Lean is a systematic approach for identifying and eliminating waste (non-value-added activities) through continuous improvement. Lean Lab is the application of Lean concepts specifically in the clinical laboratory. Most importantly, Lean Lab is about understanding what is important to patients, physicians, and other customers.
Lean Lab focuses on:
- Improving safety
- Increasing flexibility to respond to patient, physician, and other customer needs
- Reducing or eliminating wasted motion, space, and supplies, and underutilized equipment
- Instilling a consistent paced-flow of test and specimen preparation
- Maximizing staff responsibilities
- Expanding capacity by reducing costs and shortening the cycle time between ascension to analysis
- Creating a place for everything and putting everything in its place
Although the Lean approach did not originate in healthcare, the methods used can be appropriately integrated into the care delivery model.
The most common and predictable response to Lean efforts is the complaint that Lean ‘won’t work here because we are different’. Laboratories are different; they are not the same as production or hospital environments. However, the key Lean principles do apply and improvements in laboratory process that can be achieved.
There are many challenges unique to the implementation of Lean in laboratories. The Leading Edge Group has developed a proven toolkit which is specific to the laboratory environment.
Leading Edge has worked closely with many clients in implementing Lean in a hospital laboratory environment. Lean principles have been repeatedly proven to aid a laboratory in significantly increasing speed, efficiency and quality.
Among the Lean tools that have been shown to be consistently applicable in a laboratory environment are:
- Cellular Organisation. A key teaching in Lean thinking is that physical layout will affect how people work - physically separating process steps creates “hand-over points” – this can lead to increased batching of work and delays at the hand-over points, both of which can significantly increase the turnaround time of work (and therefore delays in delivering to the customer). In a Lean lab thought is given to ensure that as many process steps are conducted as closely to each other as possible – preferably within just a few steps. This naturally encourages flow of work from one process step to the next with minimal batching and hand-over points. It may be expected that up to 50-75% of turnaround time may be eliminated simply by adopting a Lean layout which supports the flow of work.
- Value stream mapping and work in progress control. “Value Stream Mapping” follows a process from beginning to end and identifies each step as adding value or not adding value, and seeks to identify examples of the “eight wastes”. In many processes waiting accounts for more than 90% of the turnaround time that the customer experiences. In these cases turnaround time may be significantly improved not by creating much better flow within the process – tying process steps closer together. Another key Lean principle is to understand the level of work that is ongoing at any one time – the “work in progress” (or “WIP”). Turnaround times increase in proportion to the amount of WIP, and there are some simple methods for controlling WIP and therefore reducing turnaround time.
- Standard work and quality monitoring. Any process improvement initiative rests on knowing what is working, and what is not, and being able to recognise whether a change has improved matters or not. Two essential components are standard work and quality monitoring. With standard work effort is applied to ensuring there is minimal variation in how a process (or process step) is performed. The process should be well described (photos and video may provide a useful addition to a SOP) and supported by training so that individuals don’t each have their own preferred way of performing a task. A Lean lab will ensure that the quality indicators are obvious to everyone – local visual displays should ensure that any change in quality is immediately apparent to all staff and managers who are involved in the process. Over time statistical measures may be put in place, but the priority to begin with is to ensure that quality is measured and visible to all. Once work has been standardised and good quality measurements put in place then the teams are encouraged to progressively improve the process.
- Simulation. Another used in Lean implementation in a laboratory environment is process simulation. Process simulation enables a virtual model of a process or laboratory to be created which allows experimentation in a cost free virtual world, without disruption to ongoing processes. For example equipment or staff may be added (or removed) to study the expected impact. Processes may also be altered or staffing arrangements (such as shift patterns or multi-skill training) changed to understand the potential benefit. Simulation can greatly help teams to understand their system, choose the best options and minimise the potential disruption of process redesign.
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