Problem-solving in pathology produces results for patients and employees

January 11, 2023  //  FOUND IN: Strategy & Leadership, ,

Approximately a 6-minute read

Key takeaways:

  • Emily Schwedler, an administrative manager in pathology, used the Practicing Healthcare Improvement class to work through ordering issues with tests for transplant patient specimens.
  • All problems discussed in the class are related to U-M Health’s BASE strategic priorities, especially ‘S’ or Safety and Quality.
  • Schwedler collaborated with others in the class, using the A3-PITCR problem-solving template and Five Whys template to solve the problem.
  • After the class, issues reported went from 96% in the first quarter to 54% in the third quarter. The reduction in incorrect or duplicate orders also saved staff between 20-40 hours of time in one quarter.

When Emily Schwedler, an administrative manager in pathology, signed up for the Practicing Healthcare Improvement class through the Quality Department, she knew there was a problem in her department – staff were spending too much time resolving ordering issues with tests for transplant patient specimens. Sometimes, either the incorrect test or duplicates of a test were being ordered.

During the 10-hour improvement class, Schwedler got to work correcting the problem. Eventually, her efforts turned into some exciting improvements both for patients and employees.

And she’s not the only one who has helped the health system improve thanks to Quality’s innovative course.

Helping to build our BASE

All problems brought to the Practicing Healthcare Improvement class are related to U-M Health’s BASE strategic priorities, so this not only creates departmental problem-solving opportunities for those taking the course, but it also allows for contributions to organizational success.

The ‘S,’ or Safety and Quality priority, is a focus for those who participate, since improving a problem can contribute to safe, high-quality care. In Schwedler’s case, correct test orders are crucial to patient safety.

“When a test is ordered, it should be clear what’s coming in. It should be clear to our laboratory what we should do to test for the patient. If we can’t do that, that’s a safety issue for the patient that could postpone the search for an organ or treatment of the patient post-transplantation,” she said.

Improvements made in Schwedler’s ordering issue have also impacted the ‘E,’ or Experience priority, as fewer errors can provide better patient satisfaction and happier employees.

A unique approach

One special aspect of the Practicing Healthcare Improvement class is that it allows you to participate in breakout groups with colleagues from other departments. This makes the learning experience unique, providing “fresh eyes” that may be able to help with your problem.

In Schwedler’s case, she received assistance from a project manager in Clinical Quality and a HITS business systems analyst to work through the A3-PITCR problem-solving template. Together, the group outlined the problem, importance, current state, targets, root causes and recommendations – doing so with the coaching and facilitation of two continuous improvement specialists from the Quality Department.

“The class really did inspire me to identify the problem and attack root causes that were creating it,” said Schwedler.

The Five Whys Template, also taught in the class, was mentioned by Schwedler as another helpful tool.By continually asking “Why?” you can move past the symptoms of a problem to identify its root causes.

After class, Schwedler created a problem log in Microsoft Teams for documentation.

“When you organize data in this way, you can hone in on exactly what the issues are. After doing this, we now have some real data to guide us forward,” she said.

In the end, she found that most of the issues stemmed from either duplicate or incorrect orders.

Another key countermeasure to reduce errors was to edit tests in the pathology handbook to match MiChart test codes. Schwedler did this in the month after class and estimated that 80% of them needed to be changed.

She also worked to create awareness of the pathology handbook and which tests to order.

“There are so many different testing workflows in transplant, so ordering can be confusing,” Schwedler said. “Correcting what we have in the pathology handbook and spreading awareness of the handbook will help us better care for our patients.”

Seeing change

Once the improvements were implemented, the issues reported went from 96% in the first quarter to 54% in the third quarter. Each issue is estimated to take between 30-60 minutes to resolve, so this has saved staff between 20-40 hours of time in one quarter. Patient safety reports related to the issue Schwedler discussed have also seen a 42% reduction, going from 36% in the second quarter to 21% in the third quarter.

What was once a major issue in the department has now been improved and implemented changes have been well-received by laboratory technicians.

“They have felt a massive difference. We have established some language such as ‘let me direct you to the pathology handbook,’ helping to create awareness,” Schwedler said. “Other common new phrases are ‘Let me send you this information,’ or ‘This is how you place an order for this kind of patient.’ I feel as though they now have the tools necessary to head off some of these incorrect order issues.”

Making an impact

Those who worked with Schwedler throughout the class have noted the impact she made on her department and the organization as a whole.

“I could tell how engaged she was in the class, and she was great at pulling ideas from others. I had no idea she was going to take this problem and run with it,” said Patti Craig, a continuous improvement specialist.

Ashley Logan-Sitko, the other continuous improvement coach that facilitated during class, plans to follow up with Emily in six months and collaborate on a Quality Month poster.

If you want to participate in the Practicing Healthcare Improvement class, click here.

Let the improvements continue!