Iovatios i the Cliical Laboratory A Overview of Lea Priciples i the Laboratory August 2007 This paper is based o the applicatio of Lea priciples withi operatios at Mayo Medical Laboratories.
Executive Summary Mayo Medical Laboratories is committed to providig cliets with high-quality laboratory testig which results i improvig patiet care ad employee safety. Oe of the ways this is accomplished is with the implemetatio of Lea maagemet priciples. Lea priciples ca be applied to ay orgaizatio that has a defied set of process steps that it follows to produce a ed product. Whether it is physical goods or a service, Lea has bee successfully implemeted i idustries ragig from maufacturig to health care. Lea is a systematic approach to process improvemet that focuses o the reductio ad elimiatio of waste, variatios, ad imbalace i the process. As this paper will describe, Mayo Medical Laboratories strived to accomplish the followig goals by usig Lea priciples: Improved operatioal performace (faster testig turaroud time, decrease i costs ad improved quality) Reduced variability i operatioal performace Operatios maagemet approach as a ed-to-ed disciplie Improved patiet ad employee safety Improved employee morale Reductio i developmet time for ew tests Reductio i testig defects ad errors durig ew test developmet ad implemetatio 1
History of Lea I 1913, the first iovator to truly itegrate a full productio process was Hery Ford. Ford used the priciples of stadard work tasks performed o a movig assembly lie to create what he termed flow productio. Wherever possible i the work flow, Ford lied up special machies with stop/go gauges that delivered stadardized pieces of equipmet directly to the assembly lie exactly whe they were eeded i the process. Ford revolutioized the maufacturig shop practices with this approach to assembly but his system lacked oe essetial compoet variety i the ed product. I the 1930s, Toyota perfected the Ford system by itroducig more cotiuity i the flow of the process that allowed for a wide variety i product offerigs. By itroducig some simple iovatios ad revisitig Ford s origial process, the Toyota Productio System was iveted. I terms of overall sales, Toyota is the leadig auto maufacturer i the world which leds credece to the success of Lea thikig. The iteret is overflowig with articles, Web sites ad books about Lea thikig. Lea thikig has bee embraced by may types of compaies aroud the world. I summary, Lea thikig is the idetificatio ad elimiatio of waste which allows maagers to pursue perfectio through cotiuous improvemet. Because of the quest for costat quality improvemet, Lea priciples are easily adaptable to the health care idustry ad have bee applied by may health care systems. Lea is a differet way of viewig ad approachig work. It is about developig a chage i the maagemet of the process ad lookig at process reorgaizatio. This is doe while itetly cocetratig o elimiatig redudat motio, recogizig waste, ad idetifyig what creates value from the cliet s perspective. Lea is a cotiuous process improvemet iitiative ad ot a ed destiatio. It is about allowig your process to flow ad cotiually strivig to improve the flow. The mai objective of Lea, whe applied i the laboratory, is to deliver quality patiet laboratory results, at the lowest cost, withi the shortest time frame while maitaiig cliet satisfactio. 2
The five Lea priciples as they apply to the cliical laboratory are: Value: Defie the value i the process from the cliet s perspective; value is that which the patiet or cliet would kowigly pay for or the attributes of a product or service (quality, speed of delivery, persoal attetio, etc.) Value Stream: Idetify the value stream for each process providig that value, challege the wasted steps, ad elimiate all of the waste that you ca Flow: Make the product or service flow cotiuously through the remaiig, value-added steps Pull: Itroduce a cotiuous flow of evets betwee all steps of the process where cotiuous flow is possible. I a well-defied pull system, the process lets you kow by iheret triggers whe somethig eeds to be doe ad the process maages itself Cotiuous Improvemet: Maage toward perfectio o a o- goig basis so the umber of steps, the amout of time, the scope of resources ad the iformatio eeded to provide the service to the cliet ad patiet is costatly uder scrutiy Implemetatio of Lea priciples ca icrease quality, throughput, capacity, ad efficiecy while decreasig cost, ivetory, space ad lead time. Ad, most importatly, it ultimately provides better patiet care. Lea is ot a acroym. It is called Lea because it is a descriptive process that uses less of everythig space, time, ivestmet i equipmet, ivetory, ad staffig resources. Lea is also kow by other ames, most otably Operatioal Effectiveess, Busiess Process Redesig, Flow, or as the history sectio describes the Toyota Productio System (TPS). 3
Lea Gettig Started Withi Mayo Medical Laboratories, whe iitiatig a Lea project, our emphasis is usually directed o the waste elimiatio. The first step is to perform a waste walk which etails direct observatio of the process while i productio i the laboratory. It takes this direct ivolvemet of activity to be able to see ad idetify the waste i the process. This direct observatio of the process is the simple part. The challege is to have the courage to idetify ad call it waste ad to istill the desire to elimiate it. Below are some types ad examples of waste that ca be foud i cliical laboratories: Types of Waste Defiitio Examples Potetial Causes Waitig Idle time created whe material, iformatio, people or equipmet is ot ready Waitig for: Tech or istrumet to become available Samples i a batch to complete testig System to come back up Excessive WIP due to large batches Equipmet problems Defects requirig re-work Push system Cliet or vedor respose Trasportatio/ Material Movemet Movemet of material or iformatio that does ot add value Samples travelig throughout the lab to be processed ad tested Carryig samples ad documets to ad from shared equipmet Takig files to aother perso Iefficiet workplace layout Large batches ad/or equipmet Islads of like machies istead of work cells Movig patiets for testig Over-processig Efforts that create o value from the cliet s stadpoit Uecessary testig due to overly sesitive istrumet Perform testig ot requested Repeated maual data etry Excess paperwork Redudat approvals Work silos No visual cotrols No stadard work Over icubatio or mixig of samples 4
