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General Laboratory: Lean Process Mapping Online Training

Process Mapping is a technique that can be used to drive waste out of a process. The process map is used to identify the value and non-value added activities, as well as the necessary non-value added activities. The objective is to redefine the process by eliminating waste.

Welcome to the Lean Process Mapping Online Training course.  The Keen but not Lean Medical Center (KLMC) Laboratory is investing time into their Lean Team who are looking at the pre-analytical area using process mapping to identify non-value added activities and drive waste out of the process. Join the KLMC team on their journey and learn how to apply this tool in your laboratory.   Select Next to continue.   Define process mapping and how the individual steps contribute to the overall process Describe how to redefine a process by eliminating waste Distinguish between value added and non-value added processes Identify the necessary non-value added activities within a process Upon successful completion of this course, you will be able to: Select Next to continue. Congratulations.  You have completed the Lean Process Mapping Online Training course.  Listed below are key points that have been presented.  Take time to review the material before you proceed to the final quiz.  Describe process mapping and how the individual steps contribute to the overall process A Process Map is a high-level view of the activities required to take a specific product from raw material to the finished product. Key steps of Process Mapping include: Description of the current process by users and stakeholders - involves identifying and confirming the main and sub-process steps Identification of value and non-value added steps Clarification of which non-value added steps are necessary Description of the new process by users and stakeholders Distinguish between value-added and non-value added activities Value Added (VA) Activities: Any activity that increases the market value or function of the product/service Typically 1-2% of the entire process time Examples:  Producing the correct result the first time and auto validation Non-value Added (NVA) Activities: Any activity that does not add market value or function or is unnecessary These activities should be eliminated, simplified, or integrated Examples: Unpacking samples and leaving them in bins for someone else to process and re-labeling samples that were incorrectly labeled Identify the necessary non-value added activities within a process Necessary non-value added activities add no value to the customer, but if they are not done the process cannot be completed or it increases the risk of error. Examples:  Quality Control and Maintenance Describe how to redefine a process by eliminating waste Remove all unnecessary non-value added activities from the process Rebuild the process logically with remaining activities Institute the new process and review Select Next to continue. In conclusion, we validated the N Latex FLC kappa and lambda assays against the Freelite™, and although the results were not directly interchangeable, there was good agreement in the binary classification of samples.  The N Latex FLC assay has the advantages of superior precision across the measuring range, and although not immune to nonlinearity, it did not exhibit gross antigen excess on the BNII analyzer. The N Latex FLC kappa and lambda assays can be used in clinical practice based on their acceptable analytical performance characteristics.   What is a Process Map? A Process Map is a high-level view of the activities required to take a specific product from raw material to the finished product.  Key steps of Process Mapping include: Description of the current process by users and stakeholders Identification of value added and non-value added steps Clarification of which non-value added steps are necessary Description of the new process by users and stakeholders Select Next to continue.   Gratulation! You have completed the Lab 101 Laboratory Organizational Structure online training course. Im Folgenden sind die wichtigsten Punkte, die vorgestellt wurden, nochmals aufgelistet. Nehmen Sie sich Zeit, die Inhalte zu überprüfen, bevor Sie mit dem abschließenden Test fortfahren. Key steps to define the current process include: Assemble a team of stakeholders Identify the main process steps Identify sub-process steps Confirm the entire process is complete Important materials needed during Process Mapping include: A room with whiteboard or flipchart Post-it notes Colored marking pens (including red) Stakeholders: Executive Leaders Middle Managers Representatives who touch the process being studied   Describe the Current Process Take a closer look at the current process under review at the KLMC Laboratory. Slide NumberText BlocksCalloutsAudio ScriptImage File1 Stakeholders at KLMC Laboratory   The Lean Team consists of the appointed Lean Team Coordinator, 3 Technical staff members, and 2 Ancillary staff members.   There are 3 stakeholders present: Section leader - pre-analytics Laboratory Medic Section leader - analytics Select Next to continue.  