Not long ago, we attended a business conference featuring a keynote speaker of some renown in management circles. His CV was certainly impressive and his presentation was compelling, but we were unprepared for the waves of adulation flowing from the audience to the speaker's dais. To say those present hung on his every pronouncement would be to understate the case. He was Albert Einstein and Oprah all rolled up into one irresistible management guru package.

At the conclusion of his speech, the room swelled with applause, and yes, even cheers. We left the hall later that day in quiet contemplation. What did this guy have that we don't? Why aren't we treated like conquering heroes when we speak at conferences? Later, back at the hotel room, over a therapeutic glass of cabernet while looking at the guru's résumé, we hit on the answer. This guy had acronyms! Not only had he invented a completely new and improved theory of personnel management, he had written books to prove the vast superiority of his ideas and liberally sprinkled each page of every book with his own inscrutable acronyms just to prove how new and unique his ideas really were.

Eureka! That's the answer! If we're going to be famous and adored consultants, we need to come up with some acronyms. In this article, let us introduce you to our first, unique acronym: LAB (Lean Architectural Basics).

The point of this article is not to explore our frustration with the alphabet soup of contemporary "management speak," but to explore how Lean design principles may be incorporated into a laboratory design.

Philosophy Explained

For the uninitiated, Lean philosophy derives primarily from Toyota Production System, which seeks to promote efficiency in the auto manufacturer's plants. Lean implementation is focused on getting the right things to the right place at the right time in the right quantity to achieve perfect workflow while minimizing waste, as well as being capable of and open to change if necessary. As Lean is a Japanese philosophy, many of the key concepts of Lean are Japanese; thus, to Westerners, much Lean terminology is nearly as obscure as the average acronym. The concepts of Lean, however, are universal and should be considered when designing a laboratory.

Laboratory design projects begin with the planning and programming phase. A series of interactive meetings is initiated to discuss workflow, equipment, support areas, future growth and ideas that might improve lab operations. In the language of Lean, such a meeting is termed a "Kaisen Event." Staff members are encouraged to examine workflow and offer ideas for improvement. The Lean concept of "why" should be introduced and stressed at these meetings. "Why" challenges participants to reject or at least question "the way we've always done it." Tasks and proposed solutions may be written on sticky notes, placed on the wall of the meeting room and rearranged to aid in the creation of flow charts (value stream or process mapping), illustrating the movement of staff members, specimens and supplies and providing a visual reference to the relative efficiencies of a given design.

Central to the evaluation of efficient design proposals and excellent tools for the planning and programming phase are the Lean concepts of "Muda, Mura and Muri."

Muda focuses on eliminating waste, specifically identifying seven unique kinds of waste. Mura is the promotion of evenness, smoothing out demand cycles. Muri seeks to guard against overburden, pushing people and/or machines too far. While some aspects of these concepts relate more directly to management than physical laboratory design, each still projects design implications. The incorporation of these concepts during this initial design phase is essential if the end product, a new or renovated lab, is to be as efficient as possible.

Improving Workflow

Improving workflow is normally the first concern of laboratory administrators, and as you're probably starting to suspect, improving workflow is also the first concern of Lean specialists. "Spaghetti diagrams" specific to each proposed design and based on the ideas and flow charts developed in the initial planning and programming meetings, may be used to illustrate the movement of specimens, supplies, staff and waste through the laboratory (Figure).

Typically, a proposed plan is overlaid with trace paper and colored markers are used to illustrate the movement of each element. Obstacles to movement and wasted motion become graphically obvious and will be used as the basis for altering the design to improve flow. Spaghetti/workflow diagrams are often done in stages as a design evolves in detail, such diagrams also evolving from "big picture" generality to intricate detail.

Lab designs based on an open core concept incorporating flexible casework and utilities are more Lean-workflow efficient than traditional departmentalized designs. Bio-safety classifications dictate the composition of the core lab. Lab areas dedicated to work with human fluids and tissue are considered, minimally, Bio-Safety Level (BSL) 2 due to the presence of bloodborne pathogens and are required to be in an enclosed room and under negative pressure. All lab areas considered BSL2 may be grouped together in the core lab. By placing microbiology and anatomic pathology in the same area with chemistry, hematology and blood bank, the flow of shared specimens improves. Space and equipment may be also shared. Obviously, some limitations apply. Blood bank cross match stations should not be sited adjacent to an automation line and BSL3 areas such as mycology, TB and molecular testing may not be in an open, core lab. Code constraints may also limit the size of an open lab space.

Work station design contributes to Lean function. In the core lab, "U"-shaped work cells incorporating high volume analyzers allow personnel to support a maximum number of instruments with a minimum number of steps. To spare technologists additional steps, space must be provided in the cell for mixers, vortexes, computers, printers and more to support the analyzers.

Back-up instruments and esoteric testing may be placed in a second layer outside the primary automation cell. Lean philosophy speaks of "autonomation" or "smart" automation, perfecting the human/machine interface and trusting machines to do what they are designed to do. Perfecting workflow in a core lab requires analyzers that are efficient and may be trusted. Ensuring your lab is equipped with trustworthy equipment is critical to efficiency.

Work stations should never be designed as a personal space, but should be arranged and equipped in like fashion, perhaps necessitating the addition of some computers, printers and small instruments. Workstation design should not necessitate the inefficiency of staff being required to move to a shared piece of equipment for each specimen, leading to wasted steps, time and the possibility of mix-ups. Providing identical work stations ensures personnel can function efficiently at any station and will decrease turnaround times (TAT).

Important to Design

Open, visual communication is important to Lean design. Overhead cabinetry should be limited to the walls. Tall storage cabinets may be used where a flexible separation is required. Under-counter storage should allow room for books, files and everyday supplies as well a waste containers.

Lean design philosophy seeks to eliminate unevenness. Most labs receive specimens in batches, especially from outreach clients, creating large fluctuations in workload over the course of a day. Many labs find to preserve their TAT, there is one point in the day when 15 workstations are required with only five required for the balance of the day. The benefit of evening out the load is obvious and desirable but may be difficult to achieve in practice. Solutions like adding extra couriers to deliver smaller batches more often may not be possible or cost effective.

Other solutions, like willingly allowing TAT to increase, may not be acceptable. None the less, a management attempt to eliminate unevenness could be a worthwhile path to improving efficiency and should be pursued by lab managers prior to the design of a new laboratory as the effectiveness of their efforts could substantially alter base line information for an architect seeking to design a Lean lab.

Willingness to Change

Perhaps the most important Lean concepts to take away are "why" and the willingness and ability to change. Technological advancement over the last two decades has rendered traditional lab design and practice obsolete. It's time to abandon "the way we've always done things" and be willing to opt for a more efficient, Lean lab capable of flexible adaptation to the inevitable technological advancements of the next 2 decades.

Karen K. Mortland is president; and Daniel B. Mortland is vice president, Mortland Planning and Design, Chicora, PA.