Measuring Percent Outliers

for Lab TAT in the ED

Judy Heng, BS MT, C(ASCP) AMT, MBA

Lab/ED TAT objectives:

Define measurement indicator - Lab TAT % Outliers. % Outliers measurement v. AVG TAT in minutes. Lab % Outliers measurement process. Technologist performance management process. Benchmark opportunities among system hospitals. Lab - ED team - system hospitals: Performance management process. Tools and information to duplicate % Outliers TAT process

improvement project. Q&A

Define measurement indicator - Lab TAT %

Outliers.

Define “% Outliers”

If lab’s TAT expectation for a Troponin I on a patient in the ED is 60 minutes, then an ‘outlier’ TAT is any TAT longer than 60 minutes.

Example of “% Outliers” in 1 month: ED Trop I result volume 3,750

Trop I TATs > 60 min 635

Lab’s Trop I “% Outliers” 16.9%

ED “% Outliers” are the lab TATs that:

Exceed the lab’s defined TAT expectation.

Cause delays for the ED physician and staff.

May delay patient treatment and/or patient disposition.

Contribute to lengthy overall ED patient turnover time.

TIP:

Physicians and ED staff tolerate and accept lab TATs that meet

defined expectations. They object to unnecessarily long lab

TATs.

Lab’s focus should be on a reduction in the

total number of ‘unnecessarily long’ TATs – the

“% Outliers”.

Example of “% Outliers” in 1 month:

ED Trop I result volume 3,750 Trop I TATs > 60 min 635 Lab’s Trop I “% Outliers” 16.9%

Using good measurement/benchmarking tools, it’s not difficult to reduce the Trop I “% Outliers” in this example to “< 5%” monthly. It’s possible to reduce your Trop I “% Outliers” to less than 2% monthly.* *Eliminating or reducing ‘variance’ is the basis of Six

Sigma process improvement.

Why measuring % Outliers beats AVG TAT

measurements in the process improvement game . . . .

It’s more effective.

% Outliers v. Avg TAT measurement*

% Outliers reduction: Measurement and improvement

effort focus on problem TATs – a smaller subset than ALL TATs.

Technologists can easily actualize the

TAT expectation at the bench – ‘ED Trop I must be < 60 min’.

Easier to benchmark between

hospital labs using different methods.

Physician treatment decisions won’t be delayed.

Improvement of lab “% Outliers”

improves ED patient turnover time.

Avg TAT focus: Average TAT can be ‘good’ – even

with high lab “% Outliers” performance

Technologists can’t easily actualize

an average TAT expectation at the bench – too non-specific.

Different methodologies often mean

different average TATs. High lab TAT “% Outliers” will

continue to delay physician treatment decisions – even if lab Avg TAT is good.

Improvements in lab Avg TAT don’t easily correlate with improved ED patient turnover time.

*Lab TAT is only one factor in the ED patient’s care environment – improving lab TAT won’t compensate for or mitigate other patient care process problems the ED may have.

Lab “% Outliers” measurement process.

LIS TAT report – 1st step

RUN DATE: 07/01/04 MIS **LIVE** PAGE 1 RUN TIME: 1341 TURN AROUND TIME REPORT xxxx xxxxxxx Medical Center -------------------------------------------------------------------------------------------------------------------------------------------------------------

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PATIENT: ALL BEGIN DATE/TIME: 06/01/04 0000 END DATE/TIME: 06/30/04 2359 LOCATION: .ERS PRIORITY: STAT

TEST: SODIUM (Basic Metabolic, Comprehensive Metabolic, Renal Panels) CALCULATION: RECEIVED TIME TO VERIFIED TIME -------------------------------------------------------------------------------------------------------------------------------------------------------------

---

RECEIVED VERIFIED TURN Name ACCOUNT# SPECIMEN# TEST DATE / TIME ID DATE / TIME ID AROUND TIME -------------------------------------------------------------------------------------------------------------------------------------------------------------

--

Z00107111XXX 0601:C00075S SODIUM 06/01/04 0030 HXH 06/01/04 0055 WGF 00025 (mins) Z00107111XXX 0601:C00076S SODIUM 06/01/04 0025 WGF 06/01/04 0055 WGF 00030 (mins) Z00107111XXX 0601:C00082S SODIUM 06/01/04 0256 WGF 06/01/04 0317 WGF 00021 (mins) Z00107111XXX 0601:C00083S SODIUM 06/01/04 0329 HXH 06/01/04 0357 WGF 00028 (mins) Z00107111XXX 0601:C00090S SODIUM 06/01/04 0428 HXH 06/01/04 0446 WGF 00018 (mins) Z00107111XXX 0601:C00102S SODIUM 06/01/04 0751 BJM 06/01/04 0809 GXM 00018 (mins)

Z00107111XXX 0601:C00112S SODIUM 06/01/04 0832 VEH 06/01/04 0904 GXM 07332 (mins)

This report came from MediTech – format is .txt file

LIS TAT report – 1st step

Suggested time frame: 30 days, 1 calendar month Required data: Profile or test method Received-in-lab TAT Verified TAT Verification tech ID TAT in minutes Patient name not needed – if present, can be deleted in Excel. Patient ID number not needed – except to validate that data is reliable. Potential measurements: Automated CBC If by test, use WBC or Hgb. Chem (Basmet+Compmet) If by test, use NA+ or CL Cardiac If by test, use Trop I UA macro If by test, use KETU UA macro+micro If by test, use UA WBC HCG Qual HCGQual Other PT/PTT, BNP, DOA, etc. Best to use 3 or 4 highest volume ED lab tests – higher volume greater

validity.

