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Automation, Leaning, and Process Improvement in the Clinical Laboratory

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Autozone SPS Process Improvement. Co-located highly automated equipment near processing ... Autozone. After Autozone. After Autozone. After Autozone ... – PowerPoint PPT presentation

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Title: Automation, Leaning, and Process Improvement in the Clinical Laboratory


1
Automation, Leaning, and Process Improvement in
the Clinical Laboratory
  • Paul J. Henderson
  • Laboratory Medicine
  • University of Washington

2
Overview
  • Lab Med Statistics
  • Current Landscape
  • Automation(Continous Flow Processing)
  • Leaning , Process Improvement (Change Management)
  • Lab Medicine Experience

3
Laboratory Medicine
  • Perform about 3.5 Million tests per year
  • 67 million Clinical budget
  • Two hospital labs, SOM labs
  • 38 Faculty
  • 800 plus employees

4
Laboratory Medicine
  • SCCA
  • Med Tech Program
  • Masters Program
  • Postdoctoral Training Programs
  • Shared Residency Program

5
HMC
6
SCCA
7
Laboratory Medicine
  • Outreach operation includes UWPN clinics, other
    hospitals and clinic in the NW
  • Partnership network with Mayo
  • Clinical and research labs in 11 locations
  • 56 million in funded research

8
Economic Landscape
  • Increased a demands services
  • Aging baby boomers-more sophisticated users of
    health care
  • Increase life span creating super users of health
    care
  • LOS changes increase consumption of services
  • Reimbursement issues
  • Change shifting in payor mix
  • Need to continue to expand and or update major
    hospital programs/facilities

9
Economic Landscape
  • Declining work force
  • Fewer people in the workforce pipeline
  • Large number of staff reaching retirement age
  • Very late recession recovery in our local market
  • www.crashnburn.com
  • Boeing downsizing
  • UW specific--
  • Impact of the Federal Investigation
  • Civil Service reform

10
How do you survive?
  • Build in capacity without added FTE
  • Optimize your use of your staff resources
  • Maximize use of automation
  • Expand on process improvements

11
Automation / Continuous Flow
  • Instrumentation is providing opportunities for
    automated processes
  • More testing on single platform
  • Higher volume/increase capacity
  • Less human intervention
  • Improved patient care driving us a continuous
    flow process-faster results, improved accuracy
  • Use of technology to improve the work flow

12
Automation
  • Early implementations total lab
  • Platform consolidation
  • Work cells
  • LIS improvements
  • Plug and play systems

13
Continuous Flow
  • Focusing on improvement of sample flow
  • Can apply to any type of testing highly automated
    or manual testing
  • Uses a process improvement methodology to change

14
Process Improvement
  • Many quality initiatives but few have had
    significant impact to lab processes
  • Needed a approach that is not make work, and
    actually improves quality and has a positive
    impact on staff
  • Lean-5s
  • TQM, Six Sigma

15
Lean
  • Systematic approach to cut waste non value added
    steps
  • Reduce cycle time
  • Customer focused
  • Usually done in short period of time

16
Lean
  • Value Stream Assessment
  • Walk the flow
  • Rapid process improvement
  • 5s-visual system
  • Measurement

17
Lean
  • What is 5 s
  • Sort
  • Simplify
  • Sweeping (see at a glance everything is in its
    place
  • Standardizing
  • Sustaining

18
Lean
  • Requires top down sponsorship/champion
  • Key stakeholders who participate
  • Must have front line staff involved
  • Communication
  • Systematic Follow up

19
Six Sigma and other PIs
  • Reduced variation leads to few defects (errors)
  • Methodology is based on MAIC
  • Measure
  • Analyze
  • Improve
  • Control
  • Provides breakthrough opportunity
  • Establishes policies, procedures that are
    followed consistently
  • Used in conjunction with lean will increase speed
    of change

20
Process Improvement In Lab Medicine
  • Lab Corp
  • SCCA
  • SPS Process Improvement
  • Formalized Automation / Continuous Flow

21
SCCA
  • Formalized teams for the project (RIP)
  • Lab Med first team
  • Staff, Faculty and Senior Administration
  • 5 days of focused effort
  • Process walk/flowchart/gap analysis/design and
    testing
  • Report outs by staff to Sr. Leadership
  • Check-in, validate
  • Implement
  • Continued follow up and check-in

22
SCCA
  • Successful implementation system wide
  • Increased critical care inpatient population by
    20
  • Increased microbiology blood culture testing by
    50
  • Required realignment of staffing to provide
    results for transfusion therapy by 800 a.m.
  • Achieved that mark 99.9 of time, still hitting
    the mark
  • Staff developed new skill sets in process
    improvement
  • Staff very invested in success of project
  • Staff very proud of their success

23
Autozone SPS Process Improvement
  • Co-located highly automated equipment near
    processing
  • Streamline pre-analytical processing
  • Processing staff, supervisors, faculty part of
    the design and implementation
  • Improvements primarily were made by the staff
  • Remodel and use existing space (and keep working)

24
Before Autozone
25
SPS before Autozone
26
SPS before Autozone
27
After Autozone
28
After Autozone
29
After Autozone
30
Continuous Flow in Lab Med
  • New charge to Faculty, Supervisors, Staff
  • Each area is to identify and improve (lean)
    process
  • Priority based on improve patient care, improve
    throughput (cycle time) TAT, and cost savings
    --free up FTE
  • Not just highly automated area
  • Will use MBO process to track progress
  • Outcomes must have agreed upon metrics

31
Continuous Flow in Lab Med
  • Outcomes reported via hospital QA process
  • Shared in department--meetings and posted
  • Commitment is to return savings back into
    projects
  • Opportunity for staff to continue to develop new
    skills
  • Lean methodology has been deployed in both
    medical centers and key supervisors have access
    to training materials or help as needed

32
Current Status
  • Continuous Flow charge given by Chair at annual
    staff awards
  • Platform selection in progress--across silos
  • Management team evaluating new management
    structure for 24 x 7 lab
  • Identifying skill sets needed for 24 x 7
  • Learning being shared--knowledge transfer

33
Next Steps
  • Department leadership to continue facilitation
  • Keep teams focus
  • Communicate, Communicate, Communicate
  • Direct resources needed to implement each phase
    and celebrate along the way

34
  • Questions?
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