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How to make six equal one: Networking laboratory operations

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How to make six equal one:
Networking laboratory operations
Linda L. Smith
Executive Director,
Laboratory Services
SSM St. Louis Network
How to make six equal one:
Networking laboratory operations
SSM Health Care
16 hospitals in 4 states
(IL, MO, OK, WI)
6,500 staff physicians
24,000 employees
Bill Thompson
CEO since Aug 11, 2011
Sister Mary Jean Ryan
CEO for 25 years
“Through our exceptional health care services, we reveal the healing presence of God.”
How to make six equal one:
Networking laboratory operations
Jim Sanger
SSM St. Louis CEO
Nov 2007 – Dec 2011
Chris Howard
SSM St. Louis CEO
January 1, 2012
How to make six equal one:
Networking laboratory operations
In 2008, led by SSM St. Louis CEO Jim Sanger, the SSM St. Louis Network
reorganized operations to transform 7 hospitals who competed with each other
into an aligned, collaborative “network” capable of winning primary market
share in the St. Louis community.
To support that goal, the SSM St. Louis laboratories had to become “one
laboratory at six different sites”.
Laboratory services needed to be consolidated where it made sense to
consolidate and lab operations had to be standardized around clinical and
operational best practices.
SSM Health Care St. Louis Network - 2,500 staff physicians, 11,500 employees
•
SSM Cardinal Glennon Children’s Hospital ( St. Louis, MO)
190 pediatric beds
SSM DePaul Health Center (Bridgeton, MO
457 beds
SSM St. Clare Health Center (Fenton, MO)
154 beds
SSM St. Joseph Health Center (St. Charles, MO)
352 beds
SSM St. Joseph Health Center (Wentzville, MO)
74 inpatient behavioral health beds
SSM St. Joseph Hospital West (Lake St. Louis, MO)
122 beds
SSM St. Mary’s Health Center (Richmond Heights, MO)
525 beds
SSM Rehabilitation Hosital (Bridgeton, MO)
60 rehab beds
6 laboratories (387 employees)
4 rapid response labs
1 “core” lab; 1 microbiology lab
1 pediatric lab
•
Minimal lab outreach
•
SSM-owned physician organization contracts with LabCorp
•
LIS пѓ HBOC Star; going live with EPIC Beaker in 2012-2013
Lab
Team Leader
FTEs/People
# Supvs
(Lab Manager)
Cardinal Glennon
Vickie McCullough
52 / 62
3
DePaul Health Ctr
Victoria McClellan
46 / 48
4
St. Clare Health Ctr
Cathy French
40 / 49
1
St. Joseph Health Ctr
Cindy Strawhun
45 / 53
4
St. Joseph West
John Konys
29 / 35
2
St. Mary’s Health Ctr
Dean Powell
68 / 79
4
Network Microbiology
Denise Nenninger
31 / 38
1
Our Team Leaders represent our “vital link”!
Overall performance excellence happens through them!
Employee engagement is their primary job, highest priorty.
L-to-R back row:
Cathy French, Cindy Strawhun, John Konys,
Dean Powell, Victoria McClellan (new)
L-to-R Front center : Denise Nenninger, Vickie McCullough
We’ve found that in these positions, we MUST have the
“right person on the bus” !!!
Primary employee engagement strategy: H-M-L
Since 2009, SSM St. Louis laboratory teams have worked together to:
•
•
•
Standardize goals, procedures, practices and performance tracking for the following:
o
Administrative policies/procedures
o
Quality management
o
Patient and employee safety
o
Staff competencies and performance
o
Financial operations
Consolidate services that reduce cost and improve quality:
o
“Lab-to-Lab” testing
o
Microbiology
o
Convert rapid response lab at behavioral health facility to POCT
o
Histology
Improve quality and reduce total costs through employee engagement and
collaborative teamwork.
