Applying LEAN management to automation.
This was the case with BC Biomedical Laboratories in 2006 when we increased the level of automation to address our rapidly growing Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) testing volumes. BC Biomedical is the largest physician-owned lab in British Columbia, Canada, serving 1.8 million patients and running 25,000 tests per day. At the time, our CT/GC testing volume was at 250 samples per day and rising by about 10% per year.
We acquired a system which replaced manual pipetting involved in sample transfers, amplification, and analysis steps with robotics, with the objective of saving time as well as reducing manual, repetitive tasks. We incorporated the new system into the current workflow and quickly realized that our processes, which were previously adapted to manual CT/GC processing, were not taking full advantage of the automation the new system could deliver. We questioned if we could achieve higher productivity by adjusting how we handle pre- and post-analytical steps, as well as those that interact with the system. In order to make process changes that would maximize the productivity and efficiency of the new system, we turned to LEAN.
Specifically, we invited a LEAN/Six Sigma consultant to perform a process review. He worked with our entire team of two clinical supervisors, 30 medical technologists, and 15 lab assistants for three days examining and applying LEAN principles to each step of our CT/GC sample processing. What followed was a journey toward enhanced productivity and cost efficiency, which inspired our staff to apply this continuous improvement tool across all aspects of our work.
We worked with the consultant to make changes that brought dramatic productivity improvements in just the first few days. This gained the immediate support of our entire team--many of whom had been hesitant to change--for the LEAN process. Overtime, we implemented more than 200 process improvements throughout the department, many of which were small, incremental changes but all of which contributed to dramatic productivity gains.
A new way of looking at workflow
Working with the consultant, the first thing we did was to adopt the "single-piece flow" approach, a core tenet of LEAN, to sample processing. Single-piece flow embraces the importance of considering each sample individually, rather than as part of a batch in order to avoid build-up of samples at any given stage, thus improving efficiency. Specifically, decisions are made about each sample in real time as it moves through the system, and problem samples are set aside for processing later so they do not delay other specimens.
The single-piece flow concept also helped us think differently about how we use the instrument. For example, we started preparing the specimens when we had just one of two trays full (46 samples), rather than waiting for a full batch of specimens on both trays (92 samples). This enabled us to reduce instrument lag time every morning and to complete the runs earlier each afternoon. We also began processing samples at the end of the day, so they would be ready the next morning. This decreased instrument lag time in the morning from 90 to 30 minutes--which freed up our techs for other tasks while the machine is running.
One area where single-piece flow helped eliminate waste was in the central-processing area. This is where samples first arrive in a large bin from doctors' offices and are labeled and entered into the LIS system. Prior to LEAN implementation, we would enter all samples from that box, label them all, and then return them to the bin unsorted. This approach was inefficient since it created a lag in the system and was prone to labeling errors. By mapping and optimizing the accessioning process, we saved about 30 minutes in the first iteration of the new process. As we further optimized the process by running pilot projects and refining the physical workspace, the incremental time savings added up. Additionally, this change to single-piece flow helped cut errors in central processing by 22%. By working with one specimen from beginning to completion, single-piece flow eliminated the potential for mislabeling specimens.
Standardizing the work
Standardization of work processes is another fundamental LEAN principle. Previously, each staff member had developed his own way of performing various manual tasks. These included creative "work-arounds" for typical process problems that might arise. When we installed a more automated instrument and tried to apply to it our ad hoc processes, our work system did not run smoothly, especially for processes that required a hand off to another person. In contrast, by standardizing how we performed each process, we were able to identify and institute best practices.
For example, previously, each technologist had his own technique for loading samples into the instrument racks. The technologist would typically label the sample before placing it in the rack and would later go back to pick up each sample from its slot in order to scan the bar code. To streamline the process, we established that all bar codes would be scanned before being applied to the samples and that all samples would be stacked from right to left, beginning in the back. These changes enabled us to save 20 to 40 minutes per day. Additionally, by loading samples from right to left, we were able to avoid having to move the wand cord out of the way each time we loaded a sample. This allowed us to save a couple of seconds per specimen, which by the end of the day could add up to several minutes.
We also standardized work areas. For example, we used to organize work lists into binders. For greater efficiency, we organized paperwork into folders, each labeled by day of the week. We also color-coded the racks to easily identify them. Additionally, we taped off and labeled each work area. These changes enabled us to save several minutes each day. Further, the physical separation of the specimen handling area from other tasks such as administrative tasks minimized the risk of contamination. Further, we reconfigured work spaces so that we all worked from left to right, in a linear fashion. This increased efficiency and further minimized risk of contamination.
In just two years, BC Biomedical's CT/GC volume increased 22% to more than 300 samples per day, while we maintained our current head count of two technologists plus one-quarter of a lab assistant's time dedicated to CT/GC testing. Our current staffing level for this bench can handle an additional 25% capacity due to the continual process improvements we have made in this area. Further, we are now able to complete the day's CT/GC run by 2:30 p.m. vs. 5:30 p.m. previously. This means that doctors are more likely to get results and, thus, may be able to treat patients a day sooner.
Our adoption of LEAN has also produced less quantifiable benefits, namely, reduced stress level of our staff, boosted staff morale, and retained superior staff. All levels of our staff feel empowered because each one has had a voice in our LEAN implementation. While our consultant gave us the initial ideas for how to implement LEAN systems, our staff came up with most of the process changes we implemented--and continue to challenge ourselves to further improve our processes.
The move to LEAN has also changed how we communicate with one another. We now have daily five-minute team meetings, usually first thing in the morning, during which we identify and resolve work-process issues we are experiencing. This enables us to fix problems quickly and makes weekly staff meetings much more efficient. We also put in place a formal workflow review process, which we conduct at least twice a year as a group. Our LEAN efforts for CT/GC testing were so successful we were then able to secure management approval to implement LEAN management throughout the microbiology lab. We subsequently deployed it to the parasitology, bacterial I.D., resistance testing, and blood-culture areas, all with similar success.
We plan to continue applying LEAN principles to work processes, particularly as we further increase automation throughout the lab. We have recently installed the next-level, fully automated system that incorporates DNA extraction for the ever-growing CT/GC volumes. This time, the move to increased automation is paying off immediately: In workflow analysis, we are achieving completion of testing duties by 11:30 a.m. and are utilizing about half of the FTE component compared to the current methodology.
LEAN has given us tools to better assess the actual workload impact of bringing any new technology into the laboratory. Additionally, with LEAN we are now more confident that before we go "live" with production, we have mapped out the process to a more efficient starting state. And by standardizing work processes, we have created a common baseline upon which to run pilot projects to continuously improve the process.
Our success with LEAN in the microbiology department has also prompted its adoption across the entire organization. The lessons learned in microbiology about single-piece flow, eliminating waste, and standardization of work processes are now being applied successfully to all areas of the organization.
David Chow, manager of microbiology and parasitology; Sabrina Smith, supervisor of microbiology; and Scott Henwick, MD, F(RCPC), clinical director of microbiology--all employed at BC Biomedical Laboratories Ltd. in Surrey, British Columbia, Canada--used a BD Diagnostics' LEAN/Six Sigma consultant, and first installed a BD Viper System, which was followed by the installation of the BD Viper System with XTR technology.
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|Author:||Chow, David; Smith, Sabrina; Henwick, Scott|
|Publication:||Medical Laboratory Observer|
|Date:||Oct 1, 2009|
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