Leaning Toward Laboratory Efficiency Online Training
Describe the Lean methodology. Differentiate the common tools used for process and quality improvements. This clinical laboratory training qualifies for continuing education units (CEU).
Welcome to the Leaning Toward Laboratory Efficiency Online Training course. This course will provide an introduction to Lean methodology. Clinical laboratories in particular have found Lean to be extremely helpful in meeting their goals for efficiency, throughput, quality, and productivity. Select Next to continue. This course was created by: Maricel Roberts, Director of Healthcare Solutions North America Lean methodology: Elimination of waste and identification of value stream Increase productivity, efficiency, and quality Lean manufacturing: Lean process: eliminate waste Hardware: eliminate non-value added tasks Plant: layout must minimize motion and transportation Why use Lean in healthcare? Today’s environment demands high quality and efficiency Lean has been proven to increase quality and safety Lean dramatically increases throughput, productivity and efficiency A Lean culture is one of continuous improvement Preliminary questions and actions: Prior to taking action, thoroughly analyze the situation Answer the “who”, “when”, “what”, “why”, and “where” questions Value Stream: All of the actions that take place to bring a product or service to completion 8 deadly wastes: Overproduction Inventory Misused resources Defects Waiting Over-processing Transportation Motion A process: Input ⇒ Series of activities ⇒ Output Process mapping: Identify and sequence all activities of a process in a flow chart or graph Value Stream Mapping: Illustrate material and information flow in a process and classify each step as value-added or non-value added Value-added: Action increases market form or function of the product or service; the customer is willing to pay for the change Non-value added: Action does not increase market form or function; the customer would not be willing to pay for the change Process Improvement: Identify, analyze, and improve a process using a proven methodology Goals: decrease number of steps, increase throughput, decrease errors (= increase quality, safety, productivity, efficiency, continual improvement) Analytical solutions: Leveling workload: Smart routing, point-in-space sampling Reduce wait states: Automated centrifugation Short sample management: Level-sense sample probes Instrument layout: Equipment designs to improve line of sight and efficient configurations Result management: Auto-repeat, auto-dilution, auto-reflex testing; single operator interface Balance technical with culture: Balance tools and methods with the human aspect of change Reasons for process improvement: Initiative fatigue Poor project selection, definition, or scope Poor understanding of customer needs or issues Poor communication Senior management fails to lead or is impatient for results Lack of stakeholder involvement Teamwork: Essential element for success Team identity, collaboration, common goal, and frequent meetings make a team more than just a “group of people” Lean Tools: Kaizen Event: Definition: Kai: “take apart” and Zen: “make better” Focused and rapid identification of root causes Focused and rapid implementation of improvements Also known as: Kaizen Blitz, Kaizen Breakthrough, or Rapid Improvement Event Visual Controls: Easily see what is happening Examples: shadow marking, colored labels for STATs Kanban: Materials flow tool that signals upstream operations in a process to deliver what and how much is needed when it is needed. Increased stays Overtime Bottlenecks and processes Threats to hospital business Increasing equipment and Reagent costs Repeated tests Inaccurate results Missed goals Physicians demanding more tests Longer ER wait times Specimen routing within laboratory Late results Timely specimen arrival Correct staffing levels Labor: right people at the right time Decreasing budgets High stress levels Shortage of qualified labor Upon successful completion of this course, you will be able to: Describe Lean methodology Identify key Lean concepts Describe the value stream Identify the purposes of some common Lean tools Select Next to continue. Lean is a systematic approach to continuous process improvement that identifies the value stream and focuses on eliminating waste. Key Considerations Instrument Selection/Automation Process Hardware Plant Significant Challenges Need to improve safety and quality Capacity constraints and queues Cash flow crisis Drive to improve efficiency Improve and maintain staff morale Achievements: Improved quality and safety Increased efficiency and productivity Improved throughput Continuous improvement Prelimary Questions Who? When? What? Why? Where? Who?: Who is affected? Who else? Who says it is a problem? Who would like a solution? Who could prevent a solution? Who needs it solved more than you? When? When does or when does it not occur? When did it or did it not appear? When do people see or not see it as a problem? When is a solution needed? When might it occur again? When will it get worse or better? What? What was done previously with similar issues? What principles underlie it? What values underlie it? What problem elements are related? What assumptions are you making? What is most important about it? Why? Why is this situation a problem? Why do you or why do you not want to solve it? Why would someone want or not want to solve it? Why does it not go away? Why is it easy or hard to solve? Where? Where is the problem most or least noticeable? Where else does it exist? Where is the best place to begin looking for solutions? Where does it fit in the larger scheme of things? “A representation