STAT Crossmatch Charter: Scope, CTQ, and Constraints
A regional blood bank's component lab chartered a Black Belt project to cut STAT crossmatch turnaround time from a baseline mean of 55 minutes to 30 minutes within 12 weeks. The sponsor wants all 14 hospital customers in scope. Dispatch data show three hospitals generate 68% of STAT requests; one uses a dedicated courier, two rely on a shared third-party courier whose dispatch the lab cannot control. The lab information system will be upgraded in six weeks, changing order-entry and result-verification screens; validation cannot be altered before go-live. The project team includes two lab technologists, a quality engineer, and an IT analyst, but no courier representative. A preliminary process map shows 11 handoffs from order entry to release. The sponsor has already signed a charter with a goal of 'improve customer satisfaction' and a scope of 'all STAT crossmatch processes.' The belt has four weeks of baseline data showing median 52 minutes, 90th percentile 81 minutes, and 9% of orders missing a timestamp.
1. Evaluate the charter's scope and goal. What revisions would you recommend before the team proceeds, and why?
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The charter is too broad and its goal is not measurable. The process map shows 11 handoffs, but the lab controls only part of the elapsed time; the third-party courier controls another part. A workable boundary is: in scope = order receipt in the lab through verified result release, plus the lab-courier interface; out of scope = courier dispatch itself, treated as a constraint with an SLA and measured separately. Alternatively, if the customer CTQ is total time from order entry, the team must include transport as a measured input and negotiate data access, not pretend it can change dispatch. The goal should name the metric, operational definition, baseline, target, and date. Because 9% of orders lack a timestamp, the baseline is not trustworthy; fix data capture before setting a hard target. A defensible target is to reduce median lab-controlled turnaround from 52 to 30 minutes and 90th percentile from 81 to 45 minutes, with total time reported by hospital and courier mode. The sponsor should approve scope exclusions and the LIS-upgrade milestone.
2. Translate the dominant customer requirement into a CTQ with an operational definition and data collection plan.
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VOC: hospitals need a crossmatch result fast enough to start transfusion without delaying care. CTQ: elapsed minutes from order entry in LIS to verified crossmatch release. Operational definition: start = timestamp when the STAT order is entered and accepted by LIS; stop = timestamp when the technologist verifies and releases the compatible unit; include rework and repeat testing; exclude cancelled orders and orders with missing start/stop (report separately). Report median, 90th percentile, and proportion <=30 minutes, stratified by hospital, courier mode, shift, and specimen arrival mode. Also define an internal CTQ: specimen-receipt-to-release time, which the lab fully controls. Data plan: extract all STAT orders for 4 weeks from LIS; reconcile with courier logs for the three high-volume hospitals; perform MSA on timestamp completeness and verification coding; plot run charts by week. This separates customer-facing performance from lab-controlled performance and prevents the team from optimizing a metric it cannot influence.
3. How should the team manage the courier and LIS-upgrade constraints?
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Use a power/interest grid. The courier is high-influence and low-interest: engage the contract owner, not the dispatcher, and agree on data sharing, pickup/drop-off timestamps, and an SLA. The lab cannot change dispatch, so treat courier time as a noise variable: stratify results by courier mode and pilot improvements with the dedicated-courier hospital first. The LIS upgrade is a high-risk change: freeze the operational definition and data extraction before go-live; run parallel timestamp capture for 2 weeks after; do not make process changes that depend on new screens until validation is complete. Add both to the risk log with owners and dates. Brief the sponsor that the 12-week target may need a milestone gate at go-live, and that total turnaround cannot be guaranteed without courier cooperation. This is stakeholder management and change control, not a technical fix.