EXCEL format – 2nd step

Pt name ACCOUNT# SPECIMEN# TEST REC DATE REC

TIME

REC

EMP IDVER DATE

VER

TIME

VER EMP

IDTAT

107185717 0628:WU:C00305S SODIUM 6/28/2004 1758 LF 6/28/2004 1810 ACP 12

107184626 0628:WU:C00269S SODIUM 6/28/2004 1506 SNH 6/28/2004 1520 ACP 14

107187266 0629:WU:C00184S SODIUM 6/29/2004 1309 BBP 6/29/2004 1323 ACP 14

107139316 0610:WU:C00217S SODIUM 6/10/2004 1553 SlP 6/10/2004 1609 ACP 16

107184323 0628:WU:C00239S SODIUM 6/28/2004 1319 BJN 6/28/2004 1335 ACP 16

107184727 0628:WU:C00263S SODIUM 6/28/2004 1445 BJN 6/28/2004 1501 ACP 16

107184652 0628:WU:C00271S SODIUM 6/28/2004 1537 BJN 6/28/2004 1553 ACP 16

107185628 0628:WU:C00303S SODIUM 6/28/2004 1742 LF 6/28/2004 1758 ACP 16

107131827 0608:WU:C00151S SODIUM 6/8/2004 1144 WFH 6/8/2004 1201 ACP 17

107184385 0628:WU:C00251S SODIUM 6/28/2004 1347 BBP 6/28/2004 1404 ACP 17

107187634 0629:WU:C00205S SODIUM 6/29/2004 1335 USU 6/29/2004 1352 BJN 17

107181961 0627:WU:C00182S SODIUM 6/27/2004 1035 PSS 6/27/2004 1053 BJN 18

107187494 0629:WU:C00199S SODIUM 6/29/2004 1315 USU 6/29/2004 1334 BJN 19

107128630 0607:WU:C00172S SODIUM 6/7/2004 1240 SNH 6/7/2004 1300 BJN 20

107139722 0610:WU:C00221S SODIUM 6/10/2004 1557 UBP 6/10/2004 1617 BJN 20

107183749 0628:WU:C00215S SODIUM 6/28/2004 1142 BJN 6/28/2004 1202 BJN 20

107183977 0628:WU:C00221S SODIUM 6/28/2004 1208 BJN 6/28/2004 1229 BJN 21

107185147 0628:WU:C00294S SODIUM 6/28/2004 1711 BBP 6/28/2004 1732 CH 21

107128553 0607:WU:C00179S SODIUM 6/7/2004 1231 WFH 6/7/2004 1253 CH 22

107184777 0628:WU:C00272S SODIUM 6/28/2004 1506 BJN 6/28/2004 1529 CH 23

107185096 0628:WU:C00290S SODIUM 6/28/2004 1726 LF 6/28/2004 1749 CH 23

107185692 0628:WU:C00308S SODIUM 6/28/2004 1806 BBP 6/28/2004 1829 CH 23

107138150 0610:WU:C00201S SODIUM 6/10/2004 1538 SDJ 6/10/2004 1607 CH 29

107181959 0627:WU:C00173S SODIUM 6/27/2004 835 BBP 6/27/2004 904 CH 29

107184501 0628:WU:C00254S SODIUM 6/28/2004 1351 SNH 6/28/2004 1422 CH 31

107185262 0628:WU:C00293S SODIUM 6/28/2004 1653 LF 6/28/2004 1725 CH 32

107185250 0628:WU:C00301S SODIUM 6/28/2004 1719 LF 6/28/2004 1751 CH 32

107184537 0628:WU:C00262S SODIUM 6/28/2004 1428 BJN 6/28/2004 1503 CH 35

107187228 0629:WU:C00172S SODIUM 6/29/2004 1137 BJN 6/29/2004 1213 CH 36

EXCEL format – 3rd step

In Excel – remove spurious TATs from data set . . .

Case study parameters - remove 1) > 300 min TATs 2) 0 to 2 min TATs (CBC, UA) 3) 0 to 6 min TATs (Chem) 4) 0 to 10 min TATs (Cardiac) Repeated investigations showed

that > 300 min TATs were add-ons or cancellations.

Results that were received into

LIS at the same time that results were verified also had to be removed from the data.

What about 100 – 299 min TATs ? Repeated investigations within

several different labs showed us that 50 – 65 % of 100–299 min TATs were legitimate TATs – actual delays that lab or circumstances between lab and ED had caused.

Periodic checks on these individual

TATs consistently indicated that the majority were actual lab-caused delays. Most of these TATs represented poor lab performance.

Import Excel data into ACCESS – ACCESS report page – 4th step

Feedback for Departmental Improvement of Chemistry - ER-TAT - December 2003

Emp ID Avg TAT %Variance From # of Outliers % of Outliers Number % Total Volume Comments

Tech AVG TAT Performed Performed

Tech 1 27 -21.69% 8 11.11% 72 4.26%

Tech 2 28 -23.52% 12 22.22% 54 3.20%

Tech 3 23 -1.74% 2 6.67% 30 1.78%

Tech 4 27 -21.20% 0 0.00% 6 0.36%

Tech 5 18 18.69% 4 1.92% 208 12.31%

Tech 6 26 -16.48% 12 6.00% 200 11.83%

Tech 7 26 -17.09% 10 10.64% 94 5.56%

Tech 8 21 7.23% 0 0.00% 6 0.36%

Tech 9 24 -7.00% 6 4.41% 136 8.05%

Tech 10 26 -14.67% 8 7.55% 106 6.27%

Tech 11 19 12.69% 2 5.00% 40 2.37%

Tech 12 29 -29.80% 10 13.89% 72 4.26%

Tech 13 17 22.42% 0 0.00% 268 15.86%

Tech 14 21 7.23% 2 11.11% 18 1.07%

Tech 15 21 6.47% 10 3.03% 330 19.53%

Tech 16 23 -3.80% 2 4.17% 48 2.84%

Tech 17 18 19.20% 0 0.00% 2 0.12%

Average Turn Around Time: 22 mins Average % Outliers: 5.1 % Total Test Performed: 1690

