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Laboratory Management System- A Change Management Case Study

Laboratory Management System

A laboratory management system (LMS) is a software-based approach that enables the activities of a modern laboratory. Among the key features are the support for workflow and data monitoring, a modular framework, and data sharing interfaces that allow its usage in controlled environments (Allen, 2013). A LIMS’s capabilities and applications have developed over time, from essential sample monitoring to an enterprise resource planning platform capable of managing various facets of laboratory informatics.

SWOT  Analysis

The opportunities and market environment for improving the clinical laboratory’s activities are investigated using the SWOT study, which identified the capabilities, vulnerabilities, opportunities, and risks that can affect an organizational entity (in the order given in Table 1), i.e., the clinical laboratory at hospitals. Strengths and vulnerabilities contribute to an institution’s internal traits, while openings and risks are external influences. Opportunities apply to laboratory situations that could advance company activities (Ugwuda and Ayoade, 2015). Weaknesses refer to deficiencies in experimental work, and eliminating them will open up fresh ways to enhance the standard of work and, ultimately, profitability. Threats are situations that can impede business activities. .

Table # 1 Summary of SWOT Analysis

Threats

Opportunities

Sales revenue decline due to reduced patient visits

Automation with hospital inbound patients billing module

Reduction in number of tests due to good health of the public

Integration of information between patient and doctors advice to contact medical test

New offers from other hospital laboratories

Labor cost expense can be reduced due to bulk testing.

  

Weakness

Strength

System glitches due to malfunction can cause problems

Available 24 hours for service due to hospital needs

High Labor cost due to high profile professional team required

Wide range of testing facility available due to hospital needs

Heavy Load at laboratory may affect professional efficiency

Profitability increased to inbound and outbound patient

   

Laboratory Management Software- Case study

Key Performance Indicators related to Laboratory Management System

Key Performance Indicators (KPIs) for Laboratory Management System are indicators of the laboratory’s performance and operations, such as programs, procedures, goods, or facilities. KPIs are often used in laboratories to monitor the inventory, equipment, climate, records, and results (Rizk, Zaki, Hossam, and Aboul-Ela, 2014). When introducing KPIs in Laboratory Management System, it must first decide what is critical to its success. Three types of KPIs exist:

Business-related key performance indicators

Lab condition key performance indicators.

key performance indicators for data and deliverables

Key performance indicators (KPIs) for the business

Business-related KPIs connect Laboratory Management System activities and the passage of time and resources (Berte, 2007). I operate a laboratory service company. Anybody wants to keep track of sales, costs, and earnings. Following are a few examples:

Sales: the amount of income that anticipates generating weekly, quarterly, or annual basis from laboratory due to

a number of the test by inbound and outbound patients.

Revenue per sample/analysis: how much profit do make from analyses based on information of Laboratory management system?

KPIs relating to the condition of the laboratory

Maintaining a clean lab is a necessary condition for producing high-quality results. It can use this collection of KPIs to assess performance in terms of operations, inventory, and atmosphere (Berler, Pavlopoulos, and Koutsouris, 2005). Through monitoring these KPIs, it can quickly identify and address any underperforming components in the well-oiled engine. These KPIs are universally applicable to all kinds of laboratories.

Quality assurance

The amount of time spent by workers at the Laboratory Management System.

Analysis turnaround time

System uptime

Inventory KPIs will provide more information regarding the consumables and equipment condition. Specific devices now have internal sensors that include information about their output. Additionally, it can keep an eye on the space in technical storage rooms and refrigerators.

Monthly consumption of consumables

Amount of consumables thrown away

Consumable usage as determined by research

Refrigerators with available room

Size and reserve of consumables inventory

Key performance indicators (KPIs) for data and deliverables

Data is distributed to the client, who uses it to make clinical, scientific, or business decisions. As a result, it can track the quality of the data and deliverables.  Regular quality management checks for accredited comparison samples may be used to track data quality. It may assess the precision and consistency of repeated measurements on reference samples and use them as key performance indicators (KPIs).

Measurements with asset-specific accuracy

The precision of calculations concerning tangible assets

The consistency of reference content serves as a check.

