Abandoning the familiar for the promise of greener pastures has a certain allure, but for many, the simple fact is that change is uncomfortable. Despite this, the staff of Fairview Health Services’ diagnostic laboratory has not only embraced change, they’ve made it contagious.
“Employees in work areas that haven’t gone through the process want to go through it because they see that it creates a better workplace,” says Rick Panning, president, laboratory services, Fairview Health Services in Minneapolis.
The “it” Panning refers to is Lean management, which was implemented by the department in 2003. Lean is an approach to business focusing on the analysis and optimization of operational processes. Taking this course of action has had tangible results for Fairview.
“Before Lean, our goal was to get testing out within 60 minutes of receiving the specimen,” Panning says. “Our goal was to use the Lean project to reach a turnaround time of 30 minutes from the point of drawing the specimen. We have not only come very close to that, but we have consistently been able to stay close to that.”
Doing What Works
About 5 years ago, Panning was eager to better the lab’s service.
“Our cost performance wasn’t very good, our productivity performance wasn’t very good, our turnaround time wasn’t very good—and it wasn’t because we had a bunch of bad people, it’s because we did not have good processes for them to work in,” Panning says.
After initially working with Six Sigma, another method for improving business performance, the management team began to learn more about—and subsequently decided to switch over to—Lean techniques.
Panning finds value in both techniques and believes identifying which approach is best for a facility lies in understanding the source of the trouble, because each tactic resolves a different set of problems.
“Six Sigma is all about reducing opportunities for error to make service more consistent, and Lean is more about getting rid of the waste in your process,” he says. He encourages organizations to take a two-step approach. “It makes a lot more sense to do Lean first, because then you’ve made your process more streamlined by taking away the wasteful steps, and the opportunities to decrease the numbers of errors with Six Sigma rise to the top after that.”
A Learning Process
When they first considered adopting Lean for their lab, Panning and several of his peers attended several 1-day seminars to gain some insight into the basics of Lean, which is essentially a rigorous look at individual processes.
For instance, one of Fairview’s early Lean projects was examining the testing and specimen collection and processing in its core lab. Each step of the routine was broken down into very fine detail, identifying all the steps involved, and monitoring the travel pattern of the person doing the work, as well as the travel pattern of the specimen as it moved through the lab. Lean’s goal is to make the sequence of events as streamlined as possible, removing all unnecessary steps.
While Panning and his team believed Lean was an opportunity they were eager to take advantage of, they realized they lacked the practical experience required to put it into practice. The solution was to enlist a consultant for their first project.
“We put together a team of six people who learned Lean while working with the consultant,” Panning says. He emphasizes the need to allow staff members to be dedicated full time to learning and supervising Lean projects. “We made the commitment to take those six people away from their day-to-day jobs, because we realized there was no way we would have seen the same results from someone working on it only half of the time.”
That core of six went on to lead subsequent Lean projects, teaching other staff members along the way.
Panning also underscores the importance of dedicating people from the lab to the Lean project team. Not only is their intimate knowledge of the environment vital to achieving an accurate breakdown of the tasks involved, but their familiarity with lab employees is critical to obtaining buy-in from their peers.
“We also try to have somebody on the team from another department inside the organization, whether it be from a change management division, quality improvement, or finance,” Panning says. A professional from outside the lab will lend a fresh perspective and is more likely to spot an area of improvement that might go unnoticed by a lab worker who has grown accustomed to it. “It also means you have someone who can take that learning outside of the lab, while we keep the lab-trained people who can then lead other projects for us.”
Having experienced ambassadors is imperative to the success of ongoing projects, in particular for convincing those who might be reluctant to take the leap. On their first Lean project, neither Panning nor his team knew what shape the actual outcome would take.
“None of us knew anything about it at that point, and you could almost divide the staff into thirds, with one third who thought it was a great idea and were excited,” he says. “On the opposite side was a third who, because they didn’t really understand it, thought it was the worst thing that could ever happen to them.” The remaining group reserved judgment, adopting a “wait and see” attitude.