Note: If audio does not automatically start, select the play arrow in the top left to begin.The KLMC Lean team has walked through the process on the Gemba (in the work area) and is now sitting in a meeting room with a set of post-it notes. They have outlined the main steps in the process and these have been placed in order on the wall. Select next to continue. 2 Main pre-analytical process steps are defined Receipt into laboratory Initial sort Transport to chemistry Main sort Labeling Centrifugation Samples to Hematology Logging in Scanning Empty centrifuge Take to decapping bench Select Next to continue.  First the team describes all of the main process steps involved such as specimen receipt, sorting, transportation, labeling and centrifugation. These steps then become the main headers for the pre-analytical process steps at KLMC. Select next to continue. 3 Individual steps are identified Sub-steps of taking samples to the decapping bench include: Walk to centrifuge Find completed batch Take rack from bench to trolley Make aliquots Destination sort Check for demographics entry 'complete' Place on decapper Take off decapper Visually check sample Place in automation rack   Select Next to continue.    Once the headers are in place the Lean team works through each of the main steps by adding all of the individual steps within each process being as detailed as possible. The list is then qualified by other members of the pre-analytic section in order to verify. In this example we can see that the individual steps of taking the samples to the decapping bench have been identified. Select next to continue. 4 Complete Process is Identified This is completed for each process step and after verification the number of steps is counted.   Note:  At KLMC a total of 80 steps were identified in the pre-analytical process.   When complete, select the X in the upper-right corner to close the window and continue.Once all of the process steps have been identified, the team reviews them for accuracy. After verification, the total number of steps is counted. At KLMC, there were a total of 80 steps identified in their current pre-analytic process. Now that the current process has been completely defined, the team can take a closer look at each of the steps to determine their value. This table shows that the majority of patients with multiple myeloma, light chain disease and amyloidosis have abnormal Free light chain ratios.   2Value Added (VA) Activities: Any activity that increases the market value or function of the product/service Typically 1-2% of the entire process time Can you think of a Value Added activity? Producing the correct result the first time and auto validation are value added activities. Non-value Added (NVA) Activities: Any activity that does not add market value or function or is unnecessary These activities should be eliminated, simplified, or integrated. Can you think of a Non-value Added activity? Two examples of Non-value added activities are unpacking samples and leaving them in bins for someone else to process and re-labeling samples that were incorrectly labeled. Image Legend 1 Value Added Activities 2 Non-value Added Activities 3 Necessary Non-value Added Activities   Identifying Value-Add and Non-value Add Activities Learn how the KLMC team categorized activities in the pre-analytical process. Slide NumberText BlocksCalloutsAudio ScriptImage File1Identified value added activities at KLMC include:   Single check demographics form and tube Appropriate centrifugation Tubes sorted to correct analytical racks    Select Next to continue.  . Note: If audio does not automatically start, select the play arrow in the top left to begin.At KLMC the team identified several value added steps. A single check of the demographics form and tube adds value for both the customer and laboratory by confirming the correct sample and test request have been received. Note that a fully automated system of radio-frequency identification or automatic barcode generation at the patient's bedside linked to the LIS would remove this step, but would have a cost implication. This could be submitted as a proposal from the Lean team to management but would be out of scope for this exercise. It is important to use common sense during this step. Another value added in this process is the sample being ready for analysis through appropriate centrifugation; however this step could be eliminated by automating the process. Also, when tubes are sorted into the correct analytical racks it allows the sample to be placed directly on the automation or analyzer with no extra motion or waste state. Select next to continue. 2 Identified non-value added activities at KLMC include: Walking to the centrifuge (waste of motion) – A solution was to redesign the area so the decapper is next to the centrifuge Taking the racks from the bench to the trolley (waste of motion) – A solution was to redesign the area so the bench is next to the trolley Checking for demographics entry to be 'complete' (check step and waste of waiting)- This can be eliminated by using value stream mapping to match the takt time (or cycle time) of the centrifuge process with the data entry process.  