Laboratory Management Software - Case Study

Root Cause Analysis of Laboratory Management System

Fundamental Mechanism

RCA is a problem-solving technique that is commonly employed to identify the fundamental root causes of an incident. An RCA is a methodical, data-driven, and well-documented examination of a case (Chauhan et al., 2013). It is a reactive technique for identifying the measures in a procedure or process that are vulnerable to failure, determining whether one or one failed and resulted in the investigated incident, and determining how to avoid the failure from occurring again. The first step in conducting an RCA is to accurately and concisely characterize the occurrence or issue. Wherever data collection is required, it is gathered to make choices based on data rather than on hypotheses of how the method operates. Since determining the root cause or triggers of a crisis, an RCA utilizes data to define disciplinary steps to fix something that went wrong due to the problem and avoid the same problem from happening in the future.

The topic at hand

Patient examination results and clinical research reports were mislabeled with the patient’s wrong name at the hospital. i.e., medical records are linked to the records of other patients. To ascertain why this occurred, we begin by creating a timeline illustrating each phase in the usual method. This requires a review of all protocols in effect for establishing, managing, and modifying the reference numbers assigned to files created by the system and later connected to patient profiles (Fernandes et al., 1997). Then, phase by step, it is possible to ascertain where the procedure collapsed in this particular instance and other measures that might be vulnerable to failure. The issue described as the cause of this error was a device fault that caused system bugs to apply the report to other patients’ medical profiles.

Corrective steps to correct any erroneous medical outcomes and alert caregivers will begin instantly, with meticulous reporting. As a result, the IT technical team has been contacted to resolve the technical issue. Once the root cause of the process breakdown has been found and the missed action or measures identified. To do this, the provider of the laboratory management framework will be consulted, and professional assistance will be delegated to the hospital to resolve those problems. These interventions require manual supervision on the attachment of reports to patient profiles to guarantee that such errors do not occur in the future. Occasionally, an RCA results in the establishment of an entirely different mechanism to deter problem recurrence. It is important to remember that the RCA is fully recorded.

Laboratory Management Software - Case Study
PDCA for dealing with the issue identified by Root Cause Analysis (RCA)

Dr. Edwards Deming introduced the concept of PDCA (Plan-Do-Check-Act) management (Westgard, 2010). The PDCA circulation is widely used in medical administration for identifying and fixing challenges and is applicable for continuous quality enhancement. PDCA accomplished the essential work after constant circulations to further strengthen management.

Plan

The Administrative Department and clinical needs required detailed research, demonstration, and preliminary design to set up the hospital’s in-house team, which would use a vendor of Laboratory management system to develop a plan to change the system to avoid issues arising from medical reports of other patients’ profiles.

Do

The goal is to have the hospital management and the vendor technical team repair the error. Act alongside eye principles such as manual report attachment of patient profiles to prevent incorrect diagnoses of diseases. Meanwhile, back-end workers concentrate on closing the disparity.

Check

A year after implementing the scheme, the facility underwent a thorough review of the laboratory management system, using an unbiased third party or internal evaluation. Additionally, if difficulties are discovered, the team does not know anything about laboratory control systems. Also, the administrative personnel that was utilizing the laboratory control method missed or ignored disclosing the bugs. In addition, the reports of Laboratory tests fail standardization, rendering the findings difficult to diagnose diseases.

Act

Hospital administration arranged workshops to address existing flaws in the management process and concluded that there are two main factors in the issues mentioned above: timeliness and unity. Medical works are complicated and time-consuming since patients’ symptoms can quickly alter, making the original method of reporting by telephone through transfer connections susceptible to producing misleading information, thus providing a complete solution for hospital management.

Operating System- Pharmacy Management System

The pharmacy management system has to ensure the efficient and successful dispensing of prescription products. Throughout the dispensing procedure at the hospital, the machine will prompt the pharmacist to ensure that the drug they have filled is for the correct patient, includes the correct sales price and dose, and the pharmaceutical label contains valid details (Saha et al., 2018). Advanced pharmacy management programs include clinical decision support, which may be designed to advise pharmacists to opportunities for clinical measures, such as providing verbal counseling to patients whose prescriptions need extra pharmacy education.

PESTEL for Pharmacy Management System at hospital

Pharmacy control systems in clinics and health care units remain highly lucrative for those concerned, despite the industry’s mixed potential forecast. Despite an aging demographic and rising obesity rates, the sector is constrained by government pricing pressures and a recent turn toward fitness (Bond, Raehl, and Franke, 2002). Political, Economic, Socio-cultural, Technological, Legal, and Environmental factors considerations all play a role in determining this industry’s potential.

