LEAN MANAGEMENT IN CLINICAL LABORATORY

LEAN MANAGEMENT IN CLINICAL LABORATORY

Lean principles can be applied to any organization that has a defined set of process steps that it follows to produce an end product. Whether it is physical goods or a service, Lean has been successfully implemented in industries ranging from manufacturing to health care. Lean is a systematic approach to process improvement that focuses on the reduction and elimination of waste, variations, and imbalance in the process.

Following goals can be achieved using lean principle in clinical laboratory:

Ø  Improved operational performance (faster testing turnaround time, decrease in costs and improved quality)

Ø  Reduced variability in operational performance

Ø  Operations management approach as an end-to-end discipline

Ø  Improved patient and employee safety

Ø  Improved employee morale

Ø  Reduction in development time for new tests

Ø  Reduction in testing defects and errors during new test development and implementation.

Lean is a different way of viewing and approaching work. It is about developing a change in the management of the process and looking at process reorganization. This is done while intently concentrating on eliminating redundant motion, recognizing waste, and identifying what creates value from the client’s perspective. Lean is a continuous process improvement initiative and not an end destination. It is about allowing your process to flow and continually striving to improve the flow.

The main objective of Lean, when applied in the laboratory, is to deliver quality patient laboratory results, at the lowest cost, within the shortest time frame while maintaining client satisfaction.

The five Lean principles as they apply to the clinical laboratory are:

Value: Define the value in the process from the client’s perspective; “value” is that  which the patient or client would knowingly pay for or the attributes of a product or service (quality, speed of delivery, personal attention, etc.)

Value Stream: Identify the value stream for each process providing that value, challenge the wasted steps, and eliminate all of the waste that you can

Flow: Make the product or service flow continuously through the remaining, value-added steps

Pull: Introduce a continuous flow of events between all steps of the process where continuous flow is possible. In a well-defined pull system, the process lets you know by inherent triggers when something needs to be done and the process manages itself

Continuous Improvement: Manage toward perfection on an on- going basis so the number of steps, the amount of time, the scope of resources and the information needed to provide the service to the client and patient is constantly under scrutiny

Implementation of Lean principles can increase quality, throughput, capacity, and efficiency while decreasing cost, inventory, space and lead time. And, most importantly, it ultimately provides better patient care. Lean is not an acronym. It is called Lean because it is a descriptive process that uses less of everything—space, time, investment in equipment, inventory, and staffing resources. Lean is also known by other names, most notably Operational Effectiveness, Business Process Redesign, Flow, or the Toyota Production System (TPS).

WASTE IN LABORATORY

There are eight types of non-value-added activities or waste.

Defects :

Work that contains errors, rework, mistakes, or lacks something necessary

Overproduction:

Making more, earlier, and/or faster than is required by the next process

Waiting:

Idle time created when material, information, people, or equipment is not ready

Not utilizing employees knowledge, skills, and abilities:

The waste of not leveraging peoples’ full talents and capabilities

Transportation:

Movement of patients and materials that adds no value

Inventory:

Any supply in excess of what is required

Motion:

Movement of people that does not add value to the product or service

Extra Processing:

Additional effort that adds no value to the product or service from the customers’ viewpoint

RIDING THE “LEAN”                                                      

There are many approaches to driving Lean within an organization. A common approach might include:

· Lean training

· Value stream analysis (VSA)

· Implementation (including rapid improvement events)

· Sustainment

IMPLEMENTING LEAN IN THE LAB

Specify value

The first step in designing any Lean laboratory is to specify value. Every activity in the laboratory is identified and categorizing as ‘value add’, ‘non value add’ (from the customers perspective) and ‘incidental’. Incidental work is non value add in itself but essential to enable ‘value add’ tasks to be carried out. A significant focus of any Lean Lab initiative will be to eliminate or reduce the non value add activities.

Identify the value stream

Another key Lean step is to develop value stream maps of the overall release process. This should avoid the error of working on point solutions that only end up moving a bottleneck to another process and therefore do not deliver overall improvements. For example, there is no real value in reducing analytical laboratory lead times below the time of a release constraint test in the Microbiology lab. You can however use increased velocity to help ‘level the load’ or to maximize individual test run efficiency.

Make value flow and create pull

A Lean laboratory will normally have a defined sequence of tests and associated analyst roles that make good use of people and equipment. A key principle is to flow work through the laboratory so that once testing begins on a sample, it is kept moving and not allowed to queue between tests. This creates a focus and drive to reduce ‘through-put’ time which can be converted into a lead-time reduction or used to allow samples to wait in an incoming queue to facilitate level loading and /or grouping for efficiency.

