Embracing Lean in Microbiology
Source: Advance for Administrators of the Laboratory – July 1, 2010
By: Christian Borjesson – Director, Microbiology, bioMérieux Inc, Marcy l'Etoile, France
Labor shortages and the need for faster TAT can be eased by automation and Lean methodologies
If necessity is the mother of invention, the recent surge in technological and process innovations transforming microbiology laboratories reflects the urgent need of hospital microbiologists who face dramatic increases in their workloads.
In particular, several critical trends looming overhead-the growing need for faster test results and testing capabilities to address multidrug resistant organisms along with a shift toward screening patients for MRSA upon admission-when combined with the deep labor shortage and dearth of students entering the clinical lab sciences field are creating a personnel crisis. The lab faces tremendous workload and economic pressures.
Growing availability of automated products for the microbiology lab can alleviate some of these pressures, but Lean process principles also play an important role. The goal of any Lean process is to maximize time spent on value-added goals while minimizing work spent on routine practices. In the case of the lab, value-added time is time that speeds delivery of results to the clinical staff so treatment decisions can be made, optimized or revised based on the patient’s medical condition.
Every manual task (e.g., administrative processes, plate streaking, time spent waiting on batch test runs, walking between instruments and shuttling specimens around), while essential to the lab, is not value-added. Upon analysis, it’s often possible to improve efficiencies in these activities and to reduce turnaround time.
Last year, bioMérieux, a global provider of in vitro diagnostics solutions, partnered with Guidon Performance Solutions, a provider of Lean and Six Sigma performance management consulting, to provide objective Lean lab assessments to our customers and help them optimize their value-added services. These assessments result in a roadmap for the microbiology laboratory with recommendations for process adjustments and re-orientation of existing equipment, staffing times and automation of various portions of the microbiology lab continuum.
The Figure shows the paths three types of samples traveled in a typical microbiology lab. As Ron Wince, president and CEO of Guidon Performance Solutions, put it, “Imagine peeling back the roof of a microbiology lab, and this is what you would see over time. It becomes obvious why we call this a spaghetti diagram.”
The Lean lab assessment kicks off with a meeting of lab leaders and an inventory of samples and types of samples received, staffing, and metrics around quality and operations. The actual assessment takes four to six days for a typical microbiology lab. Guidon physically follows samples around the lab to quantify arrival patterns, duration of steps, cycle times and staff interaction with specimens. Generally, peaks and valleys mirror sample arrival in the lab; it’s not uncommon that these peaks and valleys do not align with the staffing matrix.
At the kickoff meeting, training is provided on waste, lab flow and reduction of cycle times. Once the analysis is complete, a session is held with the entire staff to review and discuss ways to optimize lab flow and reduce waste and cycle times. According to Guidon, the team can typically initially find ways to optimize 20% of their time. With further discussion and benchmarks from other labs, 50% efficiency improvements are often found. The process is collaborative and typically cathartic for the entire laboratory, according to Wince.
“The lab staff has felt the pain of inefficiencies for a long time,” he says. “When everyone, from the lab manager down, sees a sample path chart and the entire process from start to finish, there’s a ‘eureka’ moment where they come away with a real understanding of each other’s challenges. Not only are problems revealed, but the process helps explain the workarounds that have been created to deal with these problems at every level, from administrative to specimen handling. Workarounds usually are effective in getting a process completed, but they often add new inefficiencies to the process.”
In addition to lab automation, Guidon often recommends a lab reconfiguration of varying degrees depending upon the unique needs of the lab. Too often, equipment ends up in a “free spot.” Another common problem is clustering of equipment in functional groups, which makes sense in theory, but oftentimes creates bottlenecks. Guidon often recommends a cellular flow to process a sample from end to end, which can optimize flow of specimens through lab resulting for a process improvement ranging from 30-50%.
While Lean is not new to the healthcare industry, the concept and process may be a new endeavor for microbiology labs. When compared to chemistry and other labs in the hospital, the microbiology lab has generally taken a conservative approach with respect to new technology and process adoption. This is changing, as Lean lab design audits and processes continue to be well-received-a true sign of the times for the microbiology industry given the confluence of compelling factors.
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