Political related factors

The pharmacy management scheme would adhere to a stringent regulatory structure. This legislative process, which comprises several federal bodies and several drug-related statutes, establishes critical guidelines for pharmacy management system operation. It can also have an impact on how drugs are marketed and distributed. In either situation, this dynamic regulatory environment, along with market leverage, creates a significant obstacle to entry for potential entrants in the pharmacy management system.

Economic related factors

Overall, healthcare investment is increasing, which has an impact on hospital pharmacy management demand. Whatever the explanation, it can only signify increased income for the pharmaceutical management system since it assists in allocating a sufficient number of patients for billing prescriptions and other related facilities.

Socio-cultural related factors

We have more health problems to address as a result of the aging population. This increases demand for pharmacy management solutions, which results in increased sales for the hospital. Community care may also be provided by pharmacy administration by providing patients with suitable and pharmacy products.

Technological  related factors

Utilizing a state-of-the-art pharmaceutical management solution for inventory management assists not only just the organization but also the consumer by allowing them to check the data of medications used and administered by physicians for potential reference. Such a study of the patient’s medical history by a physician will assist physicians with providing medical guidance in terms of past medications.

Legal related factors

There is considerable variation between the Political and Legal categories. As such, I can prefer to see the pharmacy management system’s regulatory mechanisms as a legal issue that can arise if the wrong medicine or inappropriate quantity of medicine has been given to patients, which may give rise to attract life risk.

Environment-related factors

Of necessity, hospitals must be cognizant of the temperature and physical environment, which must be maintained with such medications. However, medicinal product creation and manufacturing have a far lower environmental footprint than other sectors.

Root Cause Analysis

Root cause analysis (RCA) is a technique for determining the underlying causes of issues to recommend suitable remedies (Knudsen et al., 2021). RCA believes that consistently preventing and resolving root problems is more successful than addressing sub hoc symptoms and putting out flames. To conduct root cause research, we will use the 5 Why analysis and the Ishikawa Model to ascertain the possible causes of pharmacy management device glitches.

5 Why Analysis

The 5 Whys approach is a straightforward, efficient method for determining the source of a query. It may use it to aid in troubleshooting, problem-solving, and quality-improvement efforts. Begin with concern and inquire as to why it exists (Doucette et al., 2012). The ‘5 Why is’ method of root cause analysis involves repeatedly questioning why to an initial issue argument (more specifically, why to each specific ‘why’) to analyze the reasons for the problem’s nature logically. A correctly implemented, the ‘5-Why’s’ can be used to trace the ‘path of causality back to its source.

Why would the hospital prefer to integrate patient profiles into the pharmacy management system?

The main explanation for this connection is to determine the hospital’s expense per patient, which covers medication costs. Additionally, this connection is needed to connect pharmacy and medical test reports directly to patient accounts through the pharmacy and laboratory management systems.

Justification for inefficiencies in the pharmacy management system’s efficiency?

Accurate laboratory management equipment is projected to result in the highest degree of health care efficiency. The glitch occurs due to a failure of the primary system’s hard drive and a virus in the program. Hardware and applications must be upgraded from technical standpoints that have not been updated. Glitches occurred during the process of associating patient records with their profiles.

What is the justification for the pharmacy management System’s failure to accomplish the intended task?

Pharmacy Management System hardware and development requirements necessitated manufacturer updates. Vendors are charging a sufficient sum to hospital management that exceeds the hospital’s budgetary constraints. As a result, the pharmacy Management System is implemented without regard for potential changes. Still, the hospital’s administration lacks the funds necessary to buy hardware and technological upgrades.

Is it essential to upgrade hardware and applications, and if so, why?

Hardware and applications must be upgraded as technology advances. These upgrades include cyber defense, hardware sales, ransomware updates, and the addition of new modules. As a result, as time passes, hardware reliability and precision must be updated. Without certain modifications, errors in adding laboratory reports occur.

Why are bugs essential to remove? Why should not an alternative intervention be taken in the form of a manual updating of the pharmacy record?

Glitches must be avoided because if they are not, patients’ notes may be added to other patients’ records, and a doctor may diagnose the incorrect condition and consequently administer medication that may cause side effects or even put a patient’s life in danger. Additional manual intervention can result in human error. It could be a temporary arrangement but not a permanent one.

