General Laboratory: Lean Key Issue Identification Online Training

Kỹ thuật viên có thể giúp giảm liều bệnh nhân một cách đáng kể bằng cách chọn các chương trình chụp (protocol) thích hợp. Hầu hết các nhà sản xuất hiện tại đều cung cấp các protocol tích hợp cho thăm khám trẻ em. Các protocol dành riêng cho nhi của Siemens được thiết kế để tối ưu hóa giảm liều và chất lượng hình ảnh ở trẻ nhỏ hơn.   điều này đạt được thông nhờ pitch lớn hơn, bộ lọc tia dành riêng cho nhi, kernel phù hợp, và CARE Dose4D. Welcome to the Key Issue Identification Online Training course.  The Keen but not Lean Medical Center (KLMC) Laboratory is continuing their investment into their Lean Team; the difficulty they are having is that they are too successful. Everyone has a problem for them to solve so they are now looking at the use of key issue identification techniques in order to prioritize which problems they should work on first.  Join the KLMC team on their journey and learn how to apply this tool in your laboratory.   Select Next to continue.   Define Key Issue Identification Describe how to use Ishikawa diagrams to identify root causes Describe strategies that can be used to address key issues List the steps to facilitate a brainstorming session using affinity mapping to identify key issues Upon successful completion of this course, you will be able to: Select Next to continue. Một kỹ thuật khác để tăng tốc độ quét CT là sử dụng pitch cao hơn - tỷ lệ giữa độ di chuyển bàn trên mỗi vòng quay của gantry với độ rộng của chùm tia X. Bàn di chuyển càng nhanh, tốc độ quét càng cao và thăm khám được hoàn thành càng sớm. Cũng lưu ý rằng SureView sẽ tự động điều chỉnh giá trị mA trên máy CT Siemens của bạn để duy trì liều bức xạ phù hợp. Các hệ thống CT 2 đầu bóng của Siemens - như SOMATOM Flash và SOMATOM Force - sử dụng hai bóng và hai đầu thu, cho phép quét siêu nhanh với giá trị pitch cao hơn 3, trong khi vẫn duy trì chất lượng hình ảnh tối ưu. Congratulations.  You have completed the Lean Key Issue Identification Online Training course.  Listed below are key points that have been presented.  Take time to review the material before you proceed to the final quiz. Define Key Issue Identification Key Issue Identification is a process of capturing people’s ideas and organizing those thoughts around common themes. Key steps of Key Issue Identification include the following: Run a brain storming session to generate ideas and thoughts from all the people present Use Affinity Mapping to identify the 1-3 key issues Use Ishikawa (Fishbone) Diagrams to identify the root cause or causes behind each issue Identify the action items that need to be dealt with to redefine the process List the steps to facilitate a brainstorming session using affinity mapping to identify key issues Affinity mapping is the process of capturing people’s ideas and organizing those thoughts around common themes. Used during a brain storming session to identify the key issues Will often be your first step in a problem solving process Use when you have a large number of thoughts, ideas or facts that are not organized in any coherent manner Very useful when traditional solutions to a problem have failed and you need to find new ways to approach a problem Will often bring to the forefront previously unrecognized ideas Forces you to rethink how issues are connected, which could lead to an entirely new way of looking at a problem To conduct an affinity mapping brain storming session: Decide on the topic Brainstorm issues Organize issues into groups Score issues Record results Describe how to use Ishikawa diagrams to identify root causes An Ishikawa (Fishbone) Diagram is a method of determining the root cause of a problem by systematic modelling of the contributory factors. Also known as cause-effect or fishbone diagrams Useful to help characterize the nature of performance gaps and to identify improvement opportunities To use an Ishikawa Diagram: Write the problem/issue into the problem statement box Ask why is the problem associated, caused or worsened by each of the headings (people, process, equipment / material or information) and write it into the appropriate space Identify clear action areas to address or possibly repeat the affinity mapping using the Ishikawa answers as issues to identify the 3 top issues Describe strategies that can be used to address key issues Key steps to addressing the action items: People – there is a need to use ‘soft skills’, understand who can influence and undo roadblocks to resolve the issue Process – use process mapping, spaghetti mapping and/or value stream mapping to look at the specific process (it may have been seen as a minor sub process