Stanford Health Care Laboratories (Palo Alto, CA) is responsible for testing millions of specimens per year. The esoteric labs test a large portion of those specimens. They use a wide variety of instrumentation, processes, and staff in order to ensure results are accurate and timely. Over the past several years, Stanford has incorporated many quality initiatives to enhance patient experiences. Every aspect of care focuses on quality improvement to optimize processes. The laboratory department has undergone a multi-year effort to 5S every laboratory with the goal of improving the organization of materials and supplies, in order to improve workflow. Also, there has been a heavy focus on improving communication, decreasing errors, reducing turn-around-times (TATs), and optimizing customer service using huddles, gemba rounds, root cause analysis and highlighting the investigative efforts and results using A3 reports.
Recently, I had the pleasure to sit down with Merrie Bass, Stanford Health Care (SHC) Laboratory Operations Manager. She has been a laboratorian for 38 years, of which, 12 have been as the Operations Manager at SHC. We had a discussion about how laboratory quality has progressed over the years and how it has affected the 8 esoteric laboratories she oversees. She currently manages Microbiology, Virology, Special Chemistry, Molecular Genetic Pathology, Flowcytometry, Biochemical Genetics, RBC Special Studies, and Hillview Pre-Analytical.
When did you first learn about Quality Improvement and Quality Management?
As a CLS student in Nebraska, it was taught to us really early on in our training. I can’t remember a time not being involved in quality, mainly in procedures and quality control. Also, a QA manager here at Stanford long ago around 2006 created a quality competition between the cost centers (laboratories). Each cost center presented a quality improvement project and staff voted for the most beneficial to the hospital. It was fun and got med techs (clinical laboratory scientists) involved because staff did the work.
What is your favorite quality tool or method? Why?
Using visibility walls to display Press Ganey scores. With the scores on the visibility walls, staff are reminded that there are patients involved. It helps to link an actual person to that specimen they are testing. Being in the lab usually means very little contact with patients and the scores link the specimen to their testing, which can be tied directly back to the scores.
What is your impression of the evolution of laboratory quality over the years?
It has gotten better and better. You can’t have too much quality in the lab.
In your opinion, how has Stanford embraced quality in the laboratory?
The lab has its own QA dept. The QA manager and 4 Quality Coordinators are very helpful and are a very good resource. They are happy to assist with any projects and work with supervisors to make those projects a success by bringing QA and compliance knowledge to each project.
Do your labs perform process improvement projects and if so, how are they initiated?
Improvement projects are often in response to events submitted through the Stanford Alerts for Events System (SAFE), overtime, complaints, prolonged TATs, error rates, and the number of redraws. They look at what can we do to improve.
What are some examples of current process improvement projects in your labs?
In Special Chemistry, they are looking at repatriation, the process of bringing specimens that were sent out for testing back to in-house testing by making the process faster and cheaper. One way we have accomplished that is by using mass spectrometry. There are several tests that we were able to repatriate due to improving the testing process.
Another example is how Microbiology looked into reducing the number of phone calls to the department by investigating why doctors and nurses were calling. It really became a problem and it was leading to an increase in employee dissatisfaction. It is an ongoing investigation and we are using the A3 method to document our results. We actually applied to the Radiology’s RITE program for this project, but we were not accepted. It is a very competitive program.
What is the RITE Program?
The RITE (Realizing Improvement through Team Empowerment) Program is sponsored by the Stanford Radiology Department. It is an intensive 10-session, 20-week interdepartmental program where different departments apply to have their quality improvement projects included . Once accepted, the program teachers help shepherd the projects to successful completion by providing guidance and input; they are very enthusiastic, thorough, and knowledgeable. Participants undergo training and instruction in quality improvement methods.
Describe your involvement with each department’s process improvement projects?
I serve as a champion of their projects and provide support to ensure that they have all the resources that they need to be successful. I communicate and work with the supervisors who are the experts in their laboratories to ensure that the process improvement project is kept on track.
Where do you see process improvement in Stanford labs moving to in the future?
The laboratory QA department has many great ideas and fresh eyes. The support they provide is invaluable because if you don’t have support and something is broken, you don’t know how to fix it. That is the purpose of the QA dept. I am very optimistic about quality here at Stanford Labs, as the right projects get developed, they may go hospital-wide. I think we will do more, not less.