Main Issue

When the request from health worker staff for the pharmaceutical product is received, the system assigns the medicine to other patients who were not required in doctor prescription. Further, this problem affected the costing procedure for patients as medicine charge to those patients who do not require it. Side effect incidents due to medicines cannot be ruled out in such cases.

Ishikawa Model.

Ishikawa diagrams are also known as fishbone diagrams, herringbone diagrams, cause-and-effect diagrams, and Fishikawa diagrams. They are shaped like a fish skeleton, with the “ribs” reflecting the causes of an incident and the “ass” representing the ultimate result. The Ishikawa diagram aims to assist management in determining which problems must be resolved to gain or prevent a specific incident (Jayaprasad, Dhanalakshmi, Baskaran, and Hemachandran, 2018). It may also be used to classify possible causes affecting an aggregate impact in quality defect prevention. Each source of difference is a cause or explanation for imperfection. To define and describe these origins of heterogeneity, causes are typically classified into broad categories.

Mechanical Issues

The Pharmacy management system glitches are depended upon hardware and software criteria. These requirements need to be rectified by the hospital’s technical department, keeping in collaboration with vendor services. The process under which the hospital management system operated necessitated complex system-level specifications, including hardware and an operating system. The main issue was the high cost of purchase. As a result, used computers were used to power the management applications.

Environmental concerns

The staff members of the technical department were unable to obtain the correct understanding of the pharmacy management system due to which vendor services hired since the machine layout is too complex for a manual person to comprehend. To this end, it was recommended that all workers who serve on this mechanism receive professional training. Nonetheless, this is a time-consuming exercise.

Technical services.

In order to have a technical response towards the glitches of the system, the hospital technical staff needs to be healthy equipment with knowledge of the pharmacy management system at the hospital. Further, to support the staff, there was no physical manual accessible for this device because the interface integrates with other units. Such incorporation will entail technological knowledge on the part of the employee, which is not sufficient, and technical personnel is in short supply to meet such needs.

Human Strength issue

Due to creative and emerging technologies, the hospital technical team is in desperate need of skilled staff. Additionally, it needs time for a new employee to get familiar with new software. As a result, it is recommended that new employees receive professional instruction. There is some issue at the staff end which also required human interest to learning.

Technological innovation

To access technology, hospital management needs to purchase the latest hardware and software to a modified edition of advanced pharmacy management, enabling the software’s full functionality. This condition developed as a result of the hospital administration’s expenditure constraints.

PDCA  Cycle

When making minor improvements to a method and when the problem is understood, the PDCA cycle is beneficial. It enables the viability of a proposed concept to be determined, regardless of whether it is a gradual or a breakthrough development. Repetition of the PDCA loop regularly can aid in implementing Kaizen and other programs aimed at quality improvement. Additionally, TQM, ISO norms, and  thought process all adhere to the PDCA ideology (Wang et al., 2013). Using the PDCA loop promotes a methodical approach to problem-solving and strategy implementation.

Plan

In order to remove the technical issues, the hospital management will plan the formation of a committee comprises of the technical team from the hospital and vendor, who will performance grass-root diagnose of problem due to which pharmacy system unable to get accurate tagging of patients to which medicines has been provided under doctor prescription. The vendor will ensure that the technical area shall be address by them and in-house updating of hardware and software issues deal with an in-house technical team of the hospital.

Do

After the plan, teams will be deputed at the hospital to review the server of the pharmacy system. This system will be separated from leading hospital management software to see glitches in the offline environment. Meanwhile, hospital management will ensure that the day-to-day task shall not remain affected by this diagnosis. Exercise. Budget will be arranged to purchases the latest requirement from technical equipment and supplier.

Check

After the implementation of the diagnosing rectification procedure, all the pharmacy system users will before the test run on online mode. In this way, the user can identify minor day-to-day problems, and the same will be resolved by technical staff. In such ways, implementation issues can be further checked and analyzed.

Act

To address the issues identified during the inspection, the hospital administration arranged discussions and finalization of rectifications procedure to initial commercial launch of the revised pharmacy management system. Later on, the internal audit shall be arranged to address any remaining problems that might be small but must be addressed annually.

References

Allen, L., 2013. Role of a quality management system in improving patient safety — Laboratory aspects. Clinical Biochemistry, [online] 46(13-14), pp.1187-1193. Available at: https://www.sciencedirect.com/science/article/abs/pii/S0009912013001689.

