any of the tasks that need to be completed, who is going to own them, and the timeline for that to be completed. Asking regularly for feedback, doing daily huddles, and celebrating with staff following implementation are also best practices. This consistent review and course correction is the missing link more often than not in project success, and the reason why so many health system labs haven’t been successful in some of these improvements yet.
Process Improvement Meets COVID
Katie has participated in several efforts in response to the current healthcare crisis. We asked her to share some examples and takeaways from these experiences to-date. She quickly reflected on two.
One area we have assisted has been avoiding getting to critical levels of staffing due to the virus. We have developed a lab scheduling proposal to minimize opportunity for the spread of COVID-19 among staff, while still allowing hospitals to staff the lab appropriately. Similar staffing models have actually been used in other industries for years, where coworkers are assigned to team A or team B and each team has their assigned three eight-hour shifts – day, evening, and overnight. Each team works seven days on, seven days off, so they’re not interacting with each other.
Another example was development an emergency response plan should a lab get to a critical level of staffing. This included an emergency response test menu that maintains quality and critical care services while providing high value testing onsite and moving other testing to another location. One lab could function as the centralized core hub, still having complex COVID-19 negative patients who require a lot of specialized testing. A second lab could function as an alternate core hub, but smaller satellite sites would only perform tests on the emergency menu and would send everything else to the core hub. A change like this requires administrative approval and input from the Med Exec Committee, as well as a notification system to alert all sites when the emergency response test menu has been activated.
Katie continues to reflect on her COVID work to-date, recognizing that clients have been struck by just how quickly they can move things that would have normally taken months to implement. In an environment where things have had to be done out of necessity, the healthcare system has pulled together to move quickly. The pandemic has also forced the industry to finally recognize the vital role of the medical lab professional and that the hospital laboratory can provide financial stewardship and quality improvement opportunities, leading to better patient care.
Don’t Stop Now
Katie doubles down on the “we can” thought process circulating today as she observes healthcare organizations wrestling with pausing current quality, process improvement, or cost-saving efforts while they continue to deal with the pandemic. This might appear to provide focus in the short-term, but these needs are not going away. The Institute for Healthcare Improvement (IHI) recently weighed in as well, stating that the healthcare institutions who are doing the best job of handling COVID-19 are using not only epidemiology, but also quality improvement principles and methods. At critical times like this, (hospital labs) can’t afford to be spending time on wasteful processes or practices that produce defects or low quality. The time is now to implement change, one step at a time. Sharing a favorite quote, Katie leaves us with a final, impactful thought.
“The revolution is not an apple that falls when it is ripe. You have to make it fall.”
We cannot wait for change to happen naturally because it might not, or for someone else to bring about change because they might not. We must take on change ourselves.
We have to be proactive about improvement.