Automated laboratory solution is catalyst for Lean change
Time savings gained at Leicester Royal Infirmary from sample processing efficiencies
A review of specimen reception and preliminary sample handling using ‘Lean’ principles has led to improvements in the processing of a daily workload of 11,000 samples at the Leicester Royal Infirmary (LRI) Pathology Department. The sample process step that used to take 4 hours 30 minutes has been reduced to 20 minutes and a previous build up of up to 1000 samples at any given time has been eliminated. What used to be a difficult-to-manage ‘push’ workflow is now an organised and simple ‘pull’ workflow.
The move to Lean working was initiated by a Managed Pathology Services™ contract with Siemens in the Biochemistry and Haematology Department to provide an effective, efficient pathology service to the Trust. This agreement saw the installation of an ADVIA® LabCell® Automation solution, which combines clinical chemistry, immunoassay, haematology and haemostasis into a single solution. The implementation of a ‘blood science track’ was in line with Lean principles and facilitated the consolidation of platforms and eliminated the duplication of sample management tasks. LRI redesigned its procedures to fully utilise these automation capabilities and by smoothing the flow of samples through the laboratory, it has been able to free up resources for sample management and other tasks.
Anne Freestone, Blood Sciences Laboratory Manager at Leicester Royal Infirmary comments, “This new Lean approach has changed the overall outlook of the laboratory; processes are continually re-evaluated and a whole ethos of change and innovation has taken hold. It was invaluable to have Siemens Healthcare Solutions as a neutral, independent partner, looking at the laboratory with a fresh eye, sharing experiences from other laboratories and supporting the Lean team throughout the process.”
After a preliminary process review, Siemens trained a team of six LRI staff members to evaluate the situation in detail using the Lean methodology tools: spaghetti, process and value stream mapping.
The spaghetti mapping process followed a typical sample on its path through the department, identifying the actions required for each sample, as well as tracking the movement of the sample around the laboratory. This technique highlighted that samples were undergoing approximately 12 to 14 separate processing steps. Due to the backlog of samples at any given processing station, this meant that there could be in excess of 1000 samples awaiting completion at any one time.
Value stream mapping followed a typical sample through the laboratory system, timing each stage and comparing ‘touch times’ – where the sample was actually being handled – with the waiting times between stages.
Through the Lean analysis, it was identified that a bottleneck of high volume, non-urgent work flooded in relatively late in the working day from the 180 GPs served by the department. Despite up to 20 staff members booking in and sorting the requests, samples were still not being transferred to the laboratory analysers in a timely fashion to meet guaranteed one-hour turnaround times for acute units such as A & E and ITU. A ‘sweeper’ system was therefore also introduced to reduce the movement of staff around the laboratory, which led to simplified sample logistics within the laboratory and created a steady stream of samples to the analysis track. Levelling the workflow also improved the efficiency of downstream processing and analysis, allowing the ADVIA LabCell to operate at higher throughput for a more prolonged period around peak times, without exceeding the platform’s capacity.
“The NHS is ripe for Lean attention as processes have evolved over a number of years. For many Trusts what started out as a little kernel of a problem ends up as a hugely complicated process to manage as additional systems have been added over time masking the root cause,” states Tracy Ellison, Head of Healthcare Solutions, North West Europe at Siemens Healthcare Diagnostics. “Lean methodology allows organisations to review exactly what is needed in order to provide patient centric services. Leicester Royal Infirmary did just that and is now benefiting from operating a fully Lean pathology department. A small amount of specialist help at the start clarified where the problem areas lay and the in-house team are now on the pathway of continuous improvement.”