of all activities required to deliver a product or service from request to delivery.” Source: The Lean Healthcare Pocket Guide, 2006, p. 189 Over production Inventory Misused Resources Defects Waiting Processing Transportation Motion Over production Inventory Misused Resources Defects Waiting Processing Transportation Motion Large batches of work Examples: Numerous samples from one patient Barcode labels Reagents Results awaiting validation Examples: Samples Reagents Patients Staff Instruments Work to arrive in laboratory Examples: Unnecessary movement of materials Layout of laboratory Location of pathology in relation to other clinical environments Multiple drop-off points for samples Accessioning areas in wrong place Placement of equipment Examples: Sorting or resorting of samples Over inspection Labeling and relabeling A problem occurred once; therefore we added extra steps “just in case” it might happen again Examples: Stock: Poor ordering systems Poor supplier processes Role of Just-In-Time Time Obsolete equipment Examples: Walking Hand movements What is the best practice at every workstation “a place for everything and everything in its place” When the service does not meet customer expectations… Turnaround time Wrong result Wrong sample Wrong tube Examples: Highly qualified staff labelling and centrifuging samples Clinical scientists performing clerical tasks Overproduction Excess Inventory Defects Excess Motion A sequence of operations (consisting of people, machines, materials, and methods) for the design, manufacture, and delivery of a product or service. Input Laboratory specimen and request form Activity Laboratory specimen preparation and analysis Output Laboratory specimen report “Techniques to identify and sequence all the activities making up a process. Usually the output is in the form of a flow chart or diagram. Used to identify where improvements can be made and to model proposed changes and new process designs”. All the actions (VA +NVA) required to bring the product through the main flows essential to every product. Source: Learning to See, Rother and Shook, 2003, p. 3 Value added: Any activity that increases the market form or function of the product or service. Typically 1-2% of entire process time. Non-value added: Any activity that does not increase market form or function or is not necessary. Necessary non-value added activity can be classified as enabling or incidental: maintenance, calibration, quality control. Manual logs Phone calls Inventory and ordering Restocking Sample splitting Specimen retrieval Manual archiving Manual dilution and reruns Process improvement is a series of actions taken to identify, analyze, and improve existing processes within an organization to meet new goals and objectives. The actions often follow a specific methodology or strategy to create successful results. Throughput Errors Pre-analytical Analytical Post-Analytical Concerns Leveling of workload Management of Short Samples Management of “wait states” in centrifugation Instrument layout Management of panic or repeat testing Solutions Smart routing Automated centrifugation Point in space sampling Level sensing Line-of-sight and co-location Single operator interface Source: David Hamer, Blood Sciences Service Manager, Bolton Hospitals NHS Trust Implementing Lean in Pathology 18th June 2008 Technical Cultural “Tools” “People” Technical Cultural Extensive use of “tools” Use of Japanese terms and concepts Some processes made more efficient Lean belongs to a few enthusiasts Failure to embed or spread Resistance to change Results not sustained No overall transformation Technical Cultural Failure to establish flow Lack of rigor in use of tools Lean “speak” without true understanding Full potential not realized Temporary feel good factor created Better team working Increased levels of involvement But hard to sustain without results Why projects fail… Initiative fatigue Poor project selection / definition / scope Lack of understanding of customer issues Poor communication Lack of senior management leadership Senior management impatient for results Lack of involvement of stakeholders, especially the process members Characteristics of a team Common goal or purpose to pursue Collaboration and coordination of activities Regular and frequent interactions An identity distinct from members’ individual identities Source: Lean Speak 2002 Kaizen event Visual Controls Shadow marking Kanban Continuous Improvement Definition Kaizen Definition Often used interchangeably with Kaizen: “An approach to operations improvement that stresses the importance of generating continued momentum for improvement via many small increments. For some organizations it is a philosophy that underlies all aspects of management. It embraces techniques such as team-working, and use of appropriate problem-solving tools.” “Kai” means to “take apart” and “Zen” means to “make good”. Kaizen is synonymous with Continuous Improvement. A Kaizen event or blitz is a focused group of individuals dedicated to applying Lean tools to a specific area within a time period. Source: OUBS, Improving Operations, 2006 p107 Shadow Marking is an example of Visual Control or Visual Management Tools which are based upon the notion that… When Visual Management is used time is not wasted, nor is energy or effort looking for things, people, or defects. You can easily see what is happening, and whether things are running according to plan or not. They are simple and standardized. Should be sensory: color, lights, sounds, visual cues or space. Shadow Marking Before and After: After Before Definition: Simple devices to control flow of materials through a process under “pull” process control, such as “just-in-time” approaches.