Reframing beliefs about work and change processes in redesigning laboratory services.
BACKGROUND
In 1996 a team started meeting to redesign care at Intermountain Health Care's (Salt Lake City) laboratory services on a fast track to dovetail with remodeling of the physical layout. The team reframed its current beliefs about using team processes--including use of a consultant/facilitator, team size, and decision making (by criteria instead of consensus).


METHODS
Although the lab was strong in technical measurements, the sole management measurement before redesign was financial data generated by the accounting department. A comprehensive measurement system, which was required for the lab to evaluate the impact of the redesign efforts and manage its operations over time, constituted the team's first steps toward implementing the redesign effort. PROCESS REDESIGN: Once the team understood the purpose, customer expectations, desired outcomes of the specimen flow process, and the reasons for current breakdowns, it was able to design an ideal high-level process (with a floor plan to support it). Multiple subprocesses were redesigned and implemented on the basis of reframed beliefs--for example, that the process starts and ends with the customer (clinician or patient) and that there is one standardized entry point into the lab to reduce variability in processing and assign priority for analysis of specimens. For example, the team identified opportunities for improvements in the manner in which laboratory test results were communicated to physicians' offices.


CONCLUSIONS
The belief that appeared to have the most profound impact on the redesign effort was the clarification of the fundamental purpose of laboratory services and how it shapes every aspect of the business.
Kelly
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LDS Hospital, Salt Lake City, UT 84143, USA. lddkelly@ihc.com
D001291:Attitude of Health Personnel; D002984:Clinical Laboratory Information Systems; D003659:Decision Making, Organizational; D006126:Group Processes; D017721:Hospital Costs; D006754:Hospital Restructuring / Q000458:organization & administration*; D007324:Institutional Management Teams / Q000458:organization & administration*; D007755:Laboratories, Hospital / Q000191:economics / Q000458:organization & administration*; D008332:Management Quality Circles; D008854:Microscopy, Electron; D009936:Organizational Innovation; D016133:Polymerase Chain Reaction / Q000191:economics; D017064:Process Assessment, Health Care / Q000379:methods*; D013048:Specimen Handling; D014589:Utah