Berler, A., Pavlopoulos, S. and Koutsouris, D., 2005. Using Key Performance Indicators as Knowledge-Management Tools at a Regional Health-Care Authority Level. IEEE Transactions on Information Technology in Biomedicine, [online] 9(2), pp.184-192. Available at: https://ieeexplore.ieee.org/abstract/document/1435416.

Berte, L., 2007. Laboratory Quality Management: A Roadmap. Clinics in Laboratory Medicine, [online] 27(4), pp.771-790. Available at: https://www.sciencedirect.com/science/article/abs/pii/S0272271207000868.

Bond, C., Raehl, C. and Franke, T., 2002. Clinical Pharmacy Services, Hospital Pharmacy Staffing, and Medication Errors in United States Hospitals. Pharmacotherapy, [online] 22(2), pp.134-147. Available at: https://accpjournals.onlinelibrary.wiley.com/doi/abs/10.1592/phco.22.3.134.33551.

Chauhan, K., Trivedi, A., Patel, D., Gami, B., and Haridas, N., 2013. Monitoring and Root Cause Analysis of Clinical Biochemistry Turn Around Time at an Academic Hospital. Indian Journal of Clinical Biochemistry, [online] 29(4), pp.505-509. Available at: https://link.springer.com/article/10.1007%2Fs12291-013-0397-x.

Doucette, W., McDonough, R., Mormann, M., Vaschevici, R., Urmie, J. and Patterson, B., 2012. Three-year financial analysis of pharmacy services at an independent community pharmacy. Journal of the American Pharmacists Association, [online] 52(2), pp.181-187. Available at: https://www.sciencedirect.com/science/article/abs/pii/S1544319115304544.

Fernandes, C., Walker, R., Price, A., Marsden, J. and Haley, L., 1997. Root cause analysis of laboratory delays to an emergency department. The Journal of Emergency Medicine, [online] 15(5), pp.735-739. Available at: https://www.sciencedirect.com/science/article/abs/pii/S0736467997001583.

Jayaprasad, G., Dhanalakshmi, P., Baskaran, M. and Hemachandran, S., 2018. Analysis of low isolation problem in HMC using Ishikawa model: A case study. Microelectronics Reliability, [online] 81, pp.195-200. Available at: https://www.sciencedirect.com/science/article/abs/pii/S0026271417306054.

Knudsen, P., Herborg, H., Mortensen, A., Knudsen, M. and Hellebek, A., 2021. Preventing medication errors in community pharmacy: root-cause analysis of transcription errors. [online] Available at: https://qualitysafety.bmj.com/content/16/4/285.short.

Rizk, M., Zaki, A., Hossam, N. and Aboul-Ela, Y., 2014. I am evaluating actual laboratory performance using quality indicators in Alexandria University Hospital Clinical Chemistry Laboratories. Journal of the Egyptian Public Health Association, [online] 89(3), pp.105-113. Available at: https://journals.lww.com/ephaj/Fulltext/2014/12000/Evaluating_laboratory_key_performance_using.1.aspx?bid=AMCampaignWKHJ.

Saha, T., Bhuiya, R., Masum, Z., Islam, M. and Chowdhury, J., 2018. Hospital Pharmacy Management System and Future Development Approach in Bangladeshi Hospital. Bangladesh Pharmaceutical Journal, [online] 20(2), pp.180-187. Available at: https://www.banglajol.info/index.php/BPJ/article/view/37883.

Ugwuda, C. and Ayoade, A., 2015. The Perception of Dental Practitioners on Laboratory Management for Effective Dental Health Care Delivery: A Case Study of Some Selected Dental Laboratories in Lagos State, Nigeria. Malaysian Journal of Medical and Biological Research, [online] 2(2), pp.49-54. Available at: https://i-proclaim.my/journals/index.php/mjmbr/article/view/389.

Wang, L., Wang, Y., Lou, Y., Li, Y. and Zhang, X., 2013. The role of quality control circles in sustained improvement of medical quality. SpringerPlus, [online] 2(1). Available at: https://link.springer.com/article/10.1186/2193-1801-2-141.

Westgard, J., 2010. Managing quality vs. measuring uncertainty in the medical laboratory. Clinical Chemistry and Laboratory Medicine, [online] 48(1). Available at: https://www.degruyter.com/document/doi/10.1515/CCLM.2010.024/html.

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