Such varied reactions are not unexpected considering the fundamental changes involved. For managers overseeing the execution of Lean projects, it’s essential to expect and accommodate a myriad of responses.
“You have to help some people, because it is an intensive process resulting in drastic change in how they do work, so you have to help them with that change,” Panning advises. “Ultimately, employees see the work environment improve and there’s no way they’d go back to the old way, but it takes some time to get people there because in the middle it’s pretty stressful—people need to experience it and get used to it.”
Information is Power
One way to engage and encourage employees to commit to the Lean steps is to keep them informed. The lab manager or director needs to be very visible and communicate on a regular basis about each step of the process, explaining what is being done and why. Taking the time to educate staff and help them reach a comfort level with what Lean is and what its potential benefits are is an important investment.
“You don’t want to lose people in that process; they need to understand there’s a reason for going through all of this change and that ultimately their work environment should improve,” Panning says. His lab realized those goals. “It’s now a smoother process for them, and they can be more productive without having to work harder. They are able to absorb more volume and still work at a reasonable pace.”
The Fairview lab is delivering better service and consistently receiving positive feedback from physicians and nurses.
An Ongoing Process
Elemental changes come from key Lean principles, such as “one-piece flow,” which dictates that specimens are not run in batches, but processed immediately. By processing every specimen as it hits the door, putting it on the centrifuges and instruments one at a time, turnaround time improves dramatically.
Making these rudimentary adjustments is what Lean is all about, as opposed to simply tidying the surroundings. Panning warns against consultants who espouse a “quick fix” approach under the guise of Lean.
“Every consultant in the world now says they have expertise in Lean, but you have to be very careful and really find out what it is they’re actually going to do,” he says. “Some consultants believe that cleaning up the lab and reorganizing the equipment is enough to be Lean, but there’s really a whole cultural change that’s involved with Lean that takes a lot of work.”
It is work that is paying off. The lab’s adoption of Lean has worked so well, it is now being accepted throughout the facility in surgery, the pharmacy, and at nursing stations. Other hospitals in the Fairview system are also rolling out Lean projects, which generally take between 10 and 12 weeks to complete. Panning notes that results often take a bit longer to appear, depending on the situation.
“When our first project was done, we knew we didn’t need as many people in that part of the lab,” he says. Fairview’s commitment to avoid layoffs meant that adjusting to the new levels took time. “In that situation, we let attrition happen and moved people to other parts of the lab where they were needed, because you realize what your opportunity is quite quickly, and we were confident we would achieve the new level.”
The work doesn’t stop just because a particular Lean project wraps up. Measurement—of both the baseline productivity of a process before beginning and the progress that’s made after the project is complete—is essential for gauging the level of success for each effort.
“What we found is you don’t just get done, measure, note that you’ve improved, and assume it is all done,” Panning says. “You have to keep measuring—we actually put the measurements in front of our staff every day.”
Fairview has developed daily reports that are delivered via the lab’s computer system. They are printed and posted right in the laboratory so people can see them, giving individuals the opportunity to regularly look at and evaluate the performance data.
“We can look at the data behind the high level, say maybe 95% of specimens were on time yesterday, but today only 87% were on time,” Panning says. “You want to find out what was in that 13%, maybe a machine was down? Looking into the cause helps you consistently meet your goal; otherwise, it’s just too easy to fall back into the way you used to do things.”
The true measure of Lean’s success may be in the impact it has on the lab staff and their ability to deliver quality health care.
“One of the misconceptions people have is that when you implement Lean, you are just making your people robots. But ultimately, you’re removing opportunities for error and giving them a more reasonable traffic pattern, so they’re not running all over the place all the time,” Panning says. “If you do the process right, the routine stuff flows through easily, allowing people to spend time on those specimens that really need special attention.”
Dana Hinesly is a contributing writer for Clinical Lab Products.