Avera McKennan Laboratory Improves
Accuracy Rate to 99.9975 Percent

Good hospital laboratories in the United States are accurate 97 to 98 percent of the time. But such impressive showings pale in comparison to Avera McKennan's phenomenal accuracy rate, which soared to 99.9975 percent after an implementation of LEAN principles.

Out of every 1 million tests performed in the lab at Avera McKennan Hospital & University Health Center of Sioux Falls, S.D., only about 76 involve errors at some level, placing the lab at the level of 5.4 Sigma. While that level of accuracy is almost unheard of, Leo Serrano, director of laboratories at Avera McKennan, would like to progress to the 6 Sigma level - the designation for a lab with 3.4 errors for every 1 million tests.

Improving the Lab's Impressive Numbers

In 2004, the lab was better than the national average as a 3.8 Sigma lab, having an accuracy rate of 98 percent. Still, the lab needed a major upgrade. There was not enough space, turnaround times were slower than desired, and staff availability was becoming an issue.

As the first project of its kind at Avera McKennan, LEAN became the solution which turned this very good lab into an exceptional one. After seeing the phenomenal success of the project, hospital leadership wholeheartedly embraced LEAN and Process Excellence as a hospital-wide initiative.

Creating a New Lab Layout and Developing Standard Work Processes

In their initial analysis, a LEAN team made up of front-line lab employees found that technicians did a large amount of walking, with traffic patterns crossing main work areas. Work areas had multiple interruptions, with no sequencing of work. Specimens sat a long time in storage, with multiple inspection steps. Staff spent a good deal of time on non value-added activities, such as looking for tools, parts and supplies and managing inventory.

The team developed a new lab layout to minimize transportation, create uninhibited walk patterns and allow for single-piece work flow as opposed to batching. The team developed standard work processes and cut waste, such as waiting, repeated inspection steps and excess motion. Processes were modified to balance workload, utilizing staff to the best of their abilities.

"Standard work has had a huge impact. All work is done in the same way in the same time frame," Serrano said.

Along with a greatly reduced error rate, average lab turnaround time fell from 62 minutes to 35 minutes.
LEAN resulted in other benefits, such as a productivity improvement of 14 percent, improved space utilization of 1,000 square feet, inventory savings of 15 percent, and an increased capacity of 75 percent, giving the lab the ability to increase test volumes without adding FTEs. With these changes came a savings of $600,000 per year.

Lab staff keep continual close tabs on error rates, making sure quality doesn't slip from day to day. Staff also set and exceed targets for turnaround time, guaranteeing timely results.

LEAN Improvements Lead to Faster Turnaround Time and Higher Patient Satisfaction

Labs for the past 50 years have followed traditional quality controls, Serrano said. "However, LEAN takes it to a whole different level, and that's where we are."

Faster turnaround time means patients are treated faster. And a low error rate means physicians can trust the results they receive - the first time. "The bottom-line benefit for the patient is enormous," Serrano said. "Patients want to get the care they pay for. LEAN allows you to give them that without all of the waste and unnecessary functions."