Thalassemia Clinic Case

(a)

Activity Length (minutes) Immediate predecessor(s)

A Register --

B Consult and take tests A

C Sample blood 10 B

D Deliver blood sample to lab 10 C

E CBS delivers blood to bank* 120

F Test blood delivered by CBS E

G Cross-match** 150 D, F

H Retrieve blood from bank 10 G

I Deliver blood to clinic 10 H

*120mins when CBS arrives 2 hours late

**150mins (excluding travel time) if test is NEG for anti-bodies; 180mins (excluding travel time) if test is POS for anti-bodies.

Bottleneck: G

(b)

• Men

- Sometimes the porter took longer to carry the blood between sites in order to carry more blood at once; this resulted in the first blood sample waiting longer than the latter samples.

- Approx. once a week deliveries started at 10am as opposed to 8am, delaying the whole supply chain.

• Machine (or equipment/facility)

- Sometimes a took the computers longer to cross match the blood

- The clinic, lab and bank were located in different buildings and took about 10mins to travel between each site—widely dispersed.

• Material (blood in this case)

- If blood tested positive for anti-bodies than it took on average 30mins longer to find a match.

- Blood has varying shelf life, which impacts supply and the amount of time needed to match.

• Method (or procedure)

- The patients have to take the antibodies tests every time they come to the clinic.

- The rule that patients were scheduled to arrive 20 minutes in the morning could be only for those who had their sample taken before and are able to start transfusion immediately. For those have to see the doctor and run other tests, the time is not dependable, which could be more or less than 20 minutes.

- The second shift nurse, tended to multiple parties, included patients who came the day before so that they wouldn't have to wait too long the following day.

What are the most critical ones for the long waiting time?

• The