ACCESS report in Excel – 5th step

(optional)

Emp ID

Avg TAT in

Minutes

% Variance

From Tech

AVG TAT

# of

Outliers

% of

Outliers

Chems >

40 min

Number

Performed

% Total

Volume

Performed by

Tech

Performance

Feedback Comments

Tech # 1 27 -21.69% 8 11.11% 72 4.26%Tech # 2 28 -23.52% 12 22.22% 54 3.20%Tech # 3 23 -1.74% 2 6.67% 30 1.78%Tech # 4 27 -21.20% 0 0.00% 6 0.36%Tech # 5 18 18.69% 4 1.92% 208 12.31%Tech # 6 26 -16.48% 12 6.00% 200 11.83%Tech # 7 26 -17.09% 10 10.64% 94 5.56%Tech # 8 21 7.23% 0 0.00% 6 0.36%Tech # 9 24 -7.00% 6 4.41% 136 8.05%Tech # 10 26 -14.67% 8 7.55% 106 6.27%Tech # 11 19 12.69% 2 5.00% 40 2.37%Tech # 12 29 -29.80% 10 13.89% 72 4.26%Tech # 13 17 22.42% 0 0.00% 268 15.86%Tech # 14 21 7.23% 2 11.11% 18 1.07%Tech # 15 21 6.47% 10 3.03% 330 19.53%Tech # 16 23 -3.80% 2 4.17% 48 2.84%Tech # 17 18 19.20% 0 0.00% 2 0.12%Tech

AVG 22 86 5.1% 1690 6.5%

Technologist performance

management process.

Individual technologist focus on ‘reduce %

outliers’ significant improvement !

Emp ID

May 2002

% Outliers

CBCs > 30 min

Performance Feedback

Comments

Tech 1 18.75% Improve TAT, Improve % Outliers

Tech 2 7.27% GOOD !Tech 3 10.71% Improve % Outliers

Tech 4 5.26% GOOD !Tech 5 5.84% GOOD !Tech 6 30.00% Improve TAT, Improve % Outliers

Tech 7 11.59% Improve % Outliers

Tech 8 7.69% VERY GOOD !Tech 9 14.89% Improve TAT, Improve % Outliers

Tech 10 8.43% VERY GOOD !Tech 11 11.11% Improve % Outliers

Tech 12 28.57% Improve TAT, Improve % Outliers

Tech 13 4.88% BEST PRACTICE !Tech 14 9.89% VERY GOOD !Tech 15 8.86% FAIR !Tech 16 33.33% Improve TAT, Improve % Outliers

Tech 17 33.33% Improve % Outliers

Average 9.6% Lab team --> Improve % Outliers

Green = Productive

Red = Less or Not Productive

Emp ID

OCT 2003

% Outliers

CBCs > 20 min

Performance Feedback

Comments

Tech 1 2.44% VERY GOOD !Tech 2 1.34% VERY GOOD !Tech 3 0.00% EXCELLENT !Tech 4 0.00% EXCELLENT !Tech 5 0.00% VERY GOOD !Tech 6 0.00% EXCELLENT !Tech 7 0.00% EXCELLENT !Tech 8 1.37% VERY GOOD !

Tech 9 0.87% BEST PRACTICE !Tech 10 0.00% VERY GOOD !Tech 11 0.00% VERY GOOD !

Tech 12 0.00% BEST PRACTICE !Tech 13 1.85% VERY GOOD !Tech 14 3.57% VERY GOOD !Tech 15 0.00% EXCELLENT !Tech 16 0.00% EXCELLENT !Tech 17 0.00% EXCELLENT !

Average 0.6% EXCELLENT !

Green = Productive

Red = Less or Not Productive

Individual technologist focus on ‘reduce %

outliers’ significant improvement !

Emp ID

May 2002

% Outliers

Chems > 40 min

Performance Feedback

Comments

Tech 1 9.26% Improve TAT

Tech 2 13.10% Improve TAT, Improve % Outliers

Tech 3 17.24% Improve TAT, Improve % Outliers

Tech 4 18.84% Improve TAT, Improve % Outliers

Tech 5 8.45% GOOD !Tech 6 10.71% Improve TAT, Improve % Outliers

Tech 7 8.57% GOOD !Tech 8 0.00% VERY GOOD !Tech 9 26.32% Improve TAT, Improve % Outliers

Tech 10 10.00% Improve TAT

Tech 11 6.45% BEST PRACTICE !Tech 12 27.27% Improve TAT, Improve % Outliers

Tech 13 3.48% BEST PRACTICE !Tech 14 16.13% Improve TAT, Improve % Outliers

Tech 15 5.00% VERY GOOD !Tech 16 6.90% FAIR !

Average 13.6% Lab team --> Improve % Outliers

Green = Productive

Red = Less or Not Productive

Emp ID

OCT 2003

% Outliers

Chems > 35 min

Performance Feedback

Comments

Tech 1 5.00% FAIR !Tech 2 2.97% EXCELLENT !Tech 3 0.00% VERY GOOD !Tech 4 1.75% EXCELLENT !