in earlier Lean events looking at the departmental process Equipment – evaluate if it is being used properly, should it be replaced, removed or should it be moved to a different area where it improves the process Material – evaluate if it is the correct material for the process, is it being used properly, can it be removed or replaced Information – is it verbal, written, or digital, how is it being used, and what can be done to improve the situation Select Next to continue. Adaptive Dose Shield (Lá chán liều thích ứng ứng) hoạt động như thế nào? Adaptive Dose Shield sẽ chặn phần tia X không sử dụng để tái tạo hình ảnh trong quét xoắn ốc. Bộ phận chuẩn trực động (dynamic collimator) sẽ di chuyển để chặn phần tia X ở ngoài vùng thăm khám mong muốn. Adaptive Dose Shield sẽ tự động kích hoạt khi bắt đầu quét xoắn ốc và sau đó tự động đóng lại khi kết thúc quá trình quét. Hơn nữa, Adaptive Dose Shield sẽ tự động hoạt động - không cần phải bật/tắt, giúp loại bỏ bức xạ không cần thiết một cách đơn giản và hiệu quả trong quét xoắn ốc. Key Issue Identification is a process used to capture people’s ideas and organize those thoughts around common themes. The key steps of Key Issue Identification include the following: Run a brain storming session to generate ideas and thoughts from all the people present Use Affinity Mapping to identify the 1-3 key issues Use Ishikawa (Fishbone) Diagrams to identify the root cause or causes behind each issue Identify the action items that need to be dealt with to redefine the process   Materials Needed Learn about the materials needed to perform key issue identification. To perform key issue identification:  Assemble a team of 8-12 people who have knowledge and understanding of the area You will need a white board, wall or flip charts, Post-it notes (sticky notes), red, green and blue stickers or marker pens and black marker pens for the team Note: This is not an exercise to do at a computer desk.  When complete, select the X in the upper-right corner to close the window and continue.     When does it work best? Learn when key issue identification works best. Key Issue Identification The technique of Key Issue Identification can be used at any time to drill down to the vital areas that are affecting performance. It is an excellent way to get a common list of key issues at the beginning of a Lean project (or to identify the most important project to deal with). It can also be used at an operational team level to let people share their current issues in a constructive way (rather than let personal issues cloud the underlying real issues).    When complete, select the X in the upper-right corner to close the window and continue. Cause and Effect Analysis Learn how key issue identification is related to cause and effect analysis. Cause and Effect Analysis This approach is sometimes called CEDAC (Cause and Effect Diagram with Additional Cards) and was developed by Dr. Ryuji Fukuda, a Japanese expert on continuous improvement. Professor Kaoru Ishikawa created Cause & Effect Analysis in the 1960s. The technique uses a diagram-based approach for thinking through all of the possible causes of a problem. This helps you to carry out a thorough analysis of the situation. There are four steps to using Cause and Effect Analysis. Identify the problem Work out the major factors involved Identify possible causes Analyze your diagram   Try using Cause and Effect Analysis – you'll find that it is particularly useful when you're trying to solve complicated problems. When complete, select the X in the upper-right corner to close the window and continue. Tại sao tia X tạo ra "Liều"? Khi các chùm tia X đi qua cơ thể chúng ta, chúng bị tán xạ và/hoặc hấp thụ. Chúng tương tác với các mô cơ thể bằng việc truyền năng lượng của chúng để tạo ra các ion và electron tự do. Phần năng lượng được truyền được gọi là liều. Affinity mapping is the process of capturing people’s ideas and organizing those thoughts around common themes. Used during a brain storming session to identify the key issues Will often be your first step in a problem solving process Use when you have a large number of thoughts, ideas or facts that are not organized in any coherent manner Very useful when traditional solutions to a problem have failed and you need to find new ways to approach a problem Will often bring to the forefront previously unrecognized ideas Forces you to rethink how issues are connected, which could lead to an entirely new way of looking at a problem   Affinity Mapping Learn how to conduct an affinity mapping brain storming session. Checklist TitleChecklist TypeChecklist ContentDecide on topicHTML The first step is for the team to agree on the topic.  