How to make six equal one:
Networking laboratory operations
Standardizing goals, procedures, practices and performance tracking
for the following:
o
o
o
o
o
Administrative policies/procedures
Quality management
Patient and employee safety
Staff competencies and performance
Financial operations
How to make six equal one:
Standardized metrics & goals - benchmarked
2010 Network Exceptional Performance Award Winner:
SSMSL Network Labs ED Turnaround Time Performance
Category: Exceptional Team Innovation
•
Premise: Improving lab’s ED turnaround time
o
o
•
•
•
•
Improves ED patient throughput and quality
Improves physician and patient satisfaction (both ED & inpatient
Standardized data collection and analysis
Used standardized data and analysis to assess “current state”
Engaged laboratory staff to create improvement action plans
Monthly reporting, shared best practices, frequent recognition/celebrations
SSMSL Team Performance Awards
Congratulations!
How to make six equal one:
Standardized metrics & goals - benchmarked
How to make six equal one:
Standardized metrics & goals - benchmarked
SSMSL Blood Conservation Team пѓ decreased utilization and cost
SSMSL Total Hospital Costs
Blood & Blood Product Cost/APD
2011 Actual Cost /APD
2010 Actual Cost/APD
Jan
$
$
Blood and Blood Product Cost
Adjusted Patient Days
$
$
Year 2011
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
6.10 $
6.52 $
7.16 $
6.47 $
7.45 $
8.34 $
6.79 $
5.56 $
6.23 $
6.36 $
6.77 $
9.08 $
6.14 $
6.86 $
5.91 $
6.50 $
6.51 $
7.24 $
6.28 $
6.17 $
7.36 $
6.96 $
7.33 $
8.08 $
6.90
6.78
360,559 $ 353,512 $ 451,530 $ 375,339 $ 442,573 $ 487,511 $ 388,625 $ 353,393 $ 379,406 $ 392,539 $ 413,083 $ 548,351 $ 4,946,421
59,144 $ 54,249 $ 63,026 $ 57,983 $ 59,388 $ 58,446 $ 57,255 $ 63,603 $ 60,903 $ 61,735 $ 61,011 $ 60,362 $
717,105
2005 cost = $6,404,000
2006 cost = $6,046,000
2007 cost = $5,017,152
2008 cost = $5,290,273
2009 cost = $4,938,273
2010 cost = $4,596,424
2011 annualized cost =
$4,946,421
RBC cost raised from $181 per unit to $190 in June of 2007, raised to $200 in early 2008
Our teams created �1 lab at 6 sites’
Accomplishments:
Standardized policies and practices for:
Proficiency testing performance
Competency
New lab employee orientation
Continuing education
Network-standardized lab competencies.
“ONE Lab” new lab employee orientation
implemented in all labs.
Won 2010 Exceptional Commitment Team
Award for our work in setting up CAP
Online Courses for employees to use
as CE program.
SSM St. Louis Lab
Education Council
SSM St. Louis Lab
Education Council
Team Charter
Our teams created �1 lab at 6 sites’
Accomplishments:
Developed network Quality Management Plan and
standardized in all labs. Includes standardized format for
annual review and assessment.
Standardized laboratory administrative policies/procedures
for all Network labs.
Standardized tracking and reporting of lab quality events
using the occurrence reporting system.
Standardized a laboratory document control process using a
systematic SharePoint format.
Performed consistent review and assessment of network lab
quality indicators including:
Patient ID errors
Lab accuracy errors
Proficiency test survey “unsatisfactory results”
Specimen rejection rates
Critical values reporting
Quality control outliers
SSM St. Louis Lab
Quality Council
SSM St. Louis Lab
Safety Council
Project Goals from Charter:
1. Monitor lab occurrence safety codes quarterly.
2. Identify trends and recommend corrective action.
3. Review safety policies to determine “best practice”
for the standardization of SSM Network Labs.
4. Promote a safe work environment by providing
safety education for laboratory personnel.
