supercharging histology workflow - lab quality confab · staffing shortages increasing ... to...

Supercharging Histology Workflow

Kelsi Currier, MPHWorkflow Consulting SolutionsVentana Medical SystemsSeptember 2009

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Today’s Learning Objectives

• Be able to pinpoint patient safety RISKS in your AP lab

• Understand how your AP lab can unlock major GAINS with Lean methodologies

• Explore value of automation and workflow changes in the AP lab – a CASE STUDY

• Discover new solutions to move from planning to execution to create the AP lab of the FUTURE

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Ventana Medical Systems, Inc.

• Over 1,200 employees across North America

• Fully integrated commercial operations, manufacturing, research and development in Tucson, AZ

• 95 patents issued and pending

• 6,000+ systems installed in 2,000+ labs across 33 countries worldwide

• 24% annual growth

• Acquired by F. Hoffmann-La Roche in early 2008

• A division within Roche called Roche Tissue Diagnostics

Born from a relentless search to find a better and faster way to diagnose the patient

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Ventana Leads in Tissue-Based Diagnostics

• Superior workflow solutions in both automation and information systems

• A proven track record of innovation, execution and patient centricity

• Strong research and development investment

• World class capabilities in core technologies

• Unparalleled partnerships for next generation companion diagnostics

• Passion for improving standard of cancer patient care

“We will not rest until every cancer patient receives

the access to information, therapy options and

individualized care we know is possible.”

- Dr. Thomas Grogan

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Continuous Innovation for the AP Lab

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Workflow Consulting Servicesa safe, effective, efficient lab

Patient Centric Solutions

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Vantage & Advanced Workflow -Powering the Total Solution

The only complete lean workflow solution that maximizes lab productivity and patient safety

•Turnkey lab improvement solution, including lean six sigma consulting

•Streamlines laboratory workflow

•Provides positive identification, with one label for the entire lab

•Enables advanced, active tracking and reporting

•Integrates Ventana products, multiplying customer value

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Risks of Status Quo

99

22 33665544

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10

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• Overcalling

• Missing diagnosis

• What do you see in your lab?

High Potential for Human Error

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High Potential for Human Error

• Misidentification of slides/cases

• Tissue floaters

• Redundant data entry

• Handwritten logs/manual information collection

• Labeling/re-labeling

• Batch processing

• Non-standard work practices

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Media Focus on Lab Safety

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Journals Focus on Lab Safety

2-week study in histology:

• Nearly 30% of cases had manual rework: 159 hours; 1.3 FTEs

• 89% of defects were made in the analytic phase

• 2% misidentification rate; 67% of those in slide labeling

– All could have been avoided with an integrated identification system

Source: Am J Clin Pathol 2007; 128 p423

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Declining reimbursement

Staffing shortages

Increasing regulatory requirements

Mounting competition from consolidation

Consumer demand for rapid turn on results

Higher test volumes; more diverse test mixes

Market Forces

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Getting It Right…

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Lean Methodologies Unlock Major Gains

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Lean Moves Labs to the Next Level

• Improves patient safety– Reduce errors

• Improves efficiency and reduces costs– More capacity– Better staff productivity– Reduce wasteful activities– Save time and steps– Happier staff

• Improves experience for your cancer patients– Faster turnaround times– More reliable results

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Case Study - A Midwest Reference Lab

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Case Study - Change Readiness Assessment

Workflow Consulting Solutions is a catalyst for change.Assessment tool measure dimensions for change management.

How widely acknowledged are the risks of the status quo?(Quality, Patient Safety, Productivity)

1 10High Recognition Low Recognition

How widely acknowledged are the risks of the status quo?(Quality, Patient Safety, Productivity)


What is the level of severity if the change fails?(Strategic Alignment, Lost Opportunity, Loss of Credibility)

1 10Not a Big Deal Very Severe

What is the level of severity if the change fails?(Strategic Alignment, Lost Opportunity, Loss of Credibility)

1 10Very Severe

How big is this change for the organization culturally and in general?(Day to day work activities, Decision making, Logistically)?

1 10Minor Changes Major Changes

(Day to day work activities, Decision making, Logistically)?