Tech 5 0.77% BEST PRACTICE !Tech 6 0.00% EXCELLENT !Tech 7 1.92% VERY GOOD !Tech 8 7.64% FAIR !Tech 9 3.57% EXCELLENT !Tech 10 7.89% GOOD !Tech 11 5.26% VERY GOOD !Tech 12 0.00% EXCELLENT !

Tech 13 0.00% BEST PRACTICE !Tech 14 7.14% FAIR !Tech 15 0.00% VERY GOOD !

Tech 16 1.83% BEST PRACTICE !Tech 17 4.88% VERY GOOD !

Average 3.4% VERY GOOD !

Green = Productive

Red = Less or Not Productive

Individual technologist focus on ‘reduce %

outliers’ significant improvement !

Emp ID

May 2002

% Outliers

Cardiacs > 60 min

Performance Feedback

Comments

Tech 1 35.29% Improve TAT, Improve % Outliers

Tech 2 44.12% Improve TAT, Improve % Outliers

Tech 3 64.29% Improve TAT, Improve % Outliers

Tech 4 44.00% Improve TAT, Improve % Outliers

Tech 5 40.00% Improve TAT, Improve % Outliers

Tech 6 41.46% Improve TAT, Improve % Outliers

Tech 7 16.67% Improve % Outliers

Tech 8 0.00%

Tech 9 42.31% Improve TAT, Improve % Outliers

Tech 10 12.50% Improve % Outliers

Tech 11 7.14% BEST PRACTICE !Tech 12 55.77% Improve TAT, Improve % Outliers

Tech 13 8.33% BEST PRACTICE !Tech 14 33.33% Improve TAT, Improve % Outliers

Tech 15 23.53% Improve % Outliers

Tech 16 38.46% Improve TAT, Improve % Outliers

AVG 36.6% Lab team --> Improve % Outliers

Green = Productive

Red = Less or Not Productive

Emp ID

OCT 2003

% Outliers

Cardiacs > 50 min

Performance Feedback

Comments

Tech 1 5.26% TAT NEEDS IMPROVEMENT !

Tech 2 3.23% EXCELLENT !Tech 3 0.00% EXCELLENT !Tech 4 0.00% EXCELLENT !Tech 5 0.00% VERY GOOD !Tech 6 0.00%

Tech 7 4.65% FAIR !Tech 8 3.57% FAIR !Tech 9 0.00% EXCELLENT !Tech 10 0.00% EXCELLENT !Tech 11 3.03% VERY GOOD !Tech 12 0.00% EXCELLENT !

Tech 13 0.00% BEST PRACTICE !Tech 14 0.00%

Tech 15 0.00%

Tech 16 2.86% EXCELLENT !Tech 17 3.33% VERY GOOD !

AVG 2.2% EXCELLENT !

Green = Productive

Red = Less or Not Productive

Individual technologist focus on ‘reduce %

outliers’ significant improvement !

Emp ID

OCT 2003

% Outliers

UAs > 20 min

Performance Feedback

Comments

Tech 1 1.94% FAIR !Tech 2 4.62% VERY GOOD !Tech 3 4.35% FAIR !Tech 4 0.00% EXCELLENT !Tech 5 0.00% EXCELLENT !Tech 6 5.88% VERY GOOD !Tech 7 0.00% VERY GOOD !Tech 8 3.13% VERY GOOD !Tech 9 0.00% EXCELLENT !Tech 10 0.00% FAIR !Tech 11 3.28% FAIR !Tech 12 0.00% VERY GOOD !

Tech 13 0.00% BEST PRACTICE !Tech 14 0.00% EXCELLENT !Tech 15 0.00% EXCELLENT !Tech 16 4.17% VERY GOOD !Tech 17 0.00% EXCELLENT !Tech 18 0.00% VERY GOOD !

AVG 1.2% EXCELLENT !

Green = Productive

Red = Less or Not Productive

Emp ID

May 2002

% Outliers

UAs > 30 min

Performance Feedback

Comments

Tech 1 11.90% Improve TAT, Improve % Outliers

Tech 2 5.88% GOOD !Tech 3 10.00% EXCELLENT !Tech 4 3.92% GOOD !Tech 5 7.32% FAIR !Tech 6 4.17% EXCELLENT !Tech 7 14.81% Improve TAT, Improve % Outliers

Tech 8 11.11% Improve TAT, Improve % Outliers

Tech 9 9.09% Improve TAT

Tech 10 4.08% GOOD !Tech 11 1.92% EXCELLENT !Tech 12 25.00% Improve % Outliers

Tech 13 0.00% BEST PRACTICE !Tech 14 3.33% EXCELLENT !Tech 15 10.00% GOOD !Tech 16 20.00%

Tech 17 33.33% FAIR !

AVG 4.4% Lab team --> Improve % Outliers

Green = Productive

Red = Less or Not Productive

Lab ER TAT % Outliers - Department Performance

Outliers are Looooong TATs that delay ER doctors and patients.

(CBCs > 30 min; Chems > 40 min; Cardiacs > 60 min; UA's > 30 min)

10.8%

9.7%

13.4%

10.5%

9.1%

11.2%

16.2%

14.3%

3.5%3.0% 2.9%2.7%

2.1%2.4%

3.2%

2.5%

3.6%

1.4%

2.4%1.9%

3%

10% 10% 10%

10%

6% 6% 6% 6% 6% 6% 6%3% 3% 3%

3%

3%

3%

3% 3% 3%3%

2.8%

1.9%0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

Jan-

02

Feb-

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Mar-

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Apr-

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May-

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Jul-

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Feb-

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In May, 2002, lab techs verified 4,846 ER CBCs,

chemistries, cardiacs, and UAs. 649 or 13.4 % of the total

were outliers (TATs that failed established criteria).

