Abstract
The quality, timeliness, efficiency and affordability of medical services are crucial for improvement of living welfare; medical facilities should have effective management systems that facilitated the provision of quality and reliable medical services. Diagnostic laboratories play a crucial role in the entire health service provision, when different tests are accurately determined in a cost effective manner, then patients will get quality services, as it will support final decision by medical practitioners.
Adopting lean management principles in diagnostic laboratory will assist improve improving patient care and employee safety; lean is systematic approach to process improvement through facilitating efficiency in an operation. It focuses on the reduction and elimination of waste, determination of variances, determining areas of inefficiency and finally aims at creating an imbalance in the process.
Introduction
The medical service industry is highly dependent on the quality that patients can derive from the facility, to enhance efficiency, then management should ensure every department or sector maintain a high level of efficiency and conducts its business in an ethical professional manner. Lean system came into limelight with the invention of a number of combination at Ford Motor Company which were later improved by Toyota Motor Corporation, the system has a general approach of identification and elimination of waste; through the system was used initially in business arenas, it can be implemented in medical facilities with the same agenda and objectives.
Gary (1) states that Laboratory results goes a long way in shaping the decision and medication that a patient will get form medical practitioners, they rely on the report to offer medication, the crucial role calls for high-quality laboratory testing. This report discusses how a medical facility can implement a lean thinking in its diagnostic laboratory.
Objectives of lean thinking in a diagnostic laboratory
When management of medical facility have decided and settled on the need to improve their laboratory services using the lean thinking process the following are the objectives that they should have in mind:
- Improved operational performance: this means that the laboratory should aim at improving the turnaround time and the costs incurred must be managed effectively
- Reduced variability in operational performance: this ensures that the tests made are accurate and reflect what a patient is suffering from precisely
- Improved patient and employee safety: the process should ensure that both the patient and staff are protected from any accidents or misfortunes
- Improved employee motivation, the employees should be working in an environment that facilitates development of high morale
- The time of development of new tests should be reduced
- Reduction in testing defects and errors: this ensures that tests done are accurate and precise.
Marc , Ian and Alan (2) states that with the above objectives in mind, then the hospital can start the systematical method of implementation, care should be taken to ensure that all areas have been touched and given enough consideration as required by the process. The following is the implementation process:
Waste-walk
“Waste walk” is the initial step when implementing a lean thinking process in laboratory services; the aim of this process is to access the current situation and the way operations are occurring within the organization. The stage should be taken as a strategic problem diagnosis tool where the implementing team aims at recognizing a deficit between the planned operation and the real operation; it also aims at establishing areas that need to be improved. In a laboratory setting, the areas to consider include the costs expenditure, the satisfaction of patients and customer care. In a laboratory, setting wastes can be classified into the following main areas:
Waiting
The duration that patients wait to be attended either before or after undertaking the test should be analyzed, a longtime waiting can be from internal processes when material, information, people or equipment is not ready.
Transportation/Material Movement
After a test has been made, there are chances that the results will be moved in the laboratory from one corner to another before they are released to the customer, the result is having a delayed customer.
Over-processing
Within the laboratory, there are chance that results may be over-processed a factor that does not add value to the customer; they may resulted from reform testing not requested and repeated manual data entry.
Inventories
Having delays in the supply of equipments necessary for the laboratory services, the laboratory personnel’s are seen walking up and down the facility looking for facilities to attend their patients in course of that time is wasted.
Motions/Movement
The medical facility not planned in a way that can facilitate smooth flow of activities, but the staffs can be seen hopping from one corner to another.
Defect
Producing of works with some defects and errors, this reduces the reliability of the information and the quality of the service is compromised.
Overproduction and Re-prioritization
The laboratory technicians seen not committed to their tasks and they are easily interrupted.
Having finished the above stages, the next step is track down the real operation of the laboratory in the next step called mapping the value stream.
Mapping the value stream
This stage takes some tests and aims at collecting the current operation information or data, the implementing team follow a certain test from the time patient was sent to the lab until the final moment that he/she gets the results. It aims at diagnosing the system “as is”, it undertakes the following main activities:
- Tracking down an individual sample or patient throughout the system, emphasis will be place on the time the service will be offered
- Within the diagnostic laboratory, track down the movement of the sample/people at each work station
- Note the areas that value to customer is upheld and the areas that have deficits
- Highlight the areas that wastes can be recognized and the areas that customer was not satisfied or where a sample was not effectively handled
- Document the time used in every stage within the laboratory setting
- After the information has been collected, then the next step is to map or make work balance chart and/or “spaghetti diagrams”
This stage is tedious and lengthy but the most important stage as it offers the implementing team with the areas that they need to focus on. When the stage is not effectively conducted then the success of the system cannot be guaranteed. This stage the management takes time to identify the key factors that influence potential benefits (IPBs) and critical to quality factors (CTQ); it is the stage that is more time consuming because the management need to device measurement to be use to gauge the performance of the entire diagnostic laboratory.
