Improving Lab Efficiency: It all boils down to process, process, process
Source: Advanced for Administrators of the Laboratory – February 25, 2010
By: Ron Wince, Guidon Performance Solutions
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“It’s not a good time. We’ll get to that later.” How many times have you heard or said something similar when discussing critical laboratory process improvements? “Later” often turns into never. You may be too overloaded to deploy new initiatives, but waiting only exacerbates the challenges. The swine flu epidemic, like the anthrax scare in 2001, has pushed more than a few labs, not to mention administrators and technicians, close to the breaking point. Processing delays and errors due to overcapacity have surely led to preventable patient deaths--a tragic yet completely unnecessary situation. It takes just days to effectively install efficiency processes utilizing LeanSigma lab tactics and less than a week to positively impact patient outcomes while reducing laboratory stress.
Scenarios like anthrax and swine flu only underscore existing laboratory process problems. Even without such stresses the system is strained, with the aging baby boomer population requiring more tests and the growing shortage of technicians (increases in lab retirees and fewer technicians being trained). Yet when we look closer at actual work output, as much as 75% of technician time is spent executing tasks that don’t add value to the process or the sample: looking or waiting for information, filling out paperwork, walking to the next task, waiting for a pathologist, etc. Many administrations embrace technology as a silver bullet to solve these problems. While it can improve productivity, administering a technology band-aid on top of a weak collection of processes doesn’t make it better and often exposes the underlying problems that impacted performance. Real improvement resides in focusing on the current system and process: workspace layout, work flow, movements, steps, handoffs, rework loops, and computer and paperwork integration.
The LeanSigma Way
Many healthcare organizations are taking a different approach to improving productivity, solving quality problems and increasing throughput. Originally started in manufacturing, LeanSigma merges two processes initially developed to improve production systems. Lean refers to principles, tools and methods to eliminate waste and improve the flow of processes. Sigma is short for Six Sigma, a highly mathematical and analytical approach to removing variation to ensure customers experience 99.99966% error-free services or products. Elimination of waste is the key to LeanSigma lab efficiency. Removing wasteful steps and eliminating mistakes starts with adhering to three fundamental criteria:
- Is it a service the patient would be willing to pay for if they had to?
- Does the lab process transform the patient (or physician as proxy) request?
- Is it done right the first time?
LeanSigma enables administrators to model the current workflow throughout the lab. Labs that have implemented LeanSigma realize dramatic results almost immediately. For example, reduction in testing turnaround time by 54%; improvement in patient satisfaction percentile satisfaction rank from 15 to more than 60 within six months; savings of $400,000 for a blood bank that installed a new lab without adding space; achievement of a turnaround time (TAT) target goal of 95% achieved from 85% a year earlier in a clinical lab. Results like these can be achieved in a matter of days.
Three Lab Processes
How does LeanSigma work? In one lab, placement of equipment, inventory management and the LIS were targeted for efficiency improvement. Initially, samples were often moved from place to place without much being done to them. By co-locating equipment within an improved layout and redesigning work tasks, the amount of technician walking around time was reduced significantly which led to accelerated turnaround times, increased capacity for processing samples and a reduction in overtime. Consider a surgeon’s precisely-choreographed performance: He stands in one place and tools are brought to him. While it’s not possible to recreate the OR in a lab, applying similar thinking to lab staff provides a new vantage point from which to identify tasks which should be targeted to reduce non-value added time and motions. Reconfiguring the bench so technicians have what they need at their fingertips can reduce up to 20% of cycle time on a per-sample basis. Paperwork and LIS processes were another area crying out for LeanSigma transformation. The mere thought of disrupting the LIS can send lab administrators into a cold sweat but there are ways to effectively, quickly update the LIS for optimal efficiency that do not require any system downtime.
The First Step
One week. That’s all it takes to improve lab processes to ensure greater efficiency, circumvent strains, address ebbs and flows, reduce errors and improve patient outcomes. The ideal scenario is to bring together a small team of key lab technicians, managers and IT specialists with a LeanSigma leader. The team focuses on the current process and, applying common sense LeanSigma tools and principles, quickly redesigns process steps, changes the layout and reconfigures the end-to-end process flow. Within a very short time the team will have had dramatic, tangible and significant improvements in quality, flow and cycle time. Interestingly enough, once teams get a taste of how LeanSigma works and see the resultant cost-savings and improved productivity, they’ll be clamoring “why didn’t we do this sooner?!”
Ron Wince is president and CEO, Guidon Performance Solutions and a member of the Center for Health Transformation.
All contents © 2010 Advanced for Administrators of the Laboratory. All Rights Reserved.
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