ER TAT % Outliers - Total Lab PerformanceGoalER TAT % Outliers - New Targets

Lab ER TAT % Outliers - Department Performance

Outliers are Looooong TATs that delay ER doctors and patients.

(CBCs > 20 min; Chems > 35 min; Cardiacs > 50 min; UA's > 20 min)

1.9%2.4%

1.4%

3.6%

2.5%

3.2%

2.4%2.1%

2.7%2.9%3.0%3.5%

14.3%

16.2%

11.2%

9.1%

10.5%

13.4%

9.7%

10.8%

3% 3%3%3%

3%

3%

3%

3%3%3%6%6%6%6%6%6%6%

10%

10%10%10%

3%

1.9%2.8%

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

Jan-

02

Feb-

02

Mar-

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Apr-

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May-

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Jun-

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Jul-

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Aug-

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In October, 2003, lab techs verified 5,523 ER CBCs,

chemistries, cardiacs, and UAs. Only 103 or 1.9 % of the total

were outliers (TATs that failed established criteria - new targets).

ER TAT % Outliers - Total Lab PerformanceGoalER TAT % Outliers - New Targets

Tech ED TAT value to the Lab Team – 30 day time period - overall:

JULY #

12CBC Chem Card UA TOTALS

% Outliers

Red if >

3 %EVAL

Vol % of

Total

Rank =

Highest Vol %

minus Outlier

%

"Value to Lab" ER

TAT Performance

Rank

Tech 1 - 1 1 1 3 54 / 3,256

1 26 5 22 54 1.7%Tech 2 3 - - - 3 128 / 3,256

95 - - 33 128 3.9%Tech 3 1 1 - 2 4 201 / 3,256

161 28 1 11 201 6.2%Tech 4 9 - - 5 14 337 / 3,256

267 - - 70 337 10.3%

Tech 5 - - - - - 287 / 3,256

121 15 1 150 287 8.8%Tech 7 - 32 1 - 33 183 / 3,256

1 178 3 1 183 5.6%Tech 9 2 - 1 1 4 294 / 3,256

84 127 4 79 294 9.0%Tech 10 - 20 2 - 22 130 / 3,256

- 114 11 5 130 4.0%Tech 11 - 12 - - 12 248 / 3,256

16 185 6 41 248 7.6%Tech 12 - - - - - 28 / 3,256

26 - - 2 28 0.9%Tech 13 4 - - - 4 73 / 3,256

59 - 1 13 73 2.2%Tech 14 1 - - 3 4 128 / 3,256

84 3 1 40 128 3.9%Tech 15 2 13 1 3 19 246 / 3,256

84 112 8 42 246 7.5%Tech 16 - - - - - 32 / 3,256

9 - - 23 32 1.0%Tech 17 - - - - - 236 / 3,256

134 - - 102 236 7.2%Tech 18 - 10 5 - 15 93 / 3,256

- 83 9 1 93 2.8%Tech 19 - - - - - 15 / 3,256

15 - - - 15 0.5%Tech 20 - 12 6 2 20 277 / 3,256

- 210 15 52 277 8.5%

0.0%

: ) 0.5% # 10

0.0%

3.1%

: ( 0.8%

5.5%

: (

1.6%

-0.2%

0.9%

1.0%

0.8%

# 16

0.5%

7.6%

16.9%

: ( 1.3%# 20-12.9%

8.8%

1.4% # 2

2.8%

# 2

5.6%

2.3%

2.0%

4.2%

18.0%

1.3%

1.0%

-3.2%

2.8%

7.2%

-13.3%

4.8%

: (: )

: (7.2%

: )

# 3

16.1%

: (

0.0%

JUL

-3.9%

1.6%

4.2%

BEST

Practice! # 9

# 17

0.0%

# 4

: ): ( 6.2%

# 11

# 5

7.6%

7.2%

: (: )

# 1

: (

6.2%

-12.4%

4.2%# 38.8%

-0.2%

# 13 -3.2%

# 1

0.0%

7.7%: (

-13.3%

-3.9%

0.9%

# 19

# 18

# 7

# 14

# 12

# 15

-12.4%

-12.9%

Compare volumes

and % outliers by

Individual tech.

•Some techs verify

high test volumes

with very low %

outlier TATs.

•Distinct variations in

performance.

• Feedback report

alerts techs to

improve % outliers.

With a performance management system in place, with consistent feedback over time, technologists

will improve their performance:

