A Lean-Based Approach to Overcome Laboratory Challenges Using Process Excellence (PEx) Methods & Integrated Solutions – Experience of a Tertiary Care Laboratory from Mumbai

Abstract

Background: The clinical laboratory’s goal is to provide the right service at the right time with the best quality. It was observed that a scattered and complex workflow resulted in non-value-added activities and impacted turn around time. A shorter turnaround time was always in demand & discussion. After feedback from clinicians & the internal team, the laboratory took this project as a part of its Quality Improvement programme. A team from the laboratory & Process Excellence (PEx) Consultants from Ortho Clinical Diagnostics performed a workflow assessment to identify the root causes of delayed turnaround time. The team used the concept of ‘Lean’ which is a quality improvement tool that focuses on simplifying the process by removing the “waste” or “non-value added” activities. Aim: This study aimed to use integrated solutions & Lean methodology to simplify the complex laboratory workflow. Method: A pre and post intervention study was conducted using the DMAIC principle (Define, measure, analyze, improve & control). The intervention was an integrated platform for analysis of Biochemistry and Immunology samples. Laboratory Information System statistical analysis for turn around time, Operator tracking and Valustream mapping were used to identify the bottlenecks and eliminate non-value-added tasks. The laboratory turnaround time, number of vacutainers used, staff assigned to tasks, were compared in the pre-intervention (2019) & post-intervention (2022) period. Results: The adoption of an integrated platform, helped reduce turnaround time for laboratory results by 26%. The integrated system also enhanced the capacity of the laboratory to handle the workload using lesser vacutainers saving US $ 2075 & US $ 30,000 per year from saving 43800 man-hours annually. The operator motion was reduced and 6 non-value-added steps were eliminated saving the laboratory 55 minutes per batch. Also, 100 sq.ft of space was saved which was utilized by the laboratory for other specialized testing. Conclusion: Value stream mapping an important lean tool, helped the laboratory to identify bottlenecks at the pre-analytical stage due to non-value-added activities. Specific interventions like integration of the Clinical Chemistry & Immunology analyzer with central specimen receiving station the TAT compliance score improved by 41% and 6% for Biochemistry & Immunology assays respectively. The laboratory could also optimize their space, manpower and show potential savings of USD $ 32075/- per year. These measures improved the operational efficiency of the laboratory.