Kandice Kottke-Marchant

Kandice Kottke-Marchant, MD, PhD

Performing more than 20 million tests each year, the Cleveland Clinic Pathology and Laboratory Medicine Institute (PLMI) has substantial space and workflow demands. To better address them, the health system recently opened a $75 million, three-story, 135,000-square-foot, state-of-the-art building to expand laboratory operations. With a staff of more than 80 board-certified anatomic and clinical pathologists and more than 1,400 medical technologists, laboratory technicians, and support staff, the PLMI labs operate 24/7, providing pathology and lab testing services to patients at Cleveland Clinic and through the reference lab Cleveland Clinic Laboratories. CLP recently spoke with Kandice Kottke-Marchant, MD, PhD, chair of the PLMI, about what precipitated the move, how the transition has affected the lab’s workflow, and plans for the future.

CLP: Why did the lab need to expand?

Kottke-Marchant: We needed more space! The new building has allowed us to expand our Molecular Pathology Department, which contains all of our molecular diagnostics. It also allowed expansion of special chemistry, and the core of our esoteric proteomics testing, as well as our immunopathology and microbiology laboratories. We are also firmly committed to continuing to expand our reference laboratory. The new building will enable us to expand our market presence regionally, nationally, and internationally. We were dedicated to building a facility that was groundbreaking in the lab industry, but we also committed to following sustainable practices to achieve a truly “green” building.

CLP: Tell us about the transition. Were there any difficulties?

Kottke-Marchant: It was most difficult about 6 months prior to the move itself. At that point we began to plan the actual transition, and with that came the realization that so much needed to be figured out. For example: What sequence to move each lab bench; what the contingency plans are in case the tests couldn’t be performed as planned; what special needs were required to move and revalidate each piece of equipment; and assimilating to the new work spaces, finalizing work flows and specimen-handling logistics. Amazingly, the difficulties were few and far between thanks to transition planning efforts by our institute leadership and that of Balfour Resource Group, a transition planning specialty organization.

CLP: How were you able to move the lab during time periods that did not disrupt patient testing?

Kottke-Marchant: We planned most move activities on the weekends, and since most of the patient testing for the laboratories that moved occurs during the weekdays, the moves were completed and the testing platforms were available prior to the start of the work week.

CLP: How has the lab’s workflow and throughput changed?

Kottke-Marchant: Workflows have changed drastically in the new building thanks to input gained from the combined efforts of frontline employees and our continuous improvement team. We truly took into account every move employees make on a minute-by-minute basis and designed the building based on streamlining each movement to increase overall efficiencies. Specimens and supplies now move more efficiently through the value stream. Specimens are received into the central processing area and distributed by lab assistants in most cases, who act as support techs to the testing techs. Supplies enter the building and go into a modest-sized warehouse, and are then distributed by inventory coordinators to the testing personnel. Both of these workflows are improvements over the old building, and enable efficiency and skill-set matching improvements.

CLP: How have you improved efficiency?

Kottke-Marchant: To date, less tech time is spent doing non-value-adding tasks, such as retrieving specimens and supplies. Work steps that used to be located outside of the optimal work area defined as a 5-foot radius around the tech have now become within that work window. These improvements are expected to drive our labor productivity numbers upward, and those gains will be realized throughout the calendar year.

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CLP: What new instruments/equipment were needed for the new facility, and why were those selected?

Kottke-Marchant: Diagnostics such as chromosomal microarrays and sequencers. Molecular pathology diagnostics are truly the future of pathology, as is the notion of personalized medicine, so it was crucial to include such technologies in the new laboratory building. They give us more information about the patient and assist in planning based on how to tailor treatment to individual patients. The old building was not designed to handle mass spectrometer technology due to the heat and exhaust the mass spectrometers produce. As an important aspect of reference lab growth, especially in the fields of pain management and toxicology, the new building has essentially tripled our capacity. We also now have access to a complete new field of testing in proteomics and genomics.

CLP: Is the lab completely automated?

Kottke-Marchant: A lab can never be truly 100% automated. However, our labs are equipped with numerous degrees of automation, including automated chemistry testing, automated sample archiving, and automated DNA extraction. We also have state-of-the-art pneumatic tube systems for automated specimen transport.

CLP: What’s the future for the lab? Can it accommodate growth?

Kottke-Marchant: One of the main goals of this new building was to not only provide much-needed expansion, but to also create an environment that could support growth for years to come. I am confident we will be doing testing in this facility that isn’t even conceived yet.


Chris Gaerig is associate editor for CLP.