Hospital - Laboratory Specimen Receiving
Within the 1st week, the end-to-end process for some tests had improved by 25%. The lab is receiving 75% more with 33% less staff, and delivering the last specimens 1 hour earlier.
Laboratory Specimen Receiving
When improving an end to end process it is usually better to start at the end of the process closest to the customer. In a Laboratory environment, the delay may be waiting for the specimens to show up at the workbench. This is an example of one such case.
When the Current State Map was completed, it was noted that the work was processed in large batches. The courier delivers one or two large batches of samples to receiving every day. The large batch is emptied from the boxes, and then sent over to be accessioned as a batch and finally distributed at the end of the day to the various workbenches in another batch. Employees get lulled into a batch mentality and actually think it is the best way to process their work - this type of thinking is what you find in every industry including manufacturing, administration and service. We find in Laboratories that one piece flow isn't even considered in such a set up and most employees question the sanity of anyone that would propose a one piece or smaller batch process.
One receiving lab did take on the challenge to reduce batch sizes and work toward one piece flow. Circular logic was used as the reason for one large batch.This logic is true in many companies in many operations. In most of the labs we work in, you ask 'why all the work is distributed at the end of the day'. The response from receiving is something to the effect - "that's when the departments want to start the tests". When you ask the technicians why they start their testing at the end of the day, they tell you "that's when they get the specimens".
What you discover when applying the Enterprise Value Stream Mapping ™ tool is, the delay due to batching the specimens adds an average of 4 hours to the turn around time (TAT) of all the tests and for some it could be up to 24 hours. It also sends a message that there isn't any urgency to delivering the specimens.
The only visual measurement goal in the receiving area was meeting the 4 pm deadline for delivery. As this was the only measure, employee output was variable. Some days there was a lot of work and other days there was less. This is not a good work environment, where you are overworked one day and under worked another. In fact, it causes the staff a great deal of pressure and undue stress.
Lean Healthcare Inc. worked with the supervisor and his team on improving the delivery and measurement in his area. One of the benefits of Lean Labs is the interaction between all the departments. As part of their Future State Implementation Plan, the team met with their internal customers and determined when the samples would be required to meet the patient demand (Takt time). From this analysis, they set up a schedule and started to deliver smaller batches.
Pitch is a measure of the pace of work flow with regard to the patient demand. The supervisor developed a visual method for measuring the team's performance against patient demand. This ongoing measure was designed by the team, so that it was visible and understood by everyone in and out of the area. From this measurement, they (the entire lab personnel) can tell if they are ahead or behind at any time throughout the day.
The results have been impressive. Within the first week of smaller batches, the end-to-end process for some of the tests had improved by 25%. With the implementation of the smaller batches the throughput of the department improved as well as the capacity. The lab is receiving 75% more product, with 33% fewer staff and delivering the last specimens an hour earlier.
With the reduction in staff required to receive the specimens the supervisor was able to re-assign the employees to work on another value stream in the area that was unable to keep up.
Another result that is more difficult to measure, but is just as important as all the others, is staff morale and attitude. The transformation has staff excited about the changes and has created an environment where they have much more pride in the work they are involved in and the exceptional service they are providing to their doctors and patients.