1 10Major Changes

How much are the benefits of this change recognized by those involved in the change?(Cost Reduction, Employee Satisfaction)


How much are the benefits of this change recognized by those(Cost Reduction, Employee Satisfaction)


X

X

X

X

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• 80+ hours on-site with team – Involve leadership and establish accountability

– Observation and determine current state baseline

– Identify opportunities via Voice of Customer

• High level of engagement to ensure team embraces change

• Leverage expertise across Ventana

Case Study - A Two Way Partnership

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Steps to a Safe, Efficient, Effective Lab

1. Observe and record

2. Reduce or eliminate non-value added activity by mapping the flow of work through the lab

3. Map current workflow process and design future state

4. Engage team in change management to implement improvements

5. Prioritize opportunities for continuous process flow improvements

23

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Case Study - Current State Process Flow

Facts:

• 1000+ slides/cases per

day

• 17 FTEs

• 3 shifts

Facts:

• 1000+ slides/cases per

day

• 17 FTEs

• 3 shifts

24

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fa c i li ty G r o u p

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R e q s

1 8 0 0 s

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g o o d s ta in

4 5 s

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w i th b o a rd e d c a s e s

3 0 0 s

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n e c e s s a ry

6 0 s

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in C o P a th

6 0 0 s

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s lid e s

6 0 s

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T r a c k in g s y s te m

4 5 s

S c a n c a s s e t te s in t o T r a c k in g

s ys te m

5 s

P r in t B C 'd s l id e la b e ls

f ro m m ir o to m y

p r in te r

5 s

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t r a y

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S t a r t

S t a r t

Initial opportunity:

• 26% of TAT - reduce non-value adds• 20.57 hrs - reduce manual logging• $174,613 potential savings

Initial opportunity:

• 26% of TAT - reduce non-value adds• 20.57 hrs - reduce manual logging• $174,613 potential savings

Case Study - Future State Process Flows

25

Customer

Accessioning

Total C/T = 53.6 minutesValue Add: 6.2 minutes

1

Case Assembly

Total C/T = 253 minutesValue Add: 0.8 seconds

2

Cerner Co Path

Hospital grossed

cassettes

Information

Information

HospitalDoctor Client Specimens

372 seconds

53.6 minutes 60 minutes

210 seconds

184 minutes 90 minutes

44112 seconds


120 seconds


48 seconds

52.6 minutes 3 minutes

200 seconds


0.8 seconds

253 minutes Lead Time = 2120 minutes

VA / T = 45063 secondsRM = 0 secondsWIP = 2120 minutesFG = 0 secondsWork Balancing

Grossing

Total C/T = 184 minutesValue Add: 3.5 minutes

460 minutes

Tissue Processing

Total C/T = 740 minutesValue Add: 735 minutes

390 minutes

Embedding

Total C/T = 159 minutesValue Add: 2 minutes

45 minutes

Microtome

Total C/T = 52.6 minutesValue Add: 0.8 minutes

460 minutes

H&E Staining

Total C/T = 66.9 minutesValue Add: 60 minutes


Mysis LIS

PRL Hospital CoPath

IHC

Total C/T = 426 minutesValue Add: 200 seconds

1

Specials

Total C/T = 133 minutesValue Add: 30.4 minutes

1

1 minutes

1 minutes

5 minutes

5 minutes

Bottleneck areas>270 Min of Wait Time!

Use Lean and Six Sigma tools to systematically uncover non-valueadded activity/ways to maximize lab productivity and safety

Case Study - Identify Value System

26

Assumption: 17 people25 movements per person per day

Step Dist.

Receiving / Acc 225 ftGrossing / TP 25 ftEmbedding 120 ftMicrotomy 75 ftH&E Staining 120 ftDistribution 150 ftIHC and Consults 160 ft

Total905 ft

Grossing

Gross Staging

Area Cytology

Receiving Area

Slide Distribution

Desk

H & E Staining and Cover slipping

Special Stains

Embedding

Embedding

Microtomy

Microtom

y

Microtom

y

Microtom

y

Histology Supervisor

Office

ImmunoStaining

Totals:~ 58,125 ft / day ~ 11.1 miles / day ~ 3,176.6 miles / year

Case Study - Streamline Movements Current State Floor Plan

27

Case Study - Future State Histology Lab

Cut miles/yr in half!