JUL CBC Chem Card UA TOTALSVol % of

Total

Rank = Highest

Vol % minus

Outlier %

Rank = Highest Vol %

minus Outlier %

Tech 1 1 - - 1 2 213 / 2,986

106 26 12 69 213 7.1%

Tech 2 1 - - - 1 97 / 2,986

67 19 7 4 97 3.2%

Tech 3 - 3 1 1 5 336 / 2,986

114 132 34 56 336 11.3%

Tech 4 - 2 - 2 4 191 / 2,986

28 81 33 49 191 6.4%

Tech 5 - - - - - 1 / 2,986

- 1 - - 1 0.0%

Tech 6 - 3 - - 3 155 / 2,986

39 74 22 20 155 5.2%

Tech 7 - 5 - 2 7 348 / 2,986

117 134 49 48 348 11.7%

Tech 8 - 1 - - 1 284 / 2,986

146 65 27 46 284 9.5%

Tech 9 - - - 2 2 44 / 2,986

5 8 3 28 44 1.5%

Tech 10 - 6 2 2 10 366 / 2,986

56 164 66 80 366 12.3%

Tech 11 - 1 - - 1 42 / 2,986

5 20 7 10 42 1.4%

Tech 12 - - - - - 324 / 2,986

100 115 33 76 324 10.9%

Tech 13 - - - - - 44 / 2,986

43 - - 1 44 1.5%

Tech 14 - - - 1 1 41 / 2,986

18 8 3 12 41 1.4%

Tech 15 - 4 - 1 5 238 / 2,986

55 115 51 17 238 8.0%

Tech 16 - 1 - - 1 257 / 2,986

115 71 20 51 257 8.6%

Tech 17 - - - - - 4 / 2,986

4 - - - 4 0.1%

BEST Practice ! # 3

# 7

10.9%

9.8%

9.6%

3.3%

9.6%

# 8 9.2%

6.2%

6.2%

# 10 9.5%

8.2%

2.2%

9.8%

0.0%

# 16

# 12

2.4%

2.1%

: )

# 1

: )2.4%

0.0%

: ) 1.5%

0.0%

: )

10.9%

0.1%

9.2%

-3.1%

9.5%

-1.0%

5.9%

-1.1%

0.0%

: )

% Outliers

RED if > 3 %

: ): )

# 2

0.9%

1.0%

1.5%

2.7%

2.1%

1.9%

2.0%

0.4%

0.0%

: )

4.3%

4.5%

: (: )

: )

# 3

: ): )

# 15

4.3%

# 17

3.3%

2.2%

1.5%

0.1%

5.9%

-3.1%

0.0%

-1.0%

# 2

-1.1%

JUL

# 5

# 11

# 9

# 4

# 6

# 13

# 1

0.4%

: ) 8.2% # 14

Tech ED TAT value to the Lab Team – 1 year time period - overall:

% ER TAT

Outliers

2003

AVGJan-04 Feb-04 Mar-04 Apr-04 May-04 Jun-04 Jul-04 Aug-04 Sep-04 Oct-04 Nov-04 Dec-04

2004

AVG% ER TAT

Outliers

AVG

YTDTech 1 10.7% 4.3% 0.0% 0.0% 6.1% 0.0% 1.9% 5.6% 2.6% Tech 16 0.0%Tech 2 8.2% 3.2% 3.6% 0.0% 3.8% 4.6% 1.6% 2.3% 2.7% Tech 19 0.0%Tech 3 25.9% 11.3% 12.9% 6.9% 8.7% 2.6% 4.5% 2.0% 7.0% Tech 17 0.5%Tech 4 16.8% 15.0% 1.4% 2.1% 3.6% 2.2% 4.9% 4.2% 4.8% Tech 12 1.5%Tech 5 9.2% 6.0% 8.9% 3.8% 0.8% 1.0% 0.7% 0.0% 3.0% Tech 1 2.6%Tech 6 17.1% 0.0% 7.7% 8.1% 5.7% 0.0% 4.3% Tech 2 2.7%Tech 7 25.5% 22.4% 24.1% 10.0% 5.7% 37.8% 11.2% 18.0% 18.5% GOAL 3.0%Tech 8 12.1% 13.9% 5.6% 12.6% 4.6% 4.9% 10.7% 8.7% Tech 5 3.0%Tech 9 7.1% 7.6% 4.1% 4.7% 6.7% 1.4% 0.9% 1.4% 3.8% Tech 9 3.8%Tech 10 23.4% 26.0% 20.5% 13.4% 14.7% 17.6% 26.8% 16.9% 19.4% Tech 6 4.3%Tech 11 23.5% 23.4% 20.3% 9.9% 1.5% 12.5% 7.0% 4.8% 11.3% Tech 4 4.8%Tech 12 3.2% 0.5% 3.1% 0.5% 1.0% 3.3% 1.8% 0.0% 1.5% AVG 4.9%Tech 13 4.5% 9.8% 5.1% 8.7% 1.8% 3.2% 4.3% 5.5% 5.5% Tech 13 5.5%Tech 14 5.5% 7.8% 9.9% 6.9% 3.9% 5.7% 7.7% 3.1% 6.4% Tech 15 6.1%Tech 15 6.7% 5.0% 8.8% 4.5% 1.0% 3.0% 12.7% 7.7% 6.1% Tech 14 6.4%Tech 16 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% Tech 3 7.0%Tech 17 1.7% 0.7% 0.0% 0.0% 0.0% 2.0% 0.5% 0.0% 0.5% Tech 20 7.8%Tech 18 16.4% 9.0% 11.7% 13.0% 5.3% 12.3% 9.1% 16.1% 10.9% Tech 8 8.7%Tech 19 0.0% 0.0% Tech 18 10.9%Tech 20 10.6% 6.0% 12.9% 8.5% 11.2% 4.8% 3.8% 7.2% 7.8% Tech 11 11.3%AVG 12.3% 10.9% 9.5% 6.6% 4.5% 5.0% 6.3% 4.9% 6.8% Tech 7 18.5%GOAL 10.0% 10.0% 5.0% 5.0% 5.0% 3.0% 3.0% 3.0% 3.0% 3.0% 3.0% 3.0% 3.0% 4.1% Tech 10 19.4%

Lab TAT Best Practice *STARs* and the techs who are trying to be *STARs*

What are they doing consistently that co-workers

are not?

