Lean Process in Practice

Insuring Resources Commentary:

I found the article included below on GE Healthcare's website. It details how Brigham and Women's Hospital in Boston, MA, implemented Lean tools in their clinical laboratory. These processes streamlined their laboratory operations and reduced wait times for lab tests.

The article states:
"The effort brought about rapid and significant improvements in key measures of quality and consistency. For example, in just six months, average wait times in phlebotomy decreased from 14-17 minutes to 4-5 minutes. In addition processing in the laboratory for specific tests (see table) now meets cycle time goals more than 90percent of the time."

This was accomplished by "Eliminating non-value-added tasks, such as duplicative sample container labeling, and "Reconfiguring one station that had been reserved for patients susceptible to fainting by installing a chair that can be used for all patients."

There's no information in the article about cost savings, but reduced wait times and elimination of non-value added tasks must achive some savings.

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LEAN TOOLS IN THE CLINICAL LABORATORY
Rapid-improvement events enhance laboratory performance

As plans advanced to automate the Clinical Laboratories, Brigham and Women’s Hospital faced growing specimen volumes in constrained space amid concerns about technician retention and recruitment.

The hospital staff worked with the Performance Solutions consulting group of GE Healthcare and the hospitals’ Center for Clinical Excellence as a part of a Lean Skills Transfer engagement to assess laboratory performance and design process improvements at all key steps in the value stream, from the time the patient arrives to provide a specimen until the lab report is complete.

The effort brought about rapid and significant improvements in key measures of quality and consistency. For example, in just six months, average wait times in phlebotomy decreased from 14-17 minutes to 4-5 minutes. In addition processing in the laboratory for specific tests (see table) now meets cycle time goals more than 90percent of the time.

“While our volumes were growing, we were also planning for laboratory automation,” says Dr. Milenko Tanasijevic, the Director of Clinical Laboratories. “We wanted to optimize workflow first, rather than automate suboptimal processes. Lean offered a unique set of tools that allowed our staff to break processes down into discrete steps to discern between non-value-added and critical, value-added steps.

“We achieved significant improvements in patient satisfaction, reduced wait times in
phlebotomy, streamlined processes and shortened laboratory turnaround time.”

Streamlining phlebotomy

A team made up of Clinical Excellence process improvement leaders, laboratory staff, and GE lean experts conducted a value stream mapping session in November 2007. Then they performed five kaizen rapid-improvement events over the next six months, each focusing on specific process areas.

One kaizen addressed wait times in the outpatient phlebotomy clinic, a small space with five drawing stations. Patients arrive without appointments and are seen on a first-come, first-served basis. Wait times were inconsistent: some patients were seen almost on arrival, but others waited 30 to 40 minutes, or longer.

The analysis found an imbalance between demand and staffing, especially early in the day. Patients arriving before the actual opening time caused a backlog that had a ripple effect lasting into the morning. To address that, the team decided to open the center 30 minutes earlier and increase staffing during the morning hours.

The kaizen also identified ways to manage patients’ expectations and improve patient flow. A “take a number” system allowed patients to anticipate their wait time. Those patients needing urine testing had their specimens collected in the interval between arrival and blood draws.

The team also introduced a flow coordinator role, responsible for escorting patients from the waiting area to the drawing stations, instead of having the phlebotomists walk to the waiting area and call for patients. The team also took several steps to make the phlebotomists’ work more efficient. These included:

> Eliminating non-value-added tasks, such as
duplicative sample container labeling.

> Reconfiguring one station that had been reserved
for patients susceptible to fainting by installing a
chair that can be used for all patients.

Improving laboratory workflow Four kaizens addressed various aspects of laboratory sample handling and processing workflow. The critical metrics included cycle time from logging of the specimen to entry of the result to the Laboratory Information System, measured for average time and percent compliance with cycle time goals.

The team made a variety of changes in staffing and procedures to eliminate issues that caused processing bottlenecks. Data gathered during the process made it possible to optimize staff levels to meet demand.

In addition, instead of having individual technicians perform all specimen processing steps, the Lean participants devised a team-based approach, reducing technician travel distance significantly. The group also reconfigured workspace layouts and co-located equipment for efficiency.

Sustaining momentum
Using lean tools to make processes more visible to staff and patients was a key tenet in working across the value stream. Surveys showed that phlebetomy patient satisfaction increased by more than 20 percentage points after the kaizen improvements.

The benefits of Lean and the kaizen have lasted well beyond the original engagement. For example, after the first 5S project, the hospital staff undertook two more such activities in other areas of the chemistry laboratory.

“Lean and the kaizens have enabled us to brainstorm solutions and actually go out and test them in a real-time mode,” says Tanasijevic. “It shortened the interval from issue identification and idea generation to trying out proposed changes in the laboratory.”

Dorothy Goulart, MS, RN, Director of Performance Improvement with the Center for Clinical Excellence, observes, “We have had success with facilitating design sessions
and involving staff and managers in problem solving, but we were challenged to consistently implement and sustain changes. By combining change acceleration, Lean and kaizen event approaches, we have been able to strengthen our institution’s ability to achieve tangible results while building new capabilities and knowledge.”