28

Case Study - Reduce Manual Log Creation

Work Station Hours Associated CostAccessioning 3.97 $34,062Grossing 2.77 $23,737Embedding 1.30 $11,154Microtomy 0.87 $7,464H&E Staining 2.98 $23,981Immuno Staining 2.30 $19,447Special Staining 1.00 $8,580Case Assemble 5.38 $46,188

Total 20.57 $174,613

29

Process Steps Current State Future State minutes

Accessioning 53.6 11.5Grossing 183.7 31.8Tissue Processing 739.8 739.8Embedding 158.6 57.7Microtome 52.6 15.4H&E Staining 66.9 46.3IHC Staining 426.0 410.8Special Staining 133.1 117.9Case Assemble 252.7 188.9Total Time 2067 1620

Cycle Time saved 447 minutes7.4 hours $63, 492

Case Study - Reduce Cycle Time

30

Case Study - Reduce Overtime

Improvement Gains

• Current State Cycle Time in Accessioning: 29 minutes

• Future State Cycle Time in Accessioning: 11.5 minutes

• May Eliminate Over Time: 65.5 hours /pay period or $51,090/yr

31

Case Study - Improve Patient Safety

Akro-Mils Bins with Intersecting Dividers

Patient Safety Risk!


Bar Coding

32

Case Study - Improve Patient Safety

Optimize workspace to reduce crowding



Automation

33

• Total Personnel Interviewed: 11• Key Themes Reported

in order of popularity with staff1) Workflow assessment (across total flow

and individual work cells) for alignment of Lean processes

2) Tracking/bar coding need (internal and external)

3) Leadership involvement and communication increase

4) Redundant/excessive paperwork5) Space increase needed

“Staff need more efficient workspace,

better communication from management,

more physical space in which to work, and less turnover in key

roles.”

Case Study - Voice of the Customer (VOC)

34

Case Study - Impact Summary

No. Process Improvement Process Step Priority Lean Improvement Concept

1 Elimination of Handwritten slides Microtome High Waste Reduction

2 Bar Code Tracking, Data / Quality Management Histology

High Waste Reduction

3 Eliminate / reduce log creation and management of paper work Histology

High Waste Reduction

4Redesign of laboratory

Histology High Visual Workplace, Workcell design

5 Improved Automation of H&E Stainer - H&E High Wait Time Reduction

6 Install Metric Board - Key Performance Indicators General High Visual Workplace

7 Additional Tissue Processors Tissue Process

Medium Wait Time Reduction

8Review/Update Standard Work

Grossing, Microtomy, Distribution

Medium Standard Work

9Courier Routing Optimization

Receiving and Distribution

Medium Wait Time , Batch size Reduction

10Initiate 5S Concept Histology

Low Visual Workplace

11 Runner to transport resources in the lab Histology Low Wait Time Reduction

35

Reduce TAT26%

LoggingSavings

$174,613

OvertimeSavings$51,090

Bar CodingSavings$63,492

Annual Savings$289,195

Case Study - Reference Lab Opportunity

• Improved safety

• Higher employee

satisfaction

• Better patient

experience

• More competitive

lab

36

Using Lean to Create the Lab of the Future

37

Lean Transforms AP Lab Performance

QuickerresponseQuicker

response

Greater flexibilityGreater flexibility

Better qualityBetter quality

Increasedvalue

Increasedvalue

38

Lean Keeps Focus on Execution

• Lean Six Sigma is established as a continuous, cohesive way of working (not a project)

• Leadership is on board and governance is in place; both are aligned to systematically review and improve business process

• Lab staff participate in establishing accountability and chain of command at the onset of Lean Six Sigma

• Teams are focused on business process, not just tools for improvement

• Emphasis is on culture change to sustain improvement

39

Greatest Challenge is Execution!

Process improvement leads to cost reduction…

Execution leads to quantum leaps in competitive advantage and long-term financial benefits

40

Better equipment

More Sophisticated Testing

Improved Patient Safety

More Reliable Information

Automated Work Processes

Greater Efficiency, Effectiveness

Financial Stability

Competitive Advantage

Future Lab – Safe, Effective, Efficient

41

The First Step…Map Out Your Plan

Kelsi CurrierDirector, Workflow ConsultingMobile: (520) [email protected]

Ventana Medical Systems, Inc.a member of the Roche group1910 E. Innovation Park DriveTucson, Arizona 85755www.ventanamed.com

Contact Information

supercharging histology workflow - lab quality confab · staffing shortages increasing ... to...

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