Our teams created �1 lab at 6 sites’
Accomplishments:
1. The 2011 safety education topics shared throughout the
Network included:
SSM Emergency Code Education: Code Orange
Specimen Transport
Personal Protective Equipment
Ergonomics
MSDS
General Safety
Lab Safety Scavenger Hunt
Safe Work Practices
Chemical Hygiene
Fire Safety
Electrical Safety
Waste Management
2. Purchased/shared the NCCLS/CLSI Safety
DVD set throughout Network labs.
3. Network disaster plans implemented and made available to
staff via on-line network policies.
4. Council meeting agendas, meeting minutes, and employee
injury reviews maintained on the SharePoint website.
5. Began the network process of standardizing laboratory
safety policies and procedures – final completion in early
2012.
Hematology Supervisors
Accomplishments:
Standardized procedures for Sysmex (6 labs)
Collaboration on 5000/1000 validations
Collaboration on interface validations
Network “mock” inspections in 2011 and 2012
(Training for new team leaders and supervisors)
Preparation for system CAP inspection in 2014:
Policy/procedures standardization (in progress)
Standardizing checklist practices
Standardizing checklist responses
Chemistry Supervisors
Accomplishments:
Standardized procedures for Siemens Vista (5 labs)
Collaboration on Vista validations
Collaboration on Vista interface validations
Network “mock” inspections in 2011 and 2012
(Training for new team leaders and supervisors)
Preparation for system CAP inspection in 2014:
Policy/procedures standardization (in progress)
Standardizing checklist practices
Standardizing checklist responses
Our teams created �1 lab at 6 sites’
2011 Siemens Chemistry Go Lives
(SSM Corporate Contract/CCG/Premier)
2011-2012 Sysmex Hematology Upgrades
(SSM Corporate Contract/CCG/Premier)
Replaced Ortho Clinical Diagnostics chemistry:
17-year old Vitros instruments at SMHC and SJHC
Upgraded Sysmex Hematology Analyzers:
All 6 network labs (Wentzville has small Sysmex)
Standardized at 5 adult hospitals:
1. Siemens Vista 1500s and 500s
2. SMHC & DPHC пѓ 1500/500 combo
3. SMHC пѓ Centaur for network lab-to-lab chemistry
4. Go Lives :
SMHC
June, 2011
SJHC
June, 2011
DPHC
August, 2011
SCHC
September, 2011
SJHW
October, 2011
5. In-lab/between-lab collaborations, validations
6. Strong vendor support
7. Significant cost savings for network
Standardized at 6 hospitals:
1. Sysmex Alpha, 5000 and 1000
2. SMHC & DPHC пѓ Alpha/5000 and 1000
3. 4 sites пѓ 5000 and 1000
4. Go lives in progress since late 2011
5. In-lab/between-lab collaborations, validations
6. Strong vendor support
7. No total annual cost increase
(Also standardized with Siemens AUWi for UA.)
Our teams created �1 lab at 6 sites’
Blood Bank Supervisors
SSMSL Blood Conservation Team (since 2004)
1. Reduced blood product utilization
2. Reduced cost
Standardized:
1. Utilization statistics
2. Blood wastage reports
3. Transfusion audit reports
4. Specimen rejection data
5. Blood bank occurrence reporting
6. Transfusion reaction forms
7. Emergency release of blood forms and practices
8. Policies/procedures in Sharepoint Document Control
folder
9. Working on network Massive Transfusion Policy
10.Working on network quality management plan for BB
Successful network HCLL upgrade April 2012
SSMSL Blood ConservationTeam since 2004 пѓ decreased utilization and cost
BB supvs, lab Med Dirs, hospital VPMAs and med staff, MVRBC
SSMSL POCT Coordinators
Our teams created �1 lab at 6 sites’
POCT Network Team began in 2008 – recently became SYSTEM team.
