The Value Stream of an Outreach Program 


The word “value” can be defined as “something that the customer is willing to pay for.” When providing laboratory outreach services, consider the many touchpoints and activities needed to provide a quality test result to an outreach customer. Not all activities are value-added — many actually introduce waste into the system, increasing cost or the chance for errors. A value stream map can be a helpful tool for identifying opportunities to increase value across the customer relationship.

With an eye to outreach quality, visualize how a specimen flows from the source (the customer) through to the final product (a result to the provider). Common steps and operational inputs of a value stream map may include:

Common value-added activities
Order entry by customer- Access to clinical information to guide correct test selection.
- Ease of ordering desired test (in electronic health record or via a laboratory-approved, standardized requisition).
- Ability to provide necessary patient information to laboratory (diagnosis codes, additional patient information, etc.).
Specimen collection by customer- Access to correct specimen requirements.
- Professional interaction with laboratory when calling for information.
- Provision of appropriate specimen collection supplies (when appropriate).
Specimen collection by laboratory- Efficient patient process, from registration or check-in through phlebotomy.
- Short wait time.
- Patient-focused experience.
- Professional and proficient phlebotomists.
Specimen preparation- Accessible specimen processing instructions.
- Provision of specimen processing equipment (centrifuges, racks, etc.).
- Provision of specimen transportation equipment (biohazard bags).
- Provision of temperature-stabilizing materials (cold packs, dry ice, etc.).
Specimen transportation- Timely courier pickup.
- Professional courier interaction.
- Maintain correct temperature during transit.
- Effective specimen tracking.
Specimen receipt- Efficient registration and accessioning process.
- Efficient management of manual requisitions.
- Interruption-free area to minimize distractions.
- Efficient workspace with all necessary equipment within reach.
- Dedicated problem resolution process.
- Timely and efficient transfer of specimens to testing area.
Analysis/Testing- Reliable and accurate test results.
- Efficient add-on process.
Result delivery- Appropriate turnaround time.
- Immediate transmission of result to ordering provider in desired format (electronic or manual). - - Critical call-back (if necessary).
Customer service- One telephone number for all requests.
- Customer-focused experience.
- Expert staff to answer questions.
- Single-call resolution.
Supply management- Efficient supply request process.
- Provision of correct supplies.
- Tracking and reconciliation of supplies (versus tests ordered from laboratory).
- Effective supply inventory process.
- Minimal expired stock.

Many outreach programs are challenged along many steps of the value stream. For each action listed, there can be adverse consequences to not performing the step efficiently or correctly.

For example, if a laboratory has an outdated test directory or catalog, this has the potential to cause several errors:

  1. Order the wrong test.
  2. Collect the wrong specimen.
  3. Perform the wrong test.
  4. Recollect the patient specimen.
  5. Delay patient care.

One faulty test listing can break down the entire value stream.

Another example is when the laboratory receives manual test orders via different methods, such as client-created custom requisition forms, client-generated “face sheets” from their in-office electronic medical record, prescription orders, or manual requisition forms from other laboratories. Undoubtedly, this creates errors due to laboratory staff working with non-standardized forms. Common errors include inaccurate demographics or billing information, incorrect or missed tests, or incorrect ordering physicians, which may also delay testing and impact patient care. Workarounds and solutions to address these challenges include making telephone calls to clients for clarification of information, exhaustive checking and rechecking processes, and cumbersome paperwork handling and storage. With consistent requisition forms, or by limiting requisitions to as few formats as possible, registration staff should have fewer errors overall.

No laboratory is perfect. Mistakes will happen. When considering the outreach laboratory value stream, it is important to realize that without quality, there is no value. Through identifying sources for error or non-value-added activities, the hospital laboratory outreach program can rise above and demonstrate value through customer service, physician support, and patient care.

Jane Hermansen

Jane Hermansen is living her childhood dream of being a laboratory professional. With a passion for community-based medicine, she has worked with hundreds of hospitals across the US in outreach program development and growth. She currently directs the outreach consulting activities for Mayo Clinic Laboratories.