Below are several questions for you to think about and respond to on the bulletin board. Once you have gathered your thoughts, please post your responses on the bulletin board prior to our on-line sessions scheduled for Thursday, February 19, 1998 from 4-6 PM. During that time you can react to other students' responses.

1. Identify a real and existing problem in the workplace. (You may choose the health care setting or any other setting you wish.)
2. How would TQM address the problem and improve the situation in the workplace?
3. Post only the problem on the bulletin board and the class will determine how TQM will address and solve the problem.

Here is an example of a problem and how it was handled using TQM:

Problem: Unsuccessful blood draws were too high, and the morale of the morning phlebotomy team was low.

Goals: To have the 5:30 AM inpatient blood collection specimens arrive at various laboratory sections by 7:30 AM, and for the computer accession list to accurately reflect the specimens collected.

Process: The phlebotomy improvement team was established. The team included 4 phlebotomists, the phlebotomy supervisor, a chemistry technologist, and a facilitator trained in TQM. The team learned the tools and processes of TQM in four 3-hour training sessions.

Tools: The team set rules of trust; wrote a mission statement; used a flowchart to diagram the key processes involved in drawing blood; identified problems that can arise at each step of the flowchart; placed the problems into a variance matrix to determine which should be targeted for improvement; and drew up an action plan to collect data on the key problems identified for improvement.  The team surveyed both phlebotomists and customers to measure satisfaction. The matrix helped the team see that when the computer system was down, it affected the entire work flow and worsened other problems. The team then met with the computer coordinator, who created a backup list to the computer phlebotomy list.  This new list proved effective on numerous occasions. Survey results indicated that phlebotomists lacked confidence using the computer system and wanted more training.  A training curriculum was written and is being used to train new technicians in system use.  The team extended the length of training for technicians from one day to a full week, and for phlebotomists from two weeks to three weeks. New "cheat sheets" were written in simplified language to assist the phlebotomists and supplement the formal procedure manual.

Results: The team decreased unsuccessful blood draw rate from 1.8% to 0.6%, and decreased the amount of time to deliver blood to the laboratory by 30 minutes. The new work flow also was designed to allow phlebotomists to work together and learn from each other on the ward, which had a positive impact on team morale and improvement of technique. The team recommended instituting yearly competency evaluations for all phlebotomists, which put the department ahead of the other lab departments in fulfilling new regulatory requirements.

Reference: Yablonsky, T. (1995). Total Quality Management in the Laboratory. Laboratory Medicine, 26:4, 259.

Class discussion/bulletin board

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