best practices in core lab design - executive · pdf file© ortho-clinical diagnostics,...

© Ortho-Clinical Diagnostics, Inc.

Best Practices in Core Lab Design

Will today’s designs meet tomorrow’s needs?

Steve Friedland

Director, ValuMetrix Services

2 © Ortho-Clinical Diagnostics, Inc.

Key Concepts—Core Lab Design

Healthcare Reform

Understanding Production Costs

Footprint vs. Workflow

Automation-Our Current State

Closing Thoughts


“By every measure, the clinical laboratory industry is

entering a high-stakes period during the next 24 months.

Powerful trends are reducing lab budgets and payers

are cutting the prices paid for medical laboratory

testing”.

Dark Daily

Future of Healthcare Reform

Source: [email protected] Apri l3, 2013

mailto:[email protected]


“You absolutely cannot make a series of good decisions

without first confronting the brutal facts.”

Jim Collins

Good to Great

Reference: Good To Great, Jim Collins Harper Collins Publishers, Inc 2001


Understanding Production Costs

What is the customer willing to pay for?

Make or buy?


Elements of Production Cost

Floor Space

Fixed Cost of Overhead

Labor

Capital

Maintenance

Supplies

Quality (rework and mistakes cost money)


Current State: Typical Core Lab

Typically we invest up to 80% of our space, labor and capital

resources on the core tests of basic chemistry, hematology

coag and urinalysis. Is this what the healthcare system of

the future will support?

Conventional wisdom and industry trends have been

towards systems that are taking ever more space, labor and

capital investment.

Will healthcare reform require us to create a new paradigm

as these basic tests receive lower reimbursements or

become part of a bundled network or ACO payment?


Bending the Cost Curve: Core Lab of the Future

Should we be designing systems that produce these basic test

results in the smallest amount of space with the least

investment in labor and capital equipment?


Footprint vs. Workflow

If the lowest possible production cost is the goal….

What needs to change?


Traditional Laboratory Design

Traditional lab design has been footprint-based for

decades

– Typically, each department or functional area has a dedicated

and separate space for instruments and operators

Departments have a supervisory or management

structure based on function

New instrument placement is based on infrastructure

– Available floor space

– Available plumbing and electric

– Proximity of device to like methods or operators

– Automation – move everything out of the way


Traditional Lab Layouts = Waste

Not asking the people who

perform the process

Transportation Inventory Motion Waiting

187 feet

11 touches

Long travel distances for

specimens

More supplies than

needed Technologist walking to find

materials and supplies

Specimens waiting to be

processed

Over Processing Overproduction Defects Intellect

Duplicate tracking with paper

and bar code scanner Drawing extra tubes Batch receiving requires matching

of labels to specimens and

increased error potential

Source:: ValuMetrix Capabilities Presentation


Structural Layouts Drive Waste

Source: ValuMetrix Capabilities Presentation, typical lab layout


Current State

COAGULATION

CHEMISTRY IMMUNOASSAY HEMATOLOGY

TOX/TDM

SPECIMEN PROCESSING

Olympus

Olympus

Source: University of North Carolina Hospital


Current State of Lab Automation

What will it do for my lab?


Typical Goals of Automation Projects

Labor savings

Reduced manual operations

Service line expansion (with no new resources)

Error reduction

Instrument consolidation

Free resources for higher value opportunities

Be “modern” or keep pace with industry


Common Pitfalls of Automation Projects

Bottlenecks can be hard wired

– Sort and pick on front end

– Centrifugation – large batch and lock outs

– Sorting hematology can slow down chemistry

– Hard to flex staff and instruments if peak demand exceeds

automation capacity

Handling Exceptions

– Stats, short samples, peds neonates, interfering substances

– Coag – sample integrity while riding the track


Automation Footprint Options

Linear

Loop

Parallel Lines


Linear

NOTE: Depict rough scale of equipment layout; and, draw a point to point diagram of the complete product flow Distance Traveled: 446 FEET

Source: Continuum Health,

Product travel = 446 ft

Operator = 5 miles day

• Travel distance and walk patterns


Automation Layout: Loop

• Poor use of prime lab real estate

Source:: MedStar Health


Automation Footprint: Parallel Lines

O U T R E A C H

F A C I L I T A T O R

3 6 H

3 6 H

3 0 H

P C

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D R

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F I L

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P R I N T E R A B O V E

F L A T P C

K A Y


Front End Options?

