Six Sigma eliminates a blood-flow ‘bottleneck’ in YPB

Blood draw station face-lift cut wait times, raised patient satisfaction

Phlebotomist Judy Nicholls feels she is providing better service as efforts to improve the blood draw station continue to pay off.

Every month, as many as 2,500 Yale Medical Group patients arrive on the second floor of the Yale Physicians Building (YPB) to have their blood drawn and, on occasion, to have an electrocardiogram (EKG). These days, the process is almost always smooth and efficient, with minimal wait times and a high degree of patient satisfaction.

But this was not always true. A year ago, an increase in customer and physician complaints prompted Denise Fiore, vice president of clinical support services at Yale-New Haven Hospital, to assemble a team to analyze and rectify a problematic situation. “We’d made tweaks in the past, but this gave us a chance to take a big picture look,” said Fiore. “And clearly, we needed to make changes. It couldn’t be status quo.”

Last December, a team headed by Nancy Smith, the hospital’s senior manager for laboratory operations, began its assessment, and when the YPB project was wrapped up in the summer, its success, based on criteria such as an 80 percent reduction in wait times, was evident. “I’m very pleased,” said Fiore. “We’ve made significant improvements.”

Six Sigma in action

The project is an example of LEAN Six Sigma in action. Six Sigma is a data-driven methodology developed in the 1970s to improve quality control in manufacturing situations, and it came to YNHH ten years ago. Since then,YNHH, through its Institute for Excellence, has developed its own in-house training program and undertaken numerous Six Sigma projects.

Here’s how the methodology worked at the YPB. Smith, who has achieved Six Sigma “master black belt” status, and a team of YNHH-trained green belts, looked carefully at the work environment and watched the phlebotomists in action. The initial improvement, which happened last February, was a “top-to-bottom face-lift” of the blood draw station, said Smith, along with the replacement of an older, harder-to-use EKG machine with a newer model. Another, seemingly minor, change in the physical setup had big results: In the culture of the organization, one of the two restrooms had become reserved for staff only, removing this restriction “eliminated a bottleneck” for patients, said Smith.

Supervision has been key

Another bottleneck was taken care of by opening earlier: 7 in the morning rather than the 7:30 a.m. to 5:30 p.m. schedule that the blood draw station had been on. A work practice change—restocking each of the six blood-draw rooms with appropriate supplies in the late afternoon instead of randomly during the day—helped ensure that the phlebotomists could work efficiently from the moment the doors opened. The phlebotomy coordinator was relocated to the YPB location in order to monitor staff performance and behavior continuously throughout the day. This supervision has been key to maintaining the current performance metrics and not losing the progress that has been made.

“Essentially, we modeled and standardized our practices,” said Smith, adding that the procedures are now being instituted at the nine other blood draw stations in southern Connecticut locales. “And we’ve held our people to those standards.” This includes the phlebotomy manager and coordinator, who now routinely monitor wait times via computer. When these exceed 20 minutes, Deborah Anthony and Lisa Giglietti head for YPB’s second floor to help. “We’ll do whatever we can to facilitate patient flow,” says Fiore, “even if it’s just to apologize for the inconvenience and provide service recovery when necessary.”

Yale Medical Group nephrologist Richard N. Formica, MD, medical director of the kidney transplant program, has been one of the blood draw station’s biggest users over the years. “I’ve seen a dramatic improvement there,” he said, adding that slowdowns had become significant enough that he even considered adding a phlebotomist to his clinic’s staff. But the speed-up in blood draw services means that he can accommodate the nearly three dozen patients he typically sees during his morning clinics, almost all of whom need to have blood work done. “The fact that we can now get our work done efficiently is a testament to the improvements they’ve made. They’re doing a great job,” Dr. Formica said.