The KLMC Lean team assembled a group of 12 people from across the departments. They agreed that the topic was “What is stopping us meeting our turnaround time goals”. Select each checkbox to learn more about conducting an affinity mapping brain storming session.    Brainstorm issuesHTML Next, the team brainstorms issues related to the topic. Each person writes down several facts in a clear way; 1 fact per Post-it note Each person reads out the fact to the group to assure understanding (rewrite if necessary) The Post-it notes are then stuck on the white board (or alternative)  Organize issues into groupsHTML The team then works to organize the issues into groups. In silence the team arranges the Post-it notes into “like” groups A single Post-it descriptive header is made for each group  Score issuesHTML The issues are then ranked using a scoring system. Each member of the team gets a red, green and blue stick dot worth 3, 2 and 1 point respectively; and votes for the issue they see as most important with red = 3 as the highest score/most important issue Count up the scores and the top 1 - 3 scores should be chosen as the key issues  Record resultsHTML Finally, record the results of the session.  Take photographs of the post-it board during the event. When complete, select the X in the upper-right corner to close the window and continue.     Sự phân bố liều trên mặt phẳng không đồng đều. Khi tia X đi qua vật chất, chúng dần dần bị suy giảm. Do đó, liều lượng đo được ở trung tâm của một đối tượng luôn thấp hơn ở bề mặt. Để ước tính liều trung bình, khái niệm về CTDI có trọng số (CTDIw) đã được giới thiệu. CTDIw được lấy từ giá trị trung bình của 4 buồng đo ở ngoại biên và 1 buồng đo ở trung tâm phantom   CTDI thay đổi theo trường nhìn (FOV). Ví dụ, đối với chụp CT vùng thân, CTDI ở bể mặt thường lớn hơn một hoặc hai lần so với trung tâm trường chụp. Liều trung bình được ước tính bởi CTDIw, với các giá trị trọng số: một phần ba cho giá trị trung tâm và hai phần ba cho các giá trị ngoại vi.   CTDIw là một thông số kỹ thuật hữu ích phản ánh ảnh hưởng của các thông số như kVp, mAs và collimation. Nó cho phép so sánh dễ dàng các chương trình quét khác nhau và các hệ thống máy. An Ishikawa (Fishbone) Diagram is a method of determining the root cause of a problem by systematic modelling of the contributory factors. Also known as cause-effect or fishbone diagrams Useful to help characterize the nature of performance gaps and to identify improvement opportunities To use an Ishikawa Diagram: Write the problem/issue into the problem statement box Ask why is the problem associated, caused or worsened by each of the headings (people, process, equipment / material or information) and write it into the appropriate space Identify clear action areas to address or possibly repeat the affinity mapping using the Ishikawa answers as issues to identify the 3 top issues Download and print a copy of the Ishikawa Diagram template.   KLMC Team Applies Ishikawa Diagrams Learn how the KLMC team used Ishikawa Diagrams. The KLMC team took the top issue from the affinity map and wrote “Samples take too long to get from reception” in the problem statement box of their Ishikawa Diagram template. They then filled in the reasons why the problem is associated, caused or worsened by people, process, equipment and material/ information in the appropriate spaces. This identified 3 clear action areas that they could address. The Ishikawa was saved so that it could be revisited with affinity mapping if the addressed actions did not fully resolve the issue of too many ways to handle a tube in reception. Materials: Multiple forms create confusion People and Process: Lack of communication between the supervisors in the reception and core lab appears linked to confusion with sample deliveries Equipment: Centrifuge buckets not emptied fast enough   When complete, select the X in the upper-right corner to close the window and continue. Vậy, liều lượng hiệu dụng cho bệnh nhân của bạn là gì? “Liều hiệu dụng” có nghĩa là gì? Liều hiệu dụng được biểu thị bằng tổng liều được áp dụng không chỉ cho các cơ quan trong phạm vi quét, mà cho tất cả các cơ quan của cơ thể. Đơn vị của liều hiệu dụng là Sieverts (Sv), thường sử dụng milliSieverts. Điều quan trọng là phải nhận ra rằng các hiệu ứng sinh học tiềm ẩn từ bức xạ không chỉ phụ thuộc vào liều bức xạ đối với mô hoặc cơ quan, mà còn phụ thuộc vào độ nhạy sinh học của mô hoặc cơ quan được chiếu xạ. Liều hiệu dụng không thể được đo trực tiếp. Nó phải được ước tính thông qua các phương pháp phức tạp hơn, ví dụ như các kỹ thuật dựa trên Monte Carlo. Một trong những phương pháp khả dụng để tính toán liều hiệu dụng là dựa trên DLP của thăm khám. Việc tính toán sẽ ước lượng liều lượng hiệu dụng dựa trên DLP của người lớn hoặc trẻ em ở các độ tuổi khác nhau và trên các vùng cơ thể khác nhau. Hệ số chuyển đổi (k) cho phần đầu/cổ ở người lớn và trẻ em sẽ được tính toán dựa trên phantom liều vùng đầu, đường kính 16 cm. Tất cả các yếu tố chuyển đổi khác sẽ dựa trên phantom phần thân đường kính 32 cm. Nói cách khác, giá trị ước lượng của liều hiệu dụng có thể dễ dàng được tính toán từ giá trị DLP cùng với hệ số chuyển đổi liều hiệu dụng thích hợp. Trên đây là các ví dụ về hệ số chuyển đổi theo nhóm tuổi.     