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Laboratories and Lean

Laboratories have been involved with the implementation of Lean for many years now. They were the first area of the medical profession to adopt the Lean Philosophy; however, there are still many labs that haven’t started their implementation yet. A microbiology lab in Ottawa recently undertook the implementation of Lean with a great deal of success. This specific implementation takes place in the first part of the value stream where the samples are received, accessioned, labeled, plated and incubated. Their reason for implementing Lean was not to reduce the turnaround time, or increase throughput, but to reduce the stress on their employees. The employees always felt that they were rushed to complete the work. There was always an inventory of samples waiting to be completed. They were frequently under staffed due to fluctuations in staff levels. When we discussed how to make the area better, their response was to add more employees and get a larger area to receive the samples in. This response is common from employees before they discover what going Lean can do for them.

The current state mapping exercise uncovered some interesting opportunities. Many times when you map it isn’t the data that you gather that gives you the direction to the future state but rather the observations that you make. From the data we gathered, it was clear that the processing times were fairly close together at each step. We discovered early on that this wasn’t the cause of the inventory buildup.

When you draw the current state map it is important to watch the process to determine what is really happening. In this case, a few things jumped out at us.

1. The set up in the morning took 30 minutes.


2. The first samples came 30 minutes before the first break.


3. When the samples arrived all the members of the group went and opened them.


4. The employee accessioning the data on a sample was interrupted every 5 minutes by the phone.


5. There were breaks between major quantities of samples arriving.


6. The employees stayed at a position for random lengths of time.


7. There was no idea of a takt time or how many should be completed in a day.

All of these issues were not the fault of the employees, they were doing their best in a process that was not flowing (wasn’t Lean). So how can we make this better?
In the future state map, we identified the client demand and determined the take time. In this case, it was a sample of 1 per minute. Each processing step was capable of meeting this pace. There were 6 people in the area, so we identified one that would answer inquiries and resolve the issues. This left 5 employees to handle the samples when they came in. We slowed part of the process down to speed up the end to end process.

In many labs, there is a belief that you should drop everything and race over to open the bags of samples when they come in. This may be required to identify stat items, however, there are better ways to do that but I will not address that here as it wasn’t an issue in this lab.

Once all the bags were opened, there was a huge inventory to be accessioned before anyone else could begin their work. There wasn’t any flow. The solution was to slowdown the opening to match the takt time. This was hard for the employees to do at first but they tried it and found the samples were actually completed faster than before. Each employee was assigned to a station for 2 hour increments and then they rotated. Since only one employee was opening at a time, there was plenty of space in the opening area. During the time to fill the line in the morning, the employee plating and labeler would set up their areas and were ready when the first samples arrived. The employees felt more relaxed and didn’t feel rushed. At the end of the first week, one employee confirmed that they weren’t as rushed but chalked it up to having less samples. The employee was surprised to find out they had complete 25% more work that week. However, that was only the start of the success.

• The first samples were in the incubator within 40 minutes compared to 150 minutes.


• There was a 25% carryover of work from the day shift to the evening shift before Lean. After Lean, the day shift finished the work they received.


• Once they worked to takt time it was discovered that for 4 to 6 hours each day they could operate the area with only 2 employees.


• The walking was reduced.


• Productivity per employee almost doubled.


• After completing a 5S effort they freed up enough space to operate 2 work areas if they required them. Thus they could adjust their staffing to handle anywhere from less than 100 samples per shift to over 700 per shift.

There are many other benefits from this Lean implementation. For example, one interim bench review has been eliminated. With the resources freed up, some of the billing activities are completed earlier. There is more time for training new employees. Patients get their results in a more timely fashion. And one of the most important results with ‘less stress’ to all the staff along with increased pride in the service they were now able to provide.

What is even more impressive is that the success was achieved in less than 3 months.

The KAIZEN-Lean transformation would follow the following stages:

Assessment:
This would be a 5 day event where the KI Lean Advisors Team would conduct a top level view of the Value streams in the departments. From this assessment the following outputs will be delivered.

