Laboratory Redesign for Flow

Creating Flow in a Medical Lab

Problem: Issues related to poor processflow, end-product quality and turn-around-time (TAT) created many opportunities for improvement, particularly in the layout of the intake and drop-off areas of a laboratory.

 

Symptoms:

  • An insufficient number of workstations were available to lab personnel during peak periods
  • Long linear workbenches resulted in walking-time waste
  • The laboratory layout forced batching work, which in turn hampered system flow
  • The lab area was confined, overcrowded, and unorganized with fixed equipment, no standards and required multiple non-ergonomic motions

 

Solution: A team was assembled to resolve the lab workplace organization issues. A Lean Rapid Improvement Event was held to quickly change the central processing area and meet the project objectives.

 

Goals:

  • Improve the workflow in Central Processing (CP)
  • Better communicate queue information, backlogs, and capacity requirements with co-workers and management
  • Construct a work environment that fosters better teamwork, workspace utilization, and specimen focus
  • Establish organization and location standards using Lean 5S (workplace organization) principals
  • Enhance flexibility during peak demand times and accommodate future specimen requirements

Actions: The Layout & 5S Team quickly reached consensus and immediately implemented a revised laboratory design. Based on formal 5S training and hands-on practice, the improvements included:

  • Replacement of long fixed work tables with wheeled workbenches
  • Arrangement of work benches into triangular groupings called pods
  • Updating of large computer monitors with flat screens
  • Establishment of a priority location system for supplies and tools in standardized locations within the work space
  • Streamlining of reference materials and replacement of bulky binders with smaller, indexed guides
  • Testing of every movement required for one-hand retrieval and revision resulting in elimination of any two-handed tool acquisition movements
  • Revision of workspace locations to allow individual working flexibility and the  post-shift return  of all items to their designated locations

 

As the team analyzed the information they gathered, which included process flow diagrams, spaghetti diagrams, and data analysis, they discovered that 40 percent of the specimens had to flow to one area while the remaining 60 percent went to another area. The team devised a layout that would allow the bulk of the materials to flow through the center of the department.

The team also adjusted the process to allow for some individuality within a shift in terms of positioning of work items. This permitted left-handed people to arrange items to suit them. With 18 workstations, there was no rationale to explain why anyone should need to spend 10 to 15 minutes at the beginning of their shift rearranging the workstation. That inefficiency results in a wholly unacceptable three wasted work-hours per day (18 workstations x 10 minutes = 180 minutes or three work hours). If someone found it more convenient to place something differently for his/her shift, then that person should merely return the item to its standard position at the end of their shift. Visual cards showing the standard position for major task items facilitated this practice. At shift's end, it should take the technician no more than one to two minutes to return items for the next person.

 

Impact:

  • The number of workstations was increased by 50 percent, from 12 to 18, in the same space
  • Improved work flow minimized unnecessary motions (e.g., walking) and transportation (moving items) waste
  • More workspace with options for teamwork as needed
  • Better communication and visual contact among team members
  • Achievement of standards and organizational processes through the use of 5S
  • Swift implementation of the revised plan coupled with a team approach increased employee buy-in
  • A more pleasant work place!

 

Pharmacy Wait Time - Value Stream Mapping

Using Value Stream Mapping to Improve a Pharmacy

Problem: Patients using the pharmacy felt that it took too long to have prescriptions filled. Pharmacists and technicians felt that they were filling the prescriptions quickly and below the required time, that they were below standard wait times, and that the patients didn’t understand their system. They also felt that the fulfillment process had waste and inefficiencies that compromised quality. Demand was approximately 1,000 prescriptions per day for an average of about 435 patients.

 

Symptoms:

·         Patients spent approximately one hour with a nurse and provider before the prescription was released to the pharmacy, then would have to wait another 40 minutes, on average, for their prescription to be ready for pick-up

·         Patients had limited visibility of waiting queues or of their in the queue

·         Label printing equipment operated correctly only about 50 percent of the time

·         Approximately one in seven prescriptions needed some level of troubleshooting attention prior to final distribution

·         The automatic dispensing/filling robot was only at 60 percent utilization

 

Solution: A team of pharmacists, prescription [SRW3] , patient advocates, systems management, and quality improvement specialists was assembled to perform a Lean Rapid Improvement Event using Value Stream Mapping to uncover root causes and identify precise improvement actions.

 

The team created a current state map covering all process steps from patient check-in to the the final receipt of their prescription. Specific details were quantified, including queue times, processing times, activity accuracy, task difficulty, staff requirements and wasted resources. This exercise resulted in a clear picture of the process limitations.

 

The team defined an improved future process state and began to enumerate the actions items necessary to implement the improved system. This resulted in a clear action plan for the team and delineation of the resources required to complete the planning process within six months. The list included many excellent ideas that, when combined, would produce clearly measurable and sustainable improvements.

 

A third-party audit was conducted five months after the initial Value Stream Mapping (VSM) event. The results are highlighted below.

 

Impact:

·         Turn-around-time (TAT) for renewal of non-formulary medications was reduced by 86%, from 110 hours to 16 hours

·         Pending mail orders were reduced by 59%, from a backlog of approximately 2,200 orders (10 days) to 900 (4 days)

·         Patient wait times from prescription release to pick-up decreased by 35 percent to an average of 24 minutes

·         Facility performance on a cost-per unique order basis improved seven positions as a benchmark against other facilities

·         The drug file achieved 100 percent accuracy, was complete, current and correctly formatted

·         High-speed printers were completely functional with 99% uptime

·         A Q-Matic ticket system was installed to give patients visual confirmation of their queue position

 

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