Public Health Laboratory: Influenza Process Improvement Kaizen

Summary

Impact Statement:

The Kaizen event approach was selected to involve the Minnesota Department of Health (MDH) Public Health Laboratory (PHL) team in reducing the percentage of influenza tests taking longer than 6 days to verify and eliminate testing errors. Within 4 months, errors were eliminated and test time length was decreased from 25% to 17%.

Summary:

A team from the MDH PHL embarked on a quest to improve the influenza testing process. The laboratory receives more than 4,500 specimens for influenza testing per year from hospitalized influenza patients. It is critical that specimens received are tested in a timely manner so that changes in influenza activity or detection of a new influenza virus strain can be found immediately. This process not only affects partner epidemiologists who track influenza activity throughout the season but also the Minnesota hospitals that submit specimens from hospitalized influenza patients.

Influenza testing at the PHL defines trends in influenza activity in Minnesota. Data generated by this testing are used to determine whether a new influenza virus strain is circulating or whether it matches the yearly vaccine. It is critical that the influenza testing process maintains the highest quality assurance (QA) standards. Before the improvement process, the roles and responsibilities of everyone on the testing team were not well defined. This led to an inconsistent process in which some areas had too many quality checks and some areas did not have enough. As a result, some specimens were taking too long to test, and some (very few) had the wrong type of test done. Improvements to the process resulted in zero testing errors compared with the previous year and a 13% reduction in the number of specimens that were tested outside of the 7-day turnaround goal.

Organization that conducted the QI initiative:

MDH

Citation:

Lenartz, S. Public Health Quality Improvement Exchange. Public Health Laboratory: Influenza Process Improvement Kaizen. Mon, 10/23/2017 - 15:26. Available at https://phqix.org/content/public-health-laboratory-influenza-process-improvement-kaizen. Accessed May 28, 2023.

Background and Aim

Aim statement:

While influenza tests are run twice a week, reduce the percentage of specimens that take longer than 6 days to verify. • In 2012–2013, 55% of specimens took longer than 6 days; 25% took longer than 8 days. • From October to November 2013, 25% of specimens took longer than 6 days. The goal is that less than 10% of specimens will take fewer than 6 days to verify from the time of receipt. This goal was set for periods with at least a twice-per-week testing load. Kaizen goals were as follows: • Reduce testing errors to zero (a testing error is a specimen for influenza that was tested for something else or vice versa). • Implement necessary and appropriate QA checks. • Reduce handoffs from processing to results. • Improve communication among all staff members handling influenza specimens.

Need For The QI Initiative:

The following issues demonstrated the need for a quality improvement (QI) initiative: • Too many specimens were coming in from too many projects. There needed to be a streamlined process for • recognizing what project each specimen is for, • getting it tested in the appropriate time frame based on the project, and • dealing with a surge of specimens or a few specimens that need high-priority treatment. Other issues included the following: 1. QA is at risk. • The wrong test has been done on some specimens; for example, influenza testing was done on specimens that came in for herpes testing. One error was not caught, and a second was caught only as the results were entered after testing. • It is not clear whose responsibility it is to check the tubes against the paperwork. • It is not clear when it is best to assign tests and by whom (the person processing the specimen or the person running the polymerase chain reaction [PCR] test). • There is no mechanism to check that the tests requested are being requested. • What communication should there be about different specimens? 2. There are too many exceptions to the standard workflow, and they cannot be eliminated. • For example, all specimens that come in for influenza testing get PCR testing done, except when they come in as isolates. • For example, influenza tests are run every Tuesday/Thursday except when a high-priority specimen comes in. • Some specimens need other testing done besides the influenza test. 3. Result entry and verification are time consuming and are slowing down turnaround time.

Area for Improvement:

Areas for improvement include improving communication among all staff handling influenza specimens, reducing handoffs, and implementing appropriate QA checks.