‘Pull’ is interpreted as testing according to customer priority. If this is not inherent in the order in which samples arrive, then the samples are taken from an incoming queue according to customer demand and thereafter processed in FIFO order with no overtaking.

Level the load and the mix

At its simplest, leveling the load (overall workload) and the mix (the mix of sample types) is about putting the same amount of work into the lab on a daily basis. This is probably the most critical step and potentially the most beneficial for the majority of testing Laboratories. Successfully leveling a volatile load and mix will significantly improve productivity and/or lead time. The productivity improvement can be used to provide additional capacity or converted into a cost reduction.

Eliminate waste

Lean laboratories continuously look to develop solutions and re-engineer processes to eliminate or reduce the non value add and incidental tasks identified when ‘specifying value’.

Manage performance

An essential part of Lean in the Laboratory is to manage and review labs performance daily, ensuring that Key Performance Indicators (KPI's) are good and that the overall laboratory process is ‘in control’.

To further breakdown several key Lean tools, the following tools will be discussed in more detail.

· Workplace Organization (5S)

· Batch Size Reduction

· Standard Work

Workplace Organization (5S)

Workplace Organization (5S) is a method for organizing and standardizing the location of materials, information, and equipment to optimize flow and to help understand when something is out of place or missing. It helps to identify and remove what is not needed from the workplace to achieve a given task. This allows management and staff to quickly determine when something is out of place or if a problem exists. Workplace Organization can be broken into five steps (thus, 5S):

1. Sort - Sort through all items in a given area, placing a red tag / sticker on all unneeded items and moving them to a temporary holding area.

2. Set in Order - Identify the best location for remaining items, relocate out of place items, set inventory limits, and install temporary location indicators.

3. Shine - Clean everything, inside and out. Continue to inspect items by cleaning them and to prevent dirt, grime, and contamination from occurring.

4. Standardize - Create the rules for maintaining and controlling the first three S’s and use visual controls.

5. Sustain - Ensure adherence to the 5S standards through communication, training, and self discipline. Workplace Organization is often a great starting point for many laboratories. Over the years, the instinct to hold on to things “just in case,” has allowed departments to build up endless clutter. 5S allows the team to re-evaluate every item and determine what is truly needed to perform a give task at a work bench or area. 5S can be seen as the foundation for all other Lean activities. Without 5S, it could be difficult to achieve maximum results.

As 5S is implemented, it is important to remember to stay flexible. Although 5S determines were items should remain, it does not mean the items can’t be moved during daily operation. There must be flexibility for the tech to become comfortable as he or she works. At the end of the shift, items should be returned to the proper location to maintain standardization and sustainment (especially among the different shifts).

Batch Size Reduction

Evaluating and minimizing the batch size of various processes can yield substantial results. Large batch sizes lead to the potential for greater quality errors and increased lead time. By reducing batch sizes throughout the process, it can provide better agility to respond to customer demand. In addition, large batch sizes can result in downstream constraints in the process. By reducing batch sizes, it allows the product or service to move on to the next process in less time, ultimately being completed faster. For example, a batch size of ten going through three process steps (each taking one minute), it would take 30 minutes to complete the batch and 21 minutes for the first item to be processed By moving to single-piece flow or a reduced batch size throughout the process, constraints can be minimized by level-loading process steps with optimal batch sizes, work-in-process can be drastically reduced or eliminated, and turnaround time can be greatly improved.

Standard Work

Implementing standardization of the new method is the basis for sustaining all continuous improvement activities. Many times procedures exist for nearly all work performed, but are written for regulatory bodies or lawyers instead of the employees. Standard Work differs in that the procedures or work instructions are written to further define and document the best practices determined by the staff. Standard Work needs to include multiple methods of education to ensure awareness and understanding by the staff. Different methods to consider might be incorporating pictures of certain activities performed along with text or including process flow diagrams that provide a summary of the keys steps. Employees need quick methods to help them determine that they are performing their work in the most efficient manner possible. To strengthen this standardization of new processes, consider posting the process flow diagrams in various parts of the department. Having standard work in place and incorporating various methods of education will further maintain your ability to sustain the results.

CONCLUSION

Lean laboratory organization leads to improved performance, which has proved beneficial as demands on the laboratory have grown. Efficacy and turnaround time can be reduced. A decrease in cost despite an increase in demands is possible, making the hospital laboratory competitive with outside labs. Change and evolution of the laboratory will go on, since lean laboratory management is a never-ending process