Voice of Customer

– Out-Patient / reference

– In-Patient Turn Around Time expectations

– Morning run – results on floor by what time?

– Expectations for stats?

Exception Handling

– Stats

– Short samples

– Peds

– Neonates


Front End: Typical Front End Sorter

13.3 avg time PTS to sorter

2 – 32 min - max

21.6 avg time on sorter

17 – 28 min - max

17.3 avg time – load & fuge

14 – 25 min - max

7.2 avg time - wait to analyzer

1 – 17 min - max

95.7 avg rec-res TAT

62 – 143 min - max


Exception Handling


Flow of Specimen and Operator

Some Common Barriers To Flow


New Instrument Does Not Connect Off Peak Operator Walk Patterns

Distance Traveled

330 ft. in 10:04

3.0 miles in 8 hours!

Walk 22.5 % time… 1.8 hours!!!


Potential Hidden Costs of Footprint Designs Can’t meet customer demand?

– Redundant stat operations

– Ancillary labs

– POC testing

Flexibility

– Cost of change

– Adding menu or devices

– Product and operator flow during off peak times

Capital

– High capital investment

– On-going maintenance

– Floor space

Labor

– Job functions shift but no reduction


Layout is Critical

Rule 1:

– It is difficult or impossible to overcome a poor layout.

Rule 2:

– Focus on devices over work processes always adds time and

cost.

Rule 3:

– Cost of change can be significant and is frequently overlooked.


In-Cycle / Out-of-Cycle Work

In-Cycle Work – any specimen that flows through the layout

in a defined time without wait time, interruptions or human

intervention.

Out-of-Cycle Work – Any specimen that requires

intervention or that will compromise in-cycle production time.


Case Study

Marquette General Hospital

Marquette, MI


Pre-Lean Layout NOTE: Depict rough scale of equipment layout; and, draw a point to point diagram of the complete product flow Distance Traveled (feet):

Distance Traveled (meters):

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Due to the initial location of the lab automation system, operators and product

were forced to walk around the loop creating bottlenecks and adding to process

time for some sample types.

automation

Source: Marquette General Hospital, Lean Case Study


New Design: Lean Core Cell Layout

UA

One operator to run 85% to 90% of ALL tests in

the Core Lab (not just chemistry tests)

Heme

Coag



Removing Barriers

85-90% Automated Testing Cell

Before Lean After Lean



Lean Impact: Creating Flow

Before Lean After Lean



Continuous Improvement: Reducing Variations

MGH - Turn Around Times



Lean Project Metrics1

•*2 Reallocated to client services

•2 loss through attrition

METRIC CURRENT

STATE FUTURE STATE* IMPROVEMENT

Out-Patient TAT 178 minutes 57 minutes 68%

In-Patient TAT 88 minutes 44 minutes 50%

In-Patient TAT

Stat 67 minutes 36 minutes 46%

Floor Space 3400 ft^2 2900 ft^2 500 ft^2

Labor 32 FTEs 28 FTEs 4 FTEs*

Annual Overtime $71,000 $24,000 $47,000

1. Data on file. ValuMetrix® Services Case Study


Operator and Product Flow

MGH Final videos\Operator Flow-YouTube sharing.mp4

MGH Final videos\Product FlowAPRIL25YouTube

sharing.mp4

MGH Final videos/Operator Flow-YouTube sharing.mp4





MGH Final videos/Product FlowAPRIL25YouTube sharing.mp4





Closing Thoughts

Future Core Lab designs will require a significant paradigm

shift

Design always starts with Voice of Customer - VOC

Workflow first – footprint becomes an outcome of workflow

Automation – where it fits the workflow and meets demand

Learn to evaluate all elements of cost

Fewer resources for high volume basic core tests

Understand the cost of change

Human resources - View people as creative problem solvers


Thank You!

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