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.

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