Leaning Toward Laboratory Efficiency James Scott Nelson Page 1 2010 Siemens Healthcare 2009 Siemens Diagnostics. Healthcare All Diagnostics rights reserved Inc.
Today s s Roadmap Laboratory Operational process Value vs. Non-Value Activity Lean and Six Sigma Concepts and Tools Why Automation Lean Outcomes 2
Fundamental Law of Automation Quotations It is important to recognize that instruments and automation, at their best, do not resolve or fix process issues. You must first optimize processes before fully automating those processes, otherwise, you have simply automated to the highest order those bad processes. Page 3 2010 Siemens Healthcare 2009 Siemens Diagnostics. Healthcare All Diagnostics rights reserved Inc.
Clinical Lab Production Process In many ways, the Lab is similar to a manufacturing plant Raw Materials Process Oriented 24/7 Production with Priorities The Lab s Product is INFORMATION 4
The Diagnostic Process Continuum Post-Analytical pay invoices order supplies manage inventory store samples dispose of waste post-sort transmit test results technical validation Pre-Analytical prepare order collect sample transport to lab accession sample centrifuge decap tubes pre-sort/aliquot transport to analyzer Targets for Automation 5 Analytical
Lean Versus Six Sigma Six Sigma Lean Focus on standardization, Reducing variation PROBLEM FOCUSED Culture Driven by Data Focus on eliminating waste, Reducing redundancy FLOW FOCUSED Culture based on Behavior He Who Touches Least Wins! 6
Value Added vs. Non-Value Added What Is Your Customer Willing to Pay For? Value Added Any activity that increases the market form or function of the product/service. Typically 1-2% of entire process time. Non-Value Added Any activity that does not add market form or function or is not necessary. (These activities should be eliminated, simplified, reduced, or integrated.) Necessary non value added activity: enabling or incidental. (Examples: maintenance, calibration, quality control) 7
Non-Value Added Activities Sample Splitting Specimen Retrieval Manual Archiving Manual Logs Manual Dilutions and Reruns Calibration Maintenance Quality Control Inventory, Ordering Labeling, Stocking 8
Sources of NVA Waste Excess Motion Transportation Over- Processing Underutilized People Waiting Defects 9
Lean Tools 5S Value Stream Mapping Flow Charting Continuous Flow Kaizen Events Kanban Layout: Floor Plan Concepts 10
Lean 5S System Foundation for the Lean Process Organizing the Workspace Based on 5 Japanese Words Sort (Seiri) Sustain 5 1 Sort Set in Order (Seiton) Shine (Seiso) Standardize 4 5S 2 Set Standardize (Seiketsu) 3 Sustain (Shitsuke) Shine 11
Automation Assessment Goal is to Eliminate Waste Define each step from collection to released result Evaluate the impact to each step for TAT, labor, and quality Determine which steps can be shortened or eliminated Evaluate & Apply solutions that Optimize Processes Accession Centrifuge De-Cap Sort Transport Analyze Review Sort Store Add On 12
Operational Process - Flowchart Value Stream Map Specimen Post Analytical Analytical Accessioning Processing Specimen is Delivered by Courier Initial Inspection and Sort Milk Run Specimen Pick-Up (15-20 Min) Retrieve Samples From AutoLab in GLOP Visually Inspect Samples and Sort by Fill Level Samples Delivered to AutoLab for Sorting or Storage Microbiology Cytology Frozen Urine Serum/Plasma Deliver GLOPs to AutoLab Un-Spun/Aliquot Specimens to Processing Bench Full Tube 17.5 sec/sample Short Filled Tube 60% 27.5 sec/sample Un-Cap Specimen Un-Cap Specimen More Testing on Another Instrument Storage Re-Test Atlas Req. 45% 25 sec/accn Manual Req. 55% 78 sec/accn Aliquot Procedure 24 sec/accn Centrifuge Procedure 10.5 sec/accn Place Specimen in Instrument Rack Pour Sample into Short Sample Cup GLOP Tubes Together Retrieve Specimen Basket Retrieve Specimen Basket Pick up New Rack Carry Specimen Rack to Centrifuge Has Tube Been Scanned for Storage? Specimen Labeling 42 sec/accn Inspect Analyzers for Open Rack Position