Significant accomplishments:
SSMSL EPIC implementation – standardization of network POC processes
Identified 6 key areas for SSMSL Network POC Standardization
• Operator ID badges - Standardize unique ID # required
• Bar code patient ID armbands - Standardize unique patient ID # required
• Online cert/recert test - Standardize POC test cert/recert training
• Procedures - Standardize POC test cert/recert training
• Quality Assurance Program - Standardize POC QA Program
• Data management standardization
New POC testing implemented:
• Whole blood creatinine with peer group proficiency testing
• PFA testing
• Coag clinics
• Off-site lab support – QA and regulatory oversight
Led evaluation/selection of new POC glucose vendor and POC-Glu data management system
(SSM uses Lifescan)
What’s next?
Expand P-web application for all POC connectivity and data standardization
Shared connectivity between sites will allow easier access to operator training records / compliance
Considering POC Lactic Acid for ED and critical care units – sepsis initiative
completed
completed
completed
completed
in progress
in progress
How to make six equal one:
Networking laboratory operations
Consolidated services to reduce cost and improve quality:
o
o
o
o
“Lab-to-Lab” testing
Microbiology
Convert rapid response lab at behavioral health facility to POCT
Histology
SSM St. Louis
Lab-to-Lab Testing
SJHC
St. Charles, MO
Lab-to-Lab Testing
Esoteric chemistry/hematology – Core Labs
SMHC performs high $/test tests for network labs
Until 2011, SJHC performed full-service toxicology
SMHC
St. Louis, MO
Network microbiology consolidated at SJHC
Network virology consolidated at Cardinal Glennon
Future: network allergy testingпѓ Cardinal Glennon
Cardinal Glennon
Children’s
Medical Center
Before story – partial consolidation
CGCH, SJHC, and SMHC – partial consolidation
Equipment in all 3 labs very old
No standardization – everyone did �their own thing’
Quality oversight ???
Consolidation Project
Weekly meetings – took the whole “village”
“Engaged” ownership demonstrated by ALL
Action items consistently executed well
Intensely collaborative problem-solving, openness to change
After story – One Network Microbiology
Space and cost-renovation determined location (SJHC)
3 lab teams joined together to be 1 team
New Vitek 2 system with 2 readers
New BD Bactec FX blood culture instruments
Data management system
Network lab Manager
Network Microbiology medical director
Standardized
Specimen collection and supplies
Policies, procedures, reporting
Quality indicators and monitoring
Financials
SSM St. Louis 2010 - 2011
Consolidated Microbiology
Consolidating Microbiology:
After story пѓ results
New HBOC module пЃЊ
Integration of micro staff from 3 very different labs
2011 Press Ganey Employee Survey пЃЊ
2012 Press Ganey Employee Survey 100% participation
2011 Survey results пѓ 2nd %tile; 2012 пѓ 66th %tile
New manager пЃЉ
New medical director
Improved quality of clinical results
Turnaround time пѓ met, then exceeded вЂ�before’ TAT
Strong physician satisfaction (even at Glennon)
Cost effectiveness:
Cost per test from $11.90 пѓ $10.40
Annual savings in 2011 ~ $400,000
No RIF but wrkd hrs/unit significantly decreased
2011 Network Exceptional Performance Award Winner:
SSMSL Network Microbiology
Category: Exceptional Team Financial Performance and Growth
•
•
•
•
•
•
Consolidated 6-hospital microbiology testing to one site
Successfully increased microbiology coverage to 24/7
Standardized specimen collection and product utilization
Significantly improved clinical quality performance
Improved turnaround time and physician satisfaction
Annual microbiology operations expense decreased by 9%
SSMSL Team Performance Awards
Congratulations!
