LEAN Implementation Project Allows Regional Laboratory to Do More With Less

Like many laboratories across the country, Centrex Clinical Laboratories, a regional laboratory system of five laboratories and 19 patient service centers, found itself with plenty of challenges. Add the relentless pressure to do more with less along with declining reimbursement rates, a shrinking pool of qualified technologists due to state licensure requirements, patient care providers clamoring for better turn-around-times, and the need to do something different becomes imperative.  

To make this happen, Centrex assembled a team of five formal and informal leaders from across the organization to implement LEAN principles in collections, pre-analytical, and laboratory testing.  With a project timeline of 13 weeks to analyze and implement, the change would happen rapidly. 

Analyzing Workflow

The team started out by trying to understand the flow of specimens by videotaping them as they went through the collections, order entry, testing, and verification steps. The team then reviewed the video and broke down activities into value added steps (those that change the fit, form or function of the specimen for the first time) and non-value added steps. Non-value added steps included those that were required, but did not add value (such as being transported or evaluated) as well as those that could be eliminated completed (such as waiting).    

After analyzing the flow of hospital specimens, the team noticed that these specimens spent over 95% of their time waiting. Prior to implementing LEAN, phlebotomists would take batches of order labels up to the hospital floors to draw. All of the orders would be drawn before they would return to the lab. Once in the lab, the specimens would be entered into the laboratory information system (LIS) and then sorted by functional test type where they would be delivered to the lab. Once enough specimens had accumulated, a laboratory technologist would perform the tests and verify them.

"By batching, the first order was paying a significant time penalty by waiting while all the other specimens were drawn," said LEAN team member Todd Failing. 

In addition to the delays incurred during the draw process, specimens were delayed while being order entered into the LIS and again when checked into the testing area. Because work tended to clump up in these areas, there were multiple opportunities for errors to occur. This inevitably resulted in additional rework when the specimens went to be tested.

Making Innovative Adjustments

To overcome these problems, the team redesigned the collections, order entry, and testing processes. 

Instead of phlebotomists drawing patients in batches, they started drawing patients one at a time and then tubing the specimens back to the lab. On floors where tube stations were not available, standard work-in-process quantities along with a few run-rules were established to keep batches sizes to a minimum. Once orders reached the lab, they are processed and tested as they are received. During piloting of the new process, the team knew they were heading in the right direction when one of the hospital physicians "complained" he was starting to receive his results too early.   

The team noticed similar issues in specimens received from patient service centers and client physicians. Processing staff were taking racks of specimens to individual workstations where they would be entered into the LIS. They would then be sorted by functional test area where they would wait to be delivered to the laboratory. 

The team solved this problem by creating two LEAN cells or "pipes". Each pipe was designed to allow specimens to be received in, entered into the LIS, and spun down one patient at a time. The team and area managers looked at demand data by the hour and staffed each pipe based on the amount of work needing to be performed. Standard work-in-process zones were created to help regulate flow through the system and promote balanced work between staff members. 

Improved Specimen Flow with Fewer Technologists

To improve the flow of specimens in the laboratory, the team developed a new cellular layout that arranged analyzers in a loop to reduce transportation and handling and facilitate one piece flow. Over 86% of the laboratory's work is accomplished in this cell. The team also developed standard work methods that balanced workloads and allowed staff to be used to the best of their abilities. Laboratory managers created a cross-training plan to allow technologists to gain skills in all areas of cell operation. With the cross-training wrapping up, the laboratory is achieving its goal of being able to operate the cell with 12 technologists; a 20% improvement.

When asked about the new system, senior processor Char Benhoff remarked that "Getting used to the single piece flow was a challenge at first, but after working with our new process, none of us would ever want to go back to the old way of handling specimens."