Place Specimen in Instrument Rack Scan Barcodes YES NO Remove Req. from Bag Remove Req. from Bag Retrieve Specimen Basket Remove Label from Top of Tube Load Centrifuge Place Instrument Rack on Analyzer Inspect Analyzers for Open Rack Position Type Accn into Computer to Locate Print Tracking Sheet Search Racks for Specimen/AutoLab for Samples not Scanned Input Lab Order # Input Patient and Test Info. Remove Req. and Labels from Bag Place Label on Record Sheet and Initial Centrifuge Samples Visually Inspect Req. for Correct Info. Visually Inspect Req. for Correct Info. Analyze Samples Place Instrument Rack on Analyzer Place Rack and Tracking Sheet in Storage Area Inspect for Tube Type and Quantity Prepare Aliquot Tube and Label if not Previously done YES Un-Load Centrifuge Retrieve Sample Unload Instrument Racks Analyze Samples Inspect for Tube Type and Quantity Print Apex Labels Match Labels to Tubes De-Cap Specimen Re-Rack Samples Unload Instrument Racks Empty Racks when Expired Enter Tube Type and Quantity Place Label and Req. Back in Specimen Bag Place Labels on Tubes Place Bag in Basket for Labeling Pipette Specimen to Daughter Tube Carry Specimen Rack to Processing Bench Remove Tubes from Instrument Racks and Place in GLOP Print Apex Labels Label Daughter Tubes Need Aliquot? Pour Short Samples into Primary Tubes Place Label and Req. Back in Specimen Bag Place Labels on Top of Tubes to ID Aliq. Re-Cap Specimen and Daughter Tube Re-Cap Tubes Place Bag in Basket for Labeling Place Label on Record Sheet/Initial Place Tubes in GLOP NO Carry GLOP to AutoLab for Sorting or Storage Sort and Rack Tubes for Aliquot, Centrifuge, AutoLab Carry GLOP to AutoLab 58 Processes/Steps Review Results of Samples NOT Autoverified 13
Current Pre-Analytical Process 14
Automated Pre-Analytical Process 15
Ideal Process-Continuous Flow: Receive in Lab Sort Spin Sort Decap/ Aliquot Deliver to Workstation Analyze Specimens Report Results 16
Actual Specimen Process Flow Receive In Lab X Wait Sort X Wait Deliver to Workstation X Spin X Wait Wait Decap/ Aliquot X Wait Analyze Specimens Wait Report Results 17
Current Processing Steps Tubes received in Processing Placed in rack, spun and unspun together Rack walked to chemistry Tech re-sorts samples Unspun samples laid on counter Tech opens centrifuge Spun samples read individually If only Aeroset, placed in first rack Walks rack to Aeroset If only AxSym, placed in second rack Walks rack to AxSym If multiple analyzers, tech writes notes on tubes, places in first rack 18 After tech runs, takes samples to AxSym/SO After tech runs, takes samples to SO
Processing Efficiencies Tubes received in Processing Placed in rack, spun and unspun together Rack walked to chemistry Let automation SPIN DECAP SORT RESEAL RE-SORT All chemistry samples placed on StreamLab Analytical Workcell 19
Current vs. Automation Platforms TAT Variance 62% TAT Variance 6% 20
Automation TAT by Hour 21
Floor Plan Concepts IN/OUT Bench Design Consolidated Platforms/Workstations U or L Shaped Instrument Placement Automated Cells 22
Current Floor Plan Copier BD Inc 23
I nc Inc S T U A S T A I N BD I nc O S Laboratory Rearrangement 24
Floor Plan Concept 25
Documented Lean Automation Outcomes Cycle Reduction Consistently Meeting TAT Goals Increase in Productivity Fewer FTE s/reportable Increased Testing Capacity Reduction in Defects Reduction in Space Requirements Reduction in Distance Traveled Process Improvements Work Cell Redesign Equipment Placement Instrument Consolidation 26
In Conclusion Open Communication Across Departments Employee Involvement In the Process Willingness to Think Differently INVOLVES A CULTURE OF CHANGE Management Must Be Visual and Supportive 27
LEAN is a Process, Not an Event Always Look To Improve Your Process Understand Why You Do What You Do Position for Success & Growth 28
Thank you for your time! It is not the strongest of the species that survives, nor the most intelligent. It is the one that is most adaptable to change. Charles Darwin 29