1 ADVANCE for Executive Insight

clinical lab efficiency
Executive-level
administrators
would be wellserved
to understand
how strategic
investments
can help critical
laboratory functions
drive even
greater levels of
productivity, quality
and efficiency,
delivering favorable
returns on
investment (ROI)
and service level
improvements,
while simultaneously
reducing
potential operational
and patient
care errors.
FIG. 1 - EVOLUTION of productivity: PRIOR to lean and after automation
Test Volume: Reported Results
2,600,000
2,200,000
1,800,000
1,400,000
1,000,000
Test Volume:
Reported Results per
Workload Hour
began a Lean evaluation in the mid-1990s to
streamline workflow and accommodate a dramatic
volume increase resulting from the closure
of several nearby hospitals.
A workflow assessment mapped each step,
identifying best practices and possible process
changes. Only 12% of tests were conducted
manually, while 88% ran on analyzers. We embraced
the then-nascent “core lab” philosophy,
reorganizing operations according to technological
platform—automated or manual tests—
rather than according to scientific discipline,
such as biochemistry, hematology and immunology.
The core lab approach helped eliminate
testing redundancies and corresponding errors
and set the stage for implementing an automated
system.
Reducing Errors,
Enhancing Performance
Working from a blueprint of modular systems
from a manufacturer (Beckman Coulter), we began
in 1997 to implement a completely integrated,
robotic conveyor track system, ultimately becoming
the first hospital in Canada to operate in
a “total lab automation,” or TLA, environment.
The U.S. CDC notes that high levels of lab
automation successfully minimize errors, enabling
lab clinicians to concentrate more directly
on quality assurance and results interpretation.
This is because most automated systems’ targeted
accuracy and precision parameters during
LEAN Only Stand-Alone Automation Connect to Chem. TLA
74,661
Whrs
1,287,878RR
47,027
Whrs
2,565,338RR
Year 1 Year 2 Year 4 Year 6 Year 8 Year 9
Worked
Hours
70,000
60,000
50,000
40,000
30,000
17 LEAN 26 automation
55 >200%
specimen analysis significantly reduce both risks
and rates of testing errors. 4
In our experience, automation directly impacted
error rates, reducing the number of manipulations—manual
interactions with a given
specimen—by 75% and documenting increases
in catching and reporting previously undetected
errors.
After introducing Lean principles and automation,
clinical lab productivity, which we measured
as reportable results per worked hour,
more than doubled. These improvements were
accomplished through a 99% increase in volume
and a 27% decrease in worked hours.
Virtually all hospital systems in North America
face shortages of trained laboratory technologists,
which can hamper a clinical lab’s ability
to deliver timely data and increases the risk of
errors. Yet, our post-Lean, post-TLA environment
showed increased performance levels despite
losing 35% of our full-time employee (FTE)
workforce by attrition over time. We compared
our laboratory to others in the 2010 CAP Q
Probe, and the results show that we are in the
top 5% in productivity (Reported results/Non
Management staffing).
Middleware Offers
Additional Advantages
Key to our successful TLA environment has
been our Lab Information System (LIS) and particularly
our “middleware” capability, which
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