Key steps to addressing the action items: People – there is a need to use ‘soft skills’, understand who can influence and undo roadblocks to resolve the issue Process – use process mapping, spaghetti mapping and/or value stream mapping to look at the specific process (it may have been seen as a minor sub process in earlier Lean events looking at the departmental process) Equipment – evaluate if it is being used properly, should it be replaced, removed or should it be moved to a different area where it improves the process Material – evaluate if the correct material is being used for the process, is the material being used properly, if not, can it be removed or replaced Information – in what form is it: verbal, written, or digital. How is it being used and what can be done to improve the situation   Addressing Key Issues Learn how the KLMC team addressed their 3 key issues. Slide NumberText BlocksCalloutsAudio ScriptImage File1 The KLMC Lean Team has run a key issue identification workshop using affinity mapping and Ishikawa diagrams. They have identified 3 areas that need to be addressed: Materials – Multiple forms create confusion People – Lack of communication between the supervisors in the reception and core lab appears linked to confusion with sample deliveries Equipment – Centrifuge buckets not emptied fast enough   Select Next to continue. Note: If audio does not automatically start, select the play arrow in the top left to begin.The KLMC Lean Team has run a key issue identification workshop using affinity mapping and Ishikawa diagrams. They have identified 3 areas that need to be addressed. The first is that the lab's process uses multiple forms which is causing confusion. This falls in the category of Materials. The second issue is a lack of communication between the supervisors in the reception and core lab which is causing confusion with sample deliveries. This falls in the category of people. The third issue is that the centrifuge buckets are not emptied fast enough, which is in the category of equipment. This slideshow will examine how the KLMC team addressed each of these key issues. Select next to continue. 2 KLMC Key Issue:  Multiple forms create confusion Category: Materials   Further investigation: The laboratory was accepting 10 different request forms for chemistry and hematology There were forms for STAT requests, inpatient, day patient and outreach patients that were all laid out differently Action to Address the Issue: The KLMC team did a value stream map on the process of sorting and data entry of samples using these forms including the first time failure rate to obtain a baseline for measuring improvement KLMC management set up a Form Review team including the Laboratory Supervisors and stakeholders from their physician customer groups.  Within 6 months they had developed 3 simplified forms (inpatient, day patients, and outreach patients)   Select Next to continue. Within the category of materials, the KLMC team identified that multiple forms create confusion. On investigation they discovered that the laboratory was accepting 10 different request forms for chemistry and hematology; this was historic and had been accepted when the Regional Government had closed 3 smaller laboratories. Rather than introduce the KLMC form they had accepted the forms already in use. In addition there were forms for STAT requests, inpatient, day patient and outreach patients that were all laid out differently. The KLMC team did a value stream map on how the process worked with sorting and data entry of samples using these forms including the first time failure rate to have a baseline for measuring improvement. KLMC management set up a Form review team including the Laboratory Supervisors and stakeholders from their physician customer groups, and within 6 months they had developed 3 simplified forms for inpatient, day patients, and outreach patients. Select next to continue.3 KLMC Key Issue:  Lack of communication between the supervisors in Reception and Core Lab leads to confusion with sample deliveries   Category:  