Getting Your Lab Lean and Mean
Building Value through standardization
when variety is not a good thing
Today’s lab leaders face the challenge of adapting to a new healthcare system that is driven by quantifiable, quality outcomes. Producing these quality outcomes efficiently is the key to maximizing reimbursement, and the only way to thrive in the economic shift.
In this new system, a major enemy of outcomes and efficiency is the variation of test results. By reducing confidence in a lab’s data, variation prevents your lab from achieving its most optimum value and viability.
One primary cause of variation is using non-standardized, inefficient processes, many containing steps that add no value. These steps are not absolutely necessary to complete an analysis, and have a cumulative effect—driving up costs, lengthening TAT, and consuming staff resources that could be better used elsewhere.
How do you eliminate these non-value-added steps? How do you create processes that are highly valued in terms of efficiency, workflow, and reproducibility? The answer to improving your processes is through standardization.
- Variation of test results can directly affect patient outcomes and a lab’s bottom line
- Through LEAN methodology, you can improve and standardize your processes, reducing variation
- Key steps can help your lab greatly enhance quality, reduce inefficiencies, and produce credible and comparable data across your network
setting the standard
Standardization greatly improves the quality of laboratory measurements and ensures laboratories across the healthcare network are producing credible, comparable data. This reduces inefficiencies, errors, duplications, and delays that contribute to unnecessary expenditures.
The path to standardization begins with LEAN processes. LEAN is a customer-centric methodology used to continuously improve any process through the elimination of waste (i.e., non-value-added tasks). It is a pathway to better quality and lower costs. Adaptability as an attitude is essential to LEAN practices, starting with the ability to study a process and see it with fresh eyes.
"Rethinking workflow and processes can raise the ability of any clinical laboratory to do more with less—and to do it well."
Nine Steps towards lean standardization
The following are the steps you can take to streamline and standardize lab processes, taking advantage of LEAN principles and a strategic approach to workflow assessment.
While the challenge may seem daunting at first, help is out there. Companies like Roche specialize in LEAN methodology, and can play a valuable consultative role in helping you increase the performance of your lab.
Step 1: Walk the lab with your eyes wide open
The first step in improving the productivity, efficiency, and quality of your lab is to take a fresh look at every part of the process. Take a walk through your laboratory and carefully observe a process from start to finish, so you’ll have a clearer view of what works and what doesn’t. For instance, workload requirements and challenges regarding TAT, bottlenecks, and nonstandard practices are problems that laboratorians constantly face. If the methods involved in a process are causing frustration—that presents an opportunity for improvement.
Also remember that two perspectives are better than one. Roche Lab Process consultants (LPCs) can take that walk with you—helping you in defining key criteria for improvement and selecting clear, measurable objectives.
Step 2: Select a team and a process—and a partner
The next step is to bring together a team to focus on improving one process or part of a process. Form a team of chosen staff members who are already involved in the selected process. Ideally, you should also include a vendor as part of the team. LEAN-certified vendor-consultants, such as a Roche LPC, can provide a valuable viewpoint in two ways: they can provide simulation studies on their equipment, and they can look at the rest of the process objectively.
Some objectives that Roche LPCs can help you identify include integrating pre-analytics with central receiving, mitigating bottlenecks, and reducing the overall footprint of a process.
Step 3: Establish baseline metrics
Your chosen team will then measure and collect data on the process being analyzed. First, use the information as a baseline before implementing changes, and then use it to see the improvement after changes are made. Keep in mind that you should continually analyze metrics to determine where further improvement is needed.
A Roche LPC can assist you IN determining critical-to-quality metrics. Depending on your lab’s goals, they may include:
- Using less labor to produce results at current volume
- Cutting weekly overtime hours
- Reducing rework
- Dramatically increasing proportion of auto-verified results
- Reducing overall lab error rate
- Increase in results/paid hour
- Reduction in non-value-added steps
- Increase in auto-verification
- Overall medical value as defined by the people your lab serves.
Step 4: Create the standard work document
One of your team’s most challenging tasks will be to create a standard work document for the process being studied. To do this, have your team observe and map a process, beginning to end, breaking it down to its basic components, and noting the order of the steps. The team should also record what resources are used, who or what performs the tasks, and the outcomes. A Roche LPC can play a vital role in formulating a data collection plan as a part of this document, helping you measure process performance.
"As your team studies the process and its steps on the way to creating a standard work document, opportunities for improvement will become apparent."
Step 5: Identify your value-added steps
In LEAN terms, the steps that are absolutely necessary to complete an analysis are considered value-added steps. For example, in a clinical chemistry lab, these steps might include receiving the sample, centrifuging, analysis, and release of results. A Roche LPC can partner with you in streamlining a lab’s processes and improving efficiency and productivity, eliminating as many of the remaining non-value-added steps as possible. Once an agreed upon set of definite steps have been identified, the process will then be standardized.
TIP: consider auto-verification
Auto-verification can significantly boost efficiency and productivity in your processes. Increasing the current auto-verification percentage (to as high as 95%) can help:
- Eliminate waste that comes from having to verify too many samples manually
- Improve TAT and management of STATs
- Streamline workflow and increase productivity of the lab by automating repeats and reruns
Step 6: Train and Implement
After standardizing a process, it is essential that you train everyone, including supervisors, to that standard. Performing a process with consistency helps to increase efficiency and eliminate variability. Follow with implementation, using the standard work document developed by your team.
Step 7: Monitor the process
As your team members implement the new version of the process, they should monitor the process against the standard work document. Whenever possible, every shift needs to perform the work the same way, according to the standard the team has established. Then ask your team to observe the process again and gather data to evaluate the progress. Your team can also benefit from Roche dedicated LEAN methodology, part of which centers on collecting data from many sources to determine types of defects and metrics.
Step 8: Analyze and adjust
Analyze the data your team collected to show progress compared to the starting point. Outliers in the data will suggest opportunities for further improvement. Roche LPCs can assist in determining root causes of defects and opportunities for improvement. They include:
- Identifying gaps between current performance and goal performance
- Prioritizing opportunities to improve
- Identifying sources of variation
Working with a Roche LPC, you will then be able to improve the target process by developing and deploying innovative solutions centered on technology and the discipline and efficiency of your staff. They can also provide guidance on controlling the process-keeping improvements “on course” through an ongoing monitoring plan.
Step 9: Repeat with a new process
Look at each of your lab's processes, so you and your staff can go about refining those that matter most. These typically are related to cost, quality, service, and productivity. For example, your team can look at reruns and rework, and the reasons for them. First identify the problem, then concentrate on solving it. Your experiences with Roche LEAN methodology can give you a valuable head start in tackling future processes with confidence.
continue raising the bar
By staying focused on LEAN practice, you’ll see improvement as an ongoing goal rather than a one-time task. With that perspective, you can continue raising the bar on what can be accomplished. You will become increasingly innovative about eliminating waste, improving productivity, maximizing quality, and providing value for healthcare dollars spent.
This will enable you to lead your lab toward solutions that contribute to the overarching goals of your institution, starting with better outcomes for patients. And remember, expert vendors like Roche can provide invaluable assistance in helping you achieve your LEAN goals. They are there to help your lab succeed.