% ER TAT

Outliers

2003

AVGJan-04 Feb-04 Mar-04 Apr-04 May-04 Jun-04 Jul-04 Aug-04 Sep-04 Oct-04 Nov-04 Dec-04

2004

AVG% ER TAT

Outliers

AVG

YTDTech 1 10.7% 4.3% 0.0% 0.0% 6.1% 0.0% 1.9% 5.6% 2.6% Tech 16 0.0%Tech 2 8.2% 3.2% 3.6% 0.0% 3.8% 4.6% 1.6% 2.3% 2.7% Tech 17 0.5%Tech 3 25.9% 11.3% 12.9% 6.9% 8.7% 2.6% 4.5% 2.0% 7.0% Tech 12 1.5%Tech 4 16.8% 15.0% 1.4% 2.1% 3.6% 2.2% 4.9% 4.2% 4.8% Tech 1 2.6%Tech 5 9.2% 6.0% 8.9% 3.8% 0.8% 1.0% 0.7% 0.0% 3.0% Tech 2 2.7%Tech 9 7.1% 7.6% 4.1% 4.7% 6.7% 1.4% 0.9% 1.4% 3.8% Goal 3.0%Tech 12 3.2% 0.5% 3.1% 0.5% 1.0% 3.3% 1.8% 0.0% 1.5% Tech 5 3.0%Tech 16 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% Tech 9 3.8%Tech 17 1.7% 0.7% 0.0% 0.0% 0.0% 2.0% 0.5% 0.0% 0.5% Tech 4 4.8%AVG 12.3% 10.9% 9.5% 6.6% 4.5% 5.0% 6.3% 4.9% 6.8% AVG 4.9%GOAL 10.0% 10.0% 5.0% 5.0% 5.0% 3.0% 3.0% 3.0% 3.0% 3.0% 3.0% 3.0% 3.0% 4.1% Tech 3 7.0%

JULY

# 12CBC Chem Card UA TOTALS

% Outliers

Red if > 3

%EVAL

Vol % of

Total

Rank =

Highest Vol

% minus

Outlier %

"Value to Lab" ER

TAT Performance

Rank

Tech 1 - 1 1 1 3 54 / 3,256

1 26 5 22 54 1.7%Tech 2 3 - - - 3 128 / 3,256

95 - - 33 128 3.9%Tech 3 1 1 - 2 4 201 / 3,256

161 28 1 11 201 6.2%Tech 4 9 - - 5 14 337 / 3,256

267 - - 70 337 10.3%

Tech 5 - - - - - 287 / 3,256

121 15 1 150 287 8.8%Tech 9 2 - 1 1 4 294 / 3,256

84 127 4 79 294 9.0%Tech 12 - - - - - 28 / 3,256

26 - - 2 28 0.9%Tech 16 - - - - - 32 / 3,256

9 - - 23 32 1.0%Tech 17 - - - - - 236 / 3,256

134 - - 102 236 7.2%Tech 19 - - - - - 15 / 3,256

15 - - - 15 0.5%

1.0%# 16

# 12 0.9%

# 1 -3.9%

0.0% : ) 1.0%0.0%

4.2%# 3

6.2%

# 5

7.6%

7.2%

: (: ( 6.2%4.2% # 4

: ): ) 4.2%

JUL

-3.9%

1.6%BEST

Practice! # 9

# 17

# 2: )

# 30.0%

0.9%

7.2%

8.8%

0.0% # 1

# 2

5.6%

2.3%

2.0%

1.6%7.6%

8.8%

1.4%

0.0%

: ) 0.5%

Regarding the posting of results –

Your ‘best practice’ techs or *star* performers will like it !!!

Techs who want to perform well and can use objective data to

self-adjust will give it a chance – most likely make rapid improvements.

Less productive techs will challenge the data – usually for a short time. After 2 or 3 months, the improvements that occur will make

it difficult for them to challenge it.

Just the act of ‘posting results’ will stimulate significant improvement in the entire team. In fact, the best results occur

when you altogether avoid using the data punitively.

Represents ‘defining the outcomes’ (from First, Break All the Rules). Manager also serves as a “mirror”, reflects performance

information back toward the employee.

Based on concepts from Gallup management principles in First, Break All the Rules

and Follow This Path, Good To Great by Jim Collins, Execution by Bossidy &

Benchmark opportunities among system hospitals.

Lab ED TAT % Outliers Performance - 12 hospital system 8

.3%

11

.6%

9.8

%

7.3

%

5.7

%

5.5

%

3.0

%

17

.7%

6.3

%

6.3

%

23

.7%

14

.4%

8.7

%

6.5

%

9.8

%

8.7

%

5.8

%

3.2

%

9.3

%

2.3

%

5.4

%

3.2

% 4.5

%

19

.1%

4.5

%

6.8

%

5.4

% 7.0

%

6.6

%

2.9

%

2.8

%

8.0

%

1.4

%

8.8

%

2.2

%

5.7

%

6.2

%

4.9

%

5.0

%

0%

5%

10%

15%

20%

25%

Hospita

l Lab #

1

Hospita

l Lab #

2

Hospita

l Lab #

3

Hospita

l Lab #

4

Hospita

l Lab #

5

Hospita

l Lab #

6

Hospita

l Lab #

7

Hospita

l Lab #

8

Hospita

l Lab #

9

Hospita

l Lab #

10

Hospita

l Lab #

11

Hospita

l Lab #

12

Div

isio

n AVG

% O

utliers

Best Practice: #7, # 9 ; Most Improved: #11, # 8, # 12;

Division Overall: Reduced Lab TAT % Outliers from 8.7% to 5%

Nov '03 % Outlier TATs

Apr '04 % Outlier TATs

Jul '04 % Outlier TATs

Benchmark lab TAT % outliers between labs:

July 2004 ? Is there a relationship between Lab % Outliers and ER Patient Turnover in hours ?