Root Cause:

Root causes of time delays and testing errors included the following: • There was a lack of defined roles and responsibilities of both the verifier and the processor, including what demographics must be checked. • No documentation existed to cross-check what tests or specimens were pending. • There was uncertainty about assigning testing (need to auto-assign influenza tests by project number during accessioning). • Poor infrastructure was a primary cause for delays (e.g., computers not networked, inefficient confidential waste discharge steps).

Planning and Execution Details

QI Implementation:

A Kaizen event was used. It consisted of mapping the current process, identifying waste, brainstorming and prioritizing solutions, and creating an action plan to implement improvements. The Kaizen method was selected because team members were uncertain of each other's responsibilities (creating a swim lane map would be a valuable exercise), the data indicated process inefficiencies, and the supervisor wanted to engage the process owners in designing and implementing improvement strategies. At the end of the 5-day Kaizen event, an action plan was drafted, with the majority of the steps to be completed within 60 days. The supervisor managed the action plan. The facilitator conducted 30-, 60-, 90-, and 120-day check-in meetings with the sponsor and the team until the action steps were complete.

Focus activities

State/Territory laboratory services:

Influenza typing

Other Public Health Services:

QI Methods:

QI Tools:

Other QI tools:

Impact effort plot

Initiative Dates:

11/15/13 to 6/13/14

Initiative Duration:

Between 6-12 months

Methods of evaluation:

Improvements in the testing process resulted in a 14%–33% (4–6 hours) reduction in wait time for the epidemiology partners and for the more than 50 Minnesota hospitals, as well as a 14%–25% (6–8 hours) reduction in total process time. Roles and responsibilities for all team members were defined, and some manual tasks were automated. Through current- and future-state process mapping, the team reduced the number of handoffs from 3 to 1, decreased storage from 14 times to 10 times, and reduced decisions from 5 to 4. Introducing these efficiencies meant that during the 2013–2014 flu season, only 1,469 out of 4,601 (30%) specimens were tested outside of the turnaround time goal of 7 days. This was an improvement from the 2012–2013 flu season, when 2,107 of 4,822 (43.7%) specimens were tested outside of the turnaround time goal. There was also a reduction in the amount of time it took for specimens to go through the final verification step in which the results are checked one last time before they are released to epidemiology and the submitting hospital. In 2012–2013, 1,425 of 4,822 (29.6%) specimens took longer than 1 day to verify. In 2013–2014, only 715 of 4,601 (15.5%) specimens took longer than 1 day to verify. This improvement means that any changes in influenza activity will be detected more quickly, including any new influenza virus strains, and any public health intervention to stop the spread of a new influenza virus strain can happen more quickly and protect the health of Minnesotans. The team also looked at all of the quality steps and determined which were necessary. They then defined what should be checked by whom and when. Systems were also put into place that addressed gaps in the quality system and reduced redundancy throughout the remainder of the testing process. This resulted in zero mistakes in laboratory testing, meaning that all specimens received for influenza testing ended up in the correct workflow and received the correct test. The previous year, there were 12 mistakes due to improper testing workflows. The PHL already has very high standards when it comes to quality. The systems put into place from this event demonstrate the commitment to achieving the highest quality testing possible so that every result meets or exceeds the gold standard. Finally, the Kaizen event identified major gaps in the Laboratory Information System. These gaps have been addressed as business requirements for a new system that will further improve the testing process for influenza and for the entire laboratory.

Supplemental Materials:

Website URL

Supplemental Files:

Attachment	Size
PHL Flu kaizen Report Out.ppt	3.54 MB
MDH Lab Flu Kaizen Storyboard Final.ppt	3.46 MB

Public Health Laboratory: Influenza Process Improvement Kaizen

Summary

Background and Aim

Planning and Execution Details

Results

Training and Preparation

Information about the Community

Information about the Health Department

QI Staff Information

Accreditation Details

Contact Information of the Submitter

Comments

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QI Spotlight

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Public Health Laboratory: Influenza Process Improvement Kaizen

Summary

Background and Aim

Planning and Execution Details

Results

Training and Preparation

Information about the Community

Information about the Health Department

QI Staff Information

Accreditation Details

Contact Information of the Submitter

Comments

QI Spotlight