Hospital Laboratory Productivity Improvement Project
Customers of the XYZ Hospital Laboratory were dissatisfied with the turnaround time for most lab tests. Survey data showed that services delays were the #1 complaint. An analysis of data indicated that less than 55% of lab test results were available within the specified “best practice” time frames. In addition, the process had considerable variation and was not reliable.
Frequently, caregivers and physicians had to make multiple telephone calls to the lab to obtain results. A process improvement work group was formed to address these issues.
Customers are not happy with Laboratory’s current turnaround times; less than 55% of lab tests have results available within specified best practice time frames. Specimen collection and testing processes will be improved to consistently meet target time frames.
Ninety percent (90%) of lab results will be reported within target time frames within six (6) months.
Summary of productivity improvement activity
The team identified specimen transport and specimen processing as the key bottlenecks in the process and three high volume tests were identified (Basmat, CBC and troponion). To improve productivity, the lab made the following improvements:
- Every area that “touched” the process was considered to be part of the system. This included phlebotomists, lab technicians, staff supporting the pneumatic tube systems, central supply, etc.
- Phlebotomists changed from batch transportation of samples to the lab to a modified single flow. After collecting two or three samples, the phlebotomists would send the samples to the lab through the tube system before going on to the next patient. This allowed lab technologists to begin testing within just a few minutes of the sample being drawn rather than waiting two or more hours for a large batch of samples to be brought to the lab.
- Five (5) related lab instruments, previously located in three (3) areas, were moved to a central location. In addition, two (2) analyzers that had been 20 feet apart were moved to within four (4) feet of each other.
- A pneumatic tube system was used to send test specimens to the lab rather than having them hand-carried.
- The process improvement team identified transporting of specimens and processing specimens as major bottlenecks in the process. The use of single flow collection and transport along with the pneumatic tube system removed these bottlenecks.
- The peak period for sample collection was 6:00 AM to 8:00 AM each day. The transport duty schedule and lab work schedule were revised to accommodate the peak demand period.
- The improvement team used the 5S Kaizen approach to clean up and re-organize the laboratory. Equipment was removed from aisles and filing cabinets were reorganized.
- Supplies were labeled and given an assigned place. “A place for everything and everything in it’ place.”
After an intensive process improvement initiative, turnaround times for these three tests were reduced by an average of 26% for routine tests and an average of 48% for STAT tests. In addition, phone calls regarding results decreased more than 50%. This improved customer satisfaction, employee satisfaction, and productivity.
Moreover, productivity improved substantially and it was possible to re-ssign three (3) FTEs to other lab activities thus making better use of staff resources. Lab management estimates that the improvement will result in savings of more than $150,000 per year. This chart shows the improvement made in average cycle time from collection to receipt of results for morning VPT specimens.
The following chart shows the impact of the improvement on productivity.
Notice that although the Actual Hours/Stat gradually improved over the weeks of identifying, evaluating, and piloting solutions, the significant improvement occurred when the single flow transportation of specimens was implemented. The labs have continued to meet or surpass the Target Hours/Stat over time. (Remember, the Actual Hours/Stat should be at or below the Target Hours/Stat).