5.0%

7.8%

8.7%

6.5%6.8%

5.9%

7.8%

6.9% 7.1%

4.9%

3.18

3.573.65

3.39 3.42

3.54

3.523.56

3.33 3.33

2%

3%

4%

5%

6%

7%

8%

9%

10%

Oct-03 Nov-03 Dec-03 Jan-04 Feb-04 Mar-04 Apr-04 May-04 Jun-04 Jul-04

2.5

3.0

3.5

4.0

GC Lab % Outliers - Div AVG (12 Labs)

ER Patient Turnover in Hours - Div AVG (12 EDs)

Benchmark ED patient turnover time and lab % outliers:

Correlation between lab % outliers and ED patient turnover time? Maybe . . .

Hospital # 12 Relationship between Lab % Outliers v.

ED Patient Turnover Time in Hours

4.9%

6.3%

5.0%4.5%

6.6%

9.5%10.9%

12.3%

14.4%

3.233.213.11

3.25

3.40

3.57

4.14

3.98

4.14

2%

4%

6%

8%

10%

12%

14%

16%

Nov-03 Dec-03 Jan-04 Feb-04 Mar-04 Apr-04 May-04 Jun-04 Jul-04

2.00

2.50

3.00

3.50

4.00

4.50

5.00

# 12 Lab ER TAT % Outliers

ER Patient Avg TAT in Hours

Maybe . . .

Hospital # 4 Relationship between Lab % Outliers v.

ED Patient Turnover Time in Hours

2.9%2.7%

4.6%

5.8%

4.1%3.9%

5.3%

4.2%

7.3%

3.633.61

4.21

4.45

4.12

3.86

3.49

3.59

3.66

0%

1%

2%

3%

4%

5%

6%

7%

8%

9%

10%

Nov-03 Dec-03 Jan-04 Feb-04 Mar-04 Apr-04 May-04 Jun-04 Jul-04

2.0

2.5

3.0

3.5

4.0

4.5

5.0Hospital # 4 Lab ER TAT % Outliers

ER Patient Avg TAT in Hours

Maybe not . . . needs further study and more data.

Hospital # 10 Relationship between Lab % Outliers v.

ED Patient Turnover Time in Hours

5.7%

4.3%

5.2%

4.5%

7.1%7.2%

5.6%

4.5%

6.3%

2.99

3.283.16

3.32

3.183.053.05

2.953.03

0%

2%

4%

6%

8%

10%

Nov-03 Dec-03 Jan-04 Feb-04 Mar-04 Apr-04 May-04 Jun-04 Jul-04

2.0

2.5

3.0

3.5

4.0

4.5

5.0

Hospital 10 Lab ER TAT % Outliers

ER Patient Avg TAT in Hours

Benchmark technologist performance:

DIV

Rank

#

Hospital - Tech Tech's ER Test

Volume Total

Tech's Number

of Outliers

Tech's %

Outliers

Tech's ER TAT

Value to Home Lab

TAT in %

1 # 7 - XT 1,723 6 0.35% 9.4%

2 # 6 - KCX 281 1 0.36% 5.8%

3 # 12 - VXH 1,107 5 0.45% 5.3%

4 # 1 - XGP 1,337 8 0.60% 3.3%

5 # 1 - SPX 2,133 13 0.61% 5.6%

6 # 6 - EXE 1,793 11 0.61% 13.3%

7 # 5 - XSK 1,945 16 0.82% 12.1%

8 # 7 - XXX 1,170 11 0.94% 5.6%

9 # 12 - DXT 1,447 14 0.97% 7.5%

10 # 8 - SX 883 10 1.13% 16.2%

11 # 5 - XCB 1,283 15 1.17% 7.5%

12 # 7 - EXT 1,720 21 1.22% 8.5%

13 # 6 - VXS 158 2 1.27% 5.4%

14 # 1 - XAX 2,544 33 1.30% 6.2%

15 # 7 - RXG 1,556 21 1.35% 7.5%

16 # 12 - HXH 294 4 1.36% 7.6%

17 # 7 - XXA 1,839 28 1.52% 8.8%

18 # 5 - MXX 1,271 21 1.65% 7.5%

19 # 4 - LXM 1,489 25 1.68% 6.5%

20 # 7 - CXX 824 14 1.70% 5.5%

1,340 14 0.9% 7.8%

1,100 67 6.07% 0.3%

982 172 17.6% -11.2%

System's 'BEST Practice' ER TAT medical technologists

Cumulative for February, March, April, May, June, July 2004 (Tech's total volume of ER tests verified in one month must be > 150 to be included here.)

Top 20 Tech AVG

(Best Practice)

Bottom 20 tech AVG (Poor performance)

System tech average

overall

“Laboratory Best Practices:

Specimen label color different for ED. ED specimens are

prioritized.

Utilized increased POC testing.

Utilized YELLOW/RED BAGS (biohazard bags) for ED specimens.

Lab has access to ED tracking system.

Proactive ED draws rainbow with barcode label

MD notification of test results; paperless access to results.”

Announcing to the techs that there is a specimen from EC.

January 2006:“Emergency Department Benchmarks and Best Practices: A Report of the Premier ED

Survey Findings”

Lab ED team

System hospitals: Performance

management process.

Performance management across

system:

Involves lab directors/managers, ED nurse directors, ED staff, and ED physicians.

Requires standardized measurement processes – data collection

and analysis must be consistent. Requires standardized reporting system. Suggest monthly reporting. Can be automated into dashboard format. Can be used to share ‘best practice’ processes and ideas

between facilities and across system. Can be used to recognize performance excellence.

Lab TAT % Outliers Process

Improvement

Questions?