This stage the management with the assistance of departmental head should devise minimal standards required to be set for an appropriate implementation; they are guided by the corporate plan that was initially operating in the company. This happens after understanding the potential of a certain process. It is appreciated that it may not be possible to get a 100% outcome out of the projects/process in an organization; however, a minimal level that the system should not go.
Using the drawn map, work balance chart and “spaghetti diagrams” then a best line of approach is made where the team documents and have the document that give the set minimal times that a certain test should take; the approach should be more focused on stage and unit within the diagnostic laboratory.
The efficiency tool developed should include an analysis about time, quality, costs and the use of resources, at no one point should be the efficiency document is ignored in the future, it is the benchmark using the current situation in the hospital.
Application of Lean principles
Rachel and Wright (3) observes that with all the documentation and the efficiency level set, the next method is to implement the process, the implementation should be done with the support of supervisor, a lead tech, technicians, non-laboratory persons and an experienced Lean leader. All should be made to understand what is happening in the facility and their expectations.
After the implementation, which involves control and monitoring, the management should embark on improving the process further.. Feedback is of importance and considered for further decision making. The following are some of the tools for this work quality control process charts, control charts, and standardization practices. Repeatedly there may be possibility that the company devise better ways of doing things and this should not be locked out be the system.
When implementing the system, a facility management needs to analysis the current operation, and then device benchmarks to be followed and finally reinforce the use of the benchmarks. Though the process may be seen as direct and simple, it is time consuming and calls for corporation among the laboratory teams, an experienced lean manager need to pioneer the implementation. Continuous improvement is crucial in the system
What do the paradigm shifts need to be made in how laboratories are currently run?
Wastes in laboratories come from inefficiency of parties that take part in a laboratory test; when implementing a lean thinking then, the following paradigms need to be shifted:
- The work framework should be shifted to involve a framework that ensures smooth flow of tests
- Supply and setting up of laboratory equipments should be done early enough before a test
- Review visual controls and standard work interpolation
- Remove long lead time for supply replenishment, re-stock and re-order not consumption based
- Remove un-leading information and adopt a policy that facilitates concentration in on area
- Empower customers to demand for results and attendance after some time.
How adopting Lean thinking principles should make the paradigms run
Shumaker (4) says that when the system has been implemented, then any wastes within the diagnostic laboratory either resulting from staff related issues, or equipments should be removed. Efficiency will be the order of the day in the facility and ensuring that there is free flow of samples and customers within the diagnostic laboratory. The following are the expected outcome:
- Within the laboratory, there will be a reduced batch size.
- Laboratory staffing schedules and routine effectively matched to sample arrivals (customers lead-times reduced)
- Standardization of different work/unit processes in the efforts of facilitating sticking of the new system
- Reduced set-up time for testing and facilitating that quality of tests are of high quality; the outcomes are reliable
- Reduce human errors that can lead top defects, this will be possible by analyzing root cause analysis and mistake proofing
- Improve documents, sample and operational tracking management systems
The overall result is a medical facility with high laboratory services that guarantee patients quality, timeliness and cost effective laboratory services.
Conclusion
Quality medical attention is a human right, to ensure that they are available at an appropriate cost, diagnostic laboratories need to be analyzed and areas of inefficiency recognized. Snee and Hoerl (5) describes lean thinking system as a management tool that approaches waste management from a scientific angle; it analyses an entire organizations processes and by creating relationships and data analysis, the area with a deficit is recognized, then coming up with appropriate strategies to minimize wastes within a system.
Diagnostic laboratories need to develop an efficient lean process management system; under the system, the sector will establish its areas of weakness and determine the appropriate strategies to implement to improve the overall performance. When the system is implemented, then a facility will benefit from quality, reliable laboratory tests, done by motivated laboratory staffs.
References
- Gary S. Advanced Lean Thinking: Proven Methods to Reduce Waste and Improve Quality in Health Care. New York: Joint Commission Resources; 2008.
- Marc B, Ian T, Alan M. Making Hospitals Work: How to Improve Patient Care While Saving Everyone’s Time and Hospitals’ Resources. Lean. New York: Enterprise Academy Ltd; 2009.
- Investing in Hospitals of the Future. London: WHO Regional Office Europe; 2009.
- Shumaker P. What Lean Thinking can do. H&HN: Hospitals & Health Networks. 2007; 1(2):8-10.
- Snee D, Hoerl W. Leading Six Sigma: A Step-by-Step Guide Based on Experience with GE and Other Six Sigma Companies. Upper Saddle River: FT Press; 2002.