It may be necessary to reassign staff Taking tubes off of the decapper (waste of motion) Visually checking the sample (check step) - This is repeated further in the process: lids removed is checked at the load step, sample volume is checked by liquid level sense on the analyzer and HIL is checked on analyzer (in some cases this can also be checked automatically by a tube/sample detection system)             When complete, select the X in the upper-right corner to close the window and continue.Examples of non-value added activities are steps such as unpacking the samples from the plastic transport bags, sorting hematology samples into racks only to then re-rack the samples into the analyzer racks later, and sorting the chemistry tubes into racks and then reracking them into centrifuge racks. Checking tubes to confirm that they were in the LIS before they are run on the analyzer. At KLMC the team identified the following activities as non-value added steps; walking to the centrifuge, taking racks from the bench to the trolley, checking for demographics entry to be 'complete', taking tubes off the decapper, visually checking the sample. The next step for the team is to determine which of these is a non value added but necessary step in the process. The Eight Deadly Wastes of Lean Learn about the Eight Deadly Wastes of Lean. Slide NumberText BlocksCalloutsAudio ScriptImage File1 Defects:   Scrap, mistakes, errors or corrections that require additional time, resources, and money to fix.  Select Next to continue.  Note: If audio does not automatically start, select the play arrow in the top left to begin.There are eight forms of waste defined in Lean, otherwise known as “The Eight Deadly Wastes.” The first form of waste, defects is defined as any form of scrap, mistakes, errors, or corrections resulting from the work not being done correctly the first time. Examples of defects are long or variable turnaround times, an inaccurate result, an incorrect sample, or sample tube. Select Next to Continue.2 Over-Production:   Doing things too early, before other things are ready to process.  Select Next to continue.  Overproduction is defined as producing more, sooner, or faster than is required by the next step in the process. An example of this is the all too common process of collecting a “rainbow” of blood tubes (1 of every colored stopper in our stock: red top, blue top, green top, lavender top, etc.) on a patient when tests were ordered that only require one of those tubes. Select Next to Continue.3 Waiting:   Downtime that occurs when work has stopped for any reason.   Select Next to continue.  Waiting is downtime that can occur for a variety of reasons including insufficient staffing, long setup times, poor communications, and mismatched production rates. Examples include samples waiting to be spun or analyzed, waiting for depleted reagents to arrive, patients waiting for a blood draw, staff waiting for an answer from a supervisor, and samples waiting on a phlebotomy cart waiting to be sent to the laboratory for analysis. Select next to continue.4 Not Using Staff Creatively:   Misuse of qualified staff members.   Select Next to continue. The next type of waste is not using staff creatively. This is the failure to use people’s education, creativity, specialized training, ideas, and abilities appropriately. A typical example of this is using a medical technologist with a bachelor’s degree to perform phlebotomy, specimen processing, or clerical duties. Select Next to Continue.5 Transportation:   The excess movement of materials that does not add value.   Select Next to continue.  The waste of transportation involves the unnecessary movement of materials. This can be caused by a poorly laid out laboratory space, as inconvenient laboratory location, having multiple drop-off locations for samples, and improperly placed instruments. Select Next to continue.6 Inventory   Overstocking items, poor ordering system, poor supplier process.   Select Next to continue.  Inventory is defined as any supply that is in excess or lack of that required for immediate production. Lack of inventory prevents us from producing our product or service, while excess inventory adds unnecessary costs to our bottom line. Select next to continue.7 Motion   The excess movement of people, equipment, paper, information, or electronic exchanges that do not add value.   Select Next to continue.  The waste of Motion can be defined as the excess movement of people, equipment, paper, information, or electronic exchanges that do not add value. This can cause significant slowdowns. Motion can be caused by a poor laboratory layout, workstation congestion, and poor housekeeping. Select next to continue.8 Extra Processing   Putting more work, effort, or steps into a process than is required.  When complete, select the X in the upper-right corner to close the window and continue.The waste of over-processing is defined as putting more work, effort, or steps into a process than is required. Examples include the sorting and resorting of samples, over inspection of specimens, labeling and re-labeling of specimens, and, worst of all is the “oops, we had a problem so we added steps to our process that do not add value and may involve rework “just in case” the problem occurs again. Select the X in the upper right corner to close this window and continue. Certainly, FLC analysis is best used for the disease states that Serum and urine M protein is not measureable.  