The assessment will also Support the establishing the overall KAIZEN-Lean Strategy.

Delivery:
The delivery part of the plan will be in 3 phases which link to the 3 stages of Team Maturity

• Dependence. During this phase, KI Lean Advisors will assume the position of Senior Project Manager for the First Value Stream Team. The team will be led through the EVSM process whilst being trained in to delivery it in future.


• Cooperation: During this phase the first Value Stream team will have gone through the full EVSM cycle and will have completed their basic training. They will be ready to lead the next EVSM event under guidance from the KI Lean Advisors Team.


• Partnership: During this phase the internal Lean team will be fully trained and able to drive the KAIZEN-Lean implementation plans independently.

Enterprise Value Stream Mapping™

KAIZEN INSTITUTE LEAN ADVISORS (KI Lean Advisors) Promotes Lean as a strategy and a way of thinking that creates more value by eliminating activities that are considered waste. Our approach is to focus on end-to-end 'system-level' improvements (as opposed to 'point improvements'). Improving the end-to-end system-level work will dramatically improve your bottom line results and better service the needs of your patients and clients. In order for a process to reach its full potential it is important to initially understand what is happening from a system perspective (end-to-end).

We must transform the selected Value Stream(s) - from request of the service to the actual delivery of that service. If you don’t focus on the end-to-end process you will make ‘point improvements’ and create what we call ‘Exciting Chaos’. This ‘Exciting Chaos’ will inhibit the process from reaching its full potential and could ultimately undermine the success of the organization. With our innovative methodology, we eliminate the risk of obtaining only minimal results and ensure your success both culturally and technically.
The selected Value Stream(s) will be analyzed from a System perspective and all processes, activities and data will be identified and captured.

The Current State Map
The Current State Map will identify:

• Total Turnaround Time of the patient or specimen (total time required to fulfill a service from end-to-end); all value and non-value added activities.


• Delays or wait times between n activities.


• Client demand rates; critical measures such as quality


• Flow of information (documents, data, filing).

The Future State Map
A Future State Value Stream Map will be created of the end-to-end system with a focus on:

• The improvement of Flow,


• A reduction in re-hospitalization (rework).

This system approach will effectively “design out” the non-value added activities which we would term waste. The Future State helps employees lock into the desired vision and direction for the organization.

Implementation Plan

In order to achieve the Future State Map, the team creates a three to six months Implementation Plan that systematically details how the waste is going to be eliminated. KI Lean Advisors will focus the team on developing a realistic plan, utilizing existing resources, staff and information systems to achieve the Future State. The plan will be within the scope and control of the organization.

The detailed Implementation Plan identifies:

• The tools required


• Where they are required


• When they are required,


• Who is responsible for applying these tools


• The expected impact on the end to end processes and organization

The team will also establish metrics current and future to ensure that all activities identified in the implementation plan are aligned and deliver the expected future state. The Implementation Plan eliminates the opportunity for creating point improvements and avoids ‘Exciting Chaos’.

A major outcome of this Lean Transformation initiative is the creation of an environment that is patient/client focused, where services are provided in a timely fashion, at least cost and with the highest quality. To achieve this, the team must create an environment where significantly more can be accomplished with your current work force and physical assets.

In order to ensure that the training activity fully supports the Lean Transformation process, one or two value streams per hospital will be selected to pilot as part of the training. When participants learn about Enterprise Value Stream Mapping, we will then walk the chosen Gemba (the workplace) and they will effectively learn as they directly participate to adapt and apply the mapping of their value streams. The only way to ensure ‘learning’ and transfer of knowledge is by applying the concepts and tools to their unique situations. This method allows them to gain knowledge, confidence and or course pride in what they are learning in a way that training alone cannot do.

The other advantages of this method of training is that others will be able to ‘see’ the changes the team make and this will be extremely important in moving towards a new culture and way of thinking for the organization. This method will bring an immediate ROI from the teams efforts and the staff and customers will be positively affected by the improved service both with the increased speed of service and the reduction in the everyday stress of their jobs.