People   Further Investigation: Samples were always taken to the core lab by reception staff with no regular delivery system No knowledge in reception of when analyzers were or were not available Core lab staff could be waiting for samples but they did not go to or phone reception to find out if samples were ready This was completely different for STAT samples that were always processed, delivered and analyzed immediately   Select Next to continue. The KLMC team identified that within the category of people, there was no communication between the supervisors in reception and core lab. This was leading to confusion with sample deliveries. The KLMC Lean team observed the workflow and interaction between reception and the core lab: they noted that samples were always taken to the core lab by reception staff. There was no regular delivery system, there was no knowledge in reception of when analyzers were or were not available, and the core lab staff could be waiting for samples but they did not go to or phone reception to find out if samples were ready. This was completely different for STAT samples that were always processed, delivered and analyzed immediately. Select Next to continue. 4KLMC Key Issue:  Lack of communication between the supervisors in Reception and Core Lab leads to confusion with sample deliveries (continued)   Category:  People   Action to Address the Issue: The Lean team called a meeting with the Core Lab and Reception supervisors and reported back what they had seen and suggested that they formalize the delivery process They also recommended that they hold a "Start of Shift" 5 minute meeting and an "End of Shift" meeting between representatives of both departments After 3 months there was a ‘sweeper’ system in place (a follow up recommendation by the Lean Team) and samples were being delivered every 20 minutes to the core lab The supervisors felt that the meetings were too important to let just anyone attend and now they or their deputies are talking twice a day (at least)   Select Next to continue. The Lean team called a meeting with the Core Lab and Reception supervisors and reported back their observations. The team suggested the lab formalize deliveries rather than having ad hoc ones. They also recommended the lab hold a "Start of shift" 5 minute meeting and an "End of shift" meeting between representatives of both departments. At the Start of shift meeting, they could discuss that days planned events such as staffing shortages through training/holidays and planned maintenance visits by companies. At the end of shift meeting they could discuss how many samples had been processed and what if any issues had been seen. After 3 months there was a ‘sweeper’ system in place (a follow up recommendation by the Lean Team) and samples were being delivered every 20 minutes to the core lab. The supervisors felt that the meetings were too important to let just anyone attend and now they or their deputies are talking twice a day (at least)! Select Next to continue. 5 KLMC Key Issue:  The centrifuge buckets are not emptied fast enough   Category: Equipment   Further Investigation: The staff is doing multiple tasks and forgetting to unload the centrifuges   Action to Address the Issue: Various options were considered including clock timers and centrifuge completion alarms but these were considered to be extra tasks and would be too noisy in an already busy department The staff claimed that it was difficult to tell when a centrifuge was full and when it was empty. The Lean Team suggested they used visual clues and place a flag on each centrifuge – when the centrifuge is loaded the flag is seated on top of the lid. Initial trials have shown that this approach has been successful Tip: When complete, select the X in the upper-right corner to close the window and continue.  The KLMC Lean team identified that under the category of Equipment, the centrifuge buckets are not emptied fast enough. After a period of observation it was clear that this was due to staff doing multiple tasks and basically forgetting to unload the centrifuges. Various options were considered including clock timers and centrifuge completion alarms but these were considered to be extra tasks and would be too noisy in the already busy department. The staff claimed that it was difficult to tell when a centrifuge was full and when it was empty. The Lean Team suggested they use visual clues and place a flag on each centrifuge – when the centrifuge is loaded the flag is seated on top of the lid. Initial trials have shown that this approach has been successful. When complete, select the X in the upper-right corner to close the window and continue.