This post is a sidebar to the CLP July 2014 feature, “Lean Thinking in the Medical Laboratory.”
The Sonora Quest and the Henry Ford Health System Laboratories are not the only examples of Lean successes in medical laboratories. Published and presented descriptions suggest that laboratorians in all disciplines are working to implement Lean principles, and are reaping significant benefits from their efforts. Following are summaries of just a few notable projects.
LEAN WORKCELLS
Hope Greig
Asked to design and staff the laboratory of Baptist Medical Center South, a new hospital in Jacksonville, Fla, Hope Greig decided to implement a Lean-oriented physical layout, with a corresponding approach to staffing.1
The laboratory at Baptist South in many ways resembles a core laboratory. Lean concepts were used to strategically place instruments and work areas as close together as possible to minimize effort and distance. This design concentrated 80% of the testing into automated workcells.
In turn, every lab employee was cross-trained and licensed on every workcell and technique. This Lean-oriented practice enables labs to maximize their efficiency—even in the face of staff absences or unexpectedly high testing volume. When her design and staffing plan were complete, Greig found that she needed three fewer full-time employees than had been anticipated.
The laboratory at Baptist South is said to be meeting its benchmarks for turnaround time 90% of the time. The Lean approach to the design and staffing of the laboratory has contributed to the financial success of the new hospital, while also meeting the service goals required by its customers.
LEAN 24/7
Joseph Campos, PhD
Other health systems have applied Lean principles to microbiology and molecular diagnostics. Joseph Campos, PhD, director of microbiology and molecular diagnostics at Children’s National Medical Center, Washington, DC, has explained how the implementation of Lean principles transformed the microbiology and molecular diagnostic laboratories at his
institution.2,3,4
In the microbiology department it was recommended that staff from the day shift be moved to the evening and midnight shifts to enable 24-hour specimen processing and culture reading. Workcells were created to minimize unnecessary movement, and additional automation was added. More-frequent delivery of culture media was implemented in order to reduce the need for storage space. And information technology was used to standardize culture work-ups, thereby reducing mistakes and leading to better efficiency.
Prior to the adoption of Lean practices, it was taking the microbiology lab 40 to 64 hours to release the results of uncomplicated cultures. Since adopting Lean practices, the lab has been able to release final results in 34 to 40 hours.
Such improvements in turnaround time freed up sufficient resources to permit the microbiology laboratory to be responsible for receiving and organizing the storage of molecular specimens. Instrumentation was moved from the molecular biology lab to the 24-hour microbiology lab, so that stat molecular testing for C. difficile, enterovirus infections, influenza A and B, methicillin-resistant Staphylococcus aureus, and Respiratory Syncytial Virus could be processed 24 hours a day. These changes improved the clinical utility of test results by eliminating a great deal of wasted time and effort.
LEAN PROJECTS
Deirdre Church, MD, PhD
Deirdre Church, MD, PhD, has described a series of Lean projects in clinical microbiology at her institution, Calgary Laboratory Services, a centralized regional laboratory serving a population of roughly 1.25 million people.5 Lean projects included 5S workplace reorganization, a just-in-time inventory system, and implementation of MALDI-TOF tandem MS. The payoff: mean turnaround time for preliminary reports for positive gram stains was reduced by 8 hours, and final reports were available 10 hours sooner.
It is readily apparent that no aspect of laboratory medicine is exempt from Lean improvement. Lean may be the catalyst to truly reduce the cost of healthcare in the United States. This cultural transformation of work is what will be required in healthcare for the true power of Lean to be leveraged.
REFERENCES
1. Westgard S. Do it yourself Lean in the lab. [Interview with Hope Grieg, Manager of Laboratory Services, Baptist Medical Center South, Jacksonville, Fla. (online)]. Available at: https://www.westgard.com/interview4.htm. Accessed June 13, 2014.
2. Campos JM. Lean lab in action. Management Q&A [online]. Medical Laboratory Observer (March 2013). Available at: www.mlo-online.com/articles/201203/lean-lab-in-action.php. Accessed June 13, 2014.
3. Campos JM. Using Lean and automation to create the 24-hour hospital microbiology lab. Paper presented at: 2012 Executive War College; May 1-2, 2012; New Orleans. Available at: www.executivewarcollege.com/wp-content/uploads/2012/03/Campos.pdf. Accessed June 13, 2014.
4. Campos JM. The Lean transformation of the molecular diagnostics laboratory. Paper presented at: National Molecular Microbiology Diagnostics Users Group Annual Conference; October 22-23, 2012; Toronto, Ontario, Canada: Hospital for Sick Children. Available at: www.nmgroup.ca/Document/2012/2012_05.pdf. Accessed June 13, 2014.
5. Church D. Lean and the clinical microbiology laboratory. Presentation to the Quality Management Conference for Medical Laboratories; October 17, 2013; Vancouver, British Columbia: Program Office for Laboratory Quality Management, Department of Pathology and Laboratory Medicine, University of British Columbia. Available at: http://polqm.ca/conference_2013/conference_2013/presentations/DeirdreChurch_Lean_and_Clincal_Microbiology%282%29.pdf. Accessed June 13, 2014.