In these cases, the FLC analytical sensitivity is critical allowing the treating physician a measurable result to base the effectiveness of the therapy.  The first and third rows are AL and MM without measurable Urine or Serum M protein.  Each of the criteria in these rows are in part because of the FLC assays analytical sensitivity.   Necessary Non-value Added (NNVA) Activities: Activities that add no value to the customer, but if they are not done, the process cannot be completed or it increases the risk of error Can you think of any examples of laboratory activities that are Necessary Non-value Added? Performing Quality Control and Maintenance are examples of Necessary Non-value Added activities.   Clarifying Necessary Non-value Added Activities Learn which non-value added activities were identified as required in the pre-analytical process. Necessary Non-value Added Activities at the KLMC Laboratory Removal of tubes from the decapper is a waste of motion that could be eliminated by redeveloping the decapper to take the Automation trays or by having a decapper on the Automation system. Currently KLMC does not have a budget for either option which makes this a necessary but non value added step. When complete, select the X in the upper-right corner to close the window and continue.    Key steps to redefining the process include: Remove all unnecessary non-value added post-its Rebuild the process logically with the remaining post-its Try it out Re-defining the Process View the newly re-defined process at KLMC and how they are doing today. Slide NumberText BlocksCalloutsAudio ScriptImage File1Re-defined Pre-analytical Process at KLMC The VA and NNVA processes are recombined into the new process under the same main process step areas The process is walked through, and bench and equipment set ups modified as necessary The process is piloted for one week and modified as necessary - all changes documented The new process is adopted and SOPs updated as necessary     Select Next to continue. Note: The new process contains 42 steps.  This is approximately a 50% reduction in the overall number of steps.Note: If audio does not automatically start, select the play arrow in the top left to begin.At KLMC the Lean team reviewed each process and decided which were value added, non value added and necessary non value added. The Value Added and Necessary Non-Value Added post it notes were retained and an ' on paper' process was defined. The Lean team then walked through each step of the new process to verify that it was valid. It is important to have the empowerment to move equipment and benches as necessary. There are other Lean tools such as Spaghetti mapping that allows you to investigate where your staff is moving in a current process in order to ascertain what makes sense to move in the new process. The new process is presented to the staff working in the area and is piloted for one week. Any minor changes are made and documented. The new process is adopted and standard operating procedures are written and adopted into the Laboratory manual. Select Next to continue. 2A look at KLMC Laboratory Today: A single, thorough sort in specimen reception Biochemistry/Hematology equal priority No Microbiology/Immunology samples transported to lab in error that require taking back Samples no longer batched Labeling and booking done at the same time, by the same staff Samples don’t sit around partially processed Less error prone as one person does the entire process Samples transported up to the lab in smaller buckets instead of heavy transport bags – easier for staff and enables First In First Out (FIFO) system Previously: No FIFO system-some samples were left longer than others Batching was holding the samples up Now: No batching FIFO lane and rating system Continual improvement, with an aim of processing all inpatient samples within one hour When complete, select the X in the upper-right corner to close this window and continue.Today KLMC has a single, thorough sort in specimen reception. Biochemistry/Hematology is given equal priority and no Microbiology/Immunology samples are transported to the core lab in error which delayed processing of these samples. Samples are no longer batched, labeling and booking are done at the same time and by the same staff, and samples don’t sit around partially processed. The process is less error prone as one person completes the entire process. Samples are transported up to the lab in smaller buckets instead of heavy transport bags making it easier for staff and enabling a First In First Out (FIFO) system. Previously there was no FIFO system in place so some samples were left longer than others. There is a tighter schedule due to turn around time where previously batching was holding up the samples. Now no batching, a FIFO lane and ratings system provides continual improvement with an aim of processing all inpatient samples within one hour.