SSM St. Louis 2010 - 2011
POCT Lab at Behavioral Health Hospital
Before story – rapid response lab
SJHC – Wentzville Behavioral Health Hospital
Small ED serving primarily Behavioral Health
Rapid response lab = 10 FTEs (from pre BH era)
SJHW rapid response lab just 6 miles away
SJHC
St. Charles, MO
Rapid Response Lab пѓ POCT in ED Project
Lab team worked with ED, BH physicians, and nursing
Identified essential “onsite” testing
Developed multidisciplinary consensus on new model
HR and lab leaders worked closely with lab employees
No RIF–100% Wentz lab employees still working for SSM
Wentzville
After story – ED POCT lab at Wentzville
Lab supervisor provides Wentzville QA oversight
Same supervisor leads phlebotomists at West
West phlebs provide routine phlebotomy at Wentz
ED patient care tech and nurses perform POCT
Non-POC routine testing goes to SJHC in St. Charles
STAT testing (if not onsite) goes to West (6 miles away)
Current lab FTEs < 1.0; ED increase ~ .3 FTE
Proficiency testing, clinical quality, TAT excellent
Annual cost decrease in 2011 ~ $375,000
SJHW
Lake St. Louis, MO
SSM St. Louis 2012 – 2013 Histology Consolidation
Current Project
SJHC
St. Charles, MO
Converted onsite transcription to electronic service
Transcription FTEs reduced from 14 to 4.5
100% lab transcription employees still working for SSM
Significant cost reduction
Cardinal Glennon pathology services provided by
St. Louis University Department of Pathology
Pediatric needs differ from adult hospital needs
Developing contract to outsource CG histology to SLU
5 adult hospitals current partial consolidation:
SMHC histology dept пѓ SMHC, DPHC, SCHC
SJHC hisptology dept пѓ SJHC, SJHW
Plan: Consolidate histology for 5 adult hospitals at SMHC
Purchase one new IHC stainer (Ventana Benchmark Ultra)
Expand into space previously used by microbiology
Merge staff
SMHC
St. Louis, MO
Cardinal Glennon & St. Louis Univ Hosp
Laboratory Consolidation: What’s possible?
Rapid response testing for acute patient care is ~ 65-75% of total test volume in a
hospital laboratory.
Physicians expect/require test results with a 30-90 min ORDERED-VERIFIED TAT in
order to diagnose and treat acute care patients. Rapid response TAT supports ED
throughput and inpatient bed control/LOS control.
�Large box’ analyzers are necessary to perform large volume rapid response testing
with required TAT. POCT has not evolved to replace them (yet?).
Other experiences or models that meet hospital acute care needs???
3 rapid response labs:
3 “core” labs:
2010 – SSM STL Level of Consolidation
2012 – SSM STL Level of Consolidation
Summary: SSMSL “ONE” Lab Total Cost-per-test
Year
“ONE” Lab
(6 lab financial roll-up)
2008
$ 10.67
2009
$ 11.16
2010
$
9.99
2011
$
9.24
2012
$
8.31
How to make six equal one:
Networking laboratory operations
Summary:
Lab teams have collaborated effectively and truly “engaged”.
Lab leaders are sharing all performance information – transparency.
Significant standardization achieved throughout our 6 network labs.
Consolidation efforts have improved quality of results and reduced costs.
As you’ve seen, our accomplishments took the entire “village”.
Lab employees take great pride in their �results’ and are demonstrating
exceptional ownership for creating meaningful change and improvement.
Now, in 2013, lab employees are doing an extraordinary job of meeting all
our goals, including operational/financial goals !
How to make six equal one:
Networking laboratory operations
What’s next:
In 2012-2013, EPIC Beaker replaced HBOC STAR.
Our PO contracts with LabCorp – we hope to bring that back to our labs.
Deal with lower reimbursement, soft volumes, higher costs ???
Utilization – hospitals can’t afford unnecessary testing.
Future proofing:
Continue to build employee engagement and ownership accountability.
Continue �networking’ and collaborating to get best practice results.
Get out of the lab - become a more visible contributor to patient care.
Find out what YOU’RE doing well and “steal shamelessly”.
(SMJR)
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