Types of Waste Defiitio Examples Potetial Causes Ivetories More iformatio or material o had tha what is eeded at preset Lab supplies Specimes waitig aalysis Paperwork i progress Uused records i the database Log lead time for supply repleishmet Re-stock ad re-order ot cosumptio based Large reaget lot sizes Techs eed to reach to get more reagets or samples Layout of work area ill-plaed Motios/ Movemet Movemet of people that does ot add value Tech leaves work area to fid supplies Extra keystrokes or clicks o computer Gatherig tools No-ergoomic or uorgaized work cell desig Poor supply repleishmet pla Hadlig paperwork Defects Work that cotais errors, rework, mistakes or lacks somethig ecessary Failure to get the proper result o the proper patiet to the proper physicia Re-test, redraw or result revisio that could have bee avoided Data etry error Missig or iaccurate iformatio Missig or iaccurate iformatio Poor equipmet maiteace Froze sample thawed Work ot stadardized Duplicate work Sample itegrity compromised Overproductio Geeratig more iformatio tha what the cliet eeds right ow Upstream process step workig at a faster pace tha dowstream testig or aalysis process requires Testig ahead of time to suit lab schedule Ubalaced processes No visual cotrols or maagemet Push versus Pull system More iformatio tha the ext process eeds Re-prioritizatio Startig oe task, beig iterrupted (phoe, e-mail, page) ad chagig to aother task before the first task is completed Stat or priority orders Trouble-shootig Uexpected equipmet failure Equipmet prevetive maiteace lax Batchig model issues Mis-utilizatio of skills People see as a source of labor ad ot work process experts Improvemet ideas ot solicited No cotiuous improvemet culture Work area is uderstaffed Top-dow maagemet 5
After the iitial step of idetifyig the waste i the laboratory process, the secod step is to examie ad documet the curret system from start to fiish. This is kow as mappig the value stream. To scrutiize the as is system from ed to ed: Track the movemet of a idividual sample or patiet through the etire process Track the movemet of the people at each work statio Observe where the value for the cliet is beig created Highlight the wastes Break dow the time spet i each of the process steps Documet the curret state with a map, work balace chart ad spaghetti diagrams Idetifyig, documetig, ad reviewig the etire system for each testig process i the laboratory ca be a extremely tedious process but oe which is ecessary ad very effective because it almost always exposes eormous amouts of waste. Mayo Medical Laboratories realized early o i the applicatio of Lea priciples that if they did ot recogize waste ad maage the value stream to elimiate the waste, the results of their efforts would be mediocre. Figure 1. The Value Stream Map is a compoet of the Lea process that ca idetify, documet, ad review etire processes. 6
The third step i the applicatio of Lea priciples is to evisio the future state for the process with the waste elimiated. A Lea laboratory optimizes the whole value stream, from the time it receives a order util the test result is deployed ad the request is addressed. Figure 2. A compoet of the developmet of the future state map is to fid the right metrics to maage performace as the pla of actio is implemeted. A Typical Lea Project At Mayo Medical Laboratories, a typical Lea project starts out with the establishmet of a laboratory team. The laboratory team usually cosists of a supervisor, a lead tech, two or three people from the frot lies, a o-laboratory perso ad a experieced Lea leader. From the start, the commitmet from admiistratio ad upper maagemet to led their admiistrative support to the project is required. The team works with the service lie or a process matrix that has bee idetified for the Lea project. Key performace idicators are developed ad the baselie measuremets are documeted. At this stage, the team is traied i Lea thikig ad the umerous tools available for the project. Value stream mappig is performed to documet the curret state ad as the project moves forward the team is traied i other Lea tools as eeded (5S, chage maagemet, Pull/Kaba, flow layout, etc.). Oce the curret state is mapped out, a future state is documeted ad the implemetatio plaig ca begi. Executio of the pla is the ext step with the measuremet of the key performace idicators at the specified time itervals. Periodic follow up is performed which forms the basis for a cotiuous review of the process. 7
Summatio Overall, the reasos for applyig Lea methodology withi our laboratories are the same as what a cliet experieces. I the curret health care eviromet, the umber of potetial patiets cotiues to expad as the populatio grows older ad space i the laboratories is eeded to accommodate this growth. The cliical laboratory is facig a shortage of skilled professioals, ad the laboratory service level expectatios of cliets remais high ad is gettig higher. The improvemet actios implemeted from Lea projects have resulted i: Reduced batch sizes Staffig schedules matched to sample arrivals Stadardizatio of work processes with visual cues to help people stick with the stadard Reduced set up time for testig Root cause aalysis ad mistake-proofig to reduce defects due to huma error Improved operatioal trackig maagemet At Mayo Medical Laboratories, we focus o cotiually optimizig quality, patiet care, ad employee ad patiet safety. We are committed to excellet cliet service. We accomplish this by utilizig Lea processes to make cotiuous improvemets. 8
Cotributors iclude: Fazi Amirahmadi Al Dalbello Da Groseth Jea McCarthy There are various white papers available based o specific departmets at Mayo Medical Laboratories. Please cotact Mayo Laboratory Iquiry for laboratory specific Lea white papers. 9
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