The adaptation of factory mentality to the health care field is revolutionizing laboratory management and effectiveness, producing quicker results and less waste.

By Kerri Penno

What do you think of when you hear the word "lean?" Perhaps the first image your mind conjures up is a skinny Jared Fogle from a Subway advertisement holding up a pair of giant pants. Or maybe Oprah on a good week. But these days, trimming the fat applies to more than carbs and cheeseburgers—laboratories across the United States are self-evaluating and tightening their belts.

The Foundation

In the health care sense of the word, Lean refers to a set of principles revolutionizing the way laboratories operate. Laboratory professionals are working with consulting groups to adapt assembly line efficiency theories to health care.

Udi Shorr, a writer with Z Group, a marketing communications company, Highland Park, NJ, who has written a number of case studies on the effects of Lean in the lab, described the foundation of Lean as, "the application of factory time and motion efficiency practices" to the lab. This means cutting down on inventory, waste and inefficient labor.

James Womack, president and founder of the Lean Enterprise Institute, Brookline, MA, adapted the Lean principles from Toyota, which had expanded on Henry Ford's factory innovations.¹

Lean is about "safety and standardization between all clinics, processes and procedures; consistency, cleanliness and cost savings by eliminating unnecessary steps," according to Lori Remmel, MS, CLS, CPCT, director of laboratory services at Quad/Med Corporate Health Services, Sussex, WI.

Jo Ann Hegarty, MT(ASCP)SBB, marketing director at ValuMetrix Services consulting group, Ortho-Clinical Diagnostics, Raritan, NJ, has helped a number of laboratories incorporate Lean into their management strategy. Her organization works with lab staff, putting together a group from both sides dedicated to carrying out the process. "Our goal is to transfer the knowledge and ability to use Lean tools and sustain improvements for the long term," she said.

She described the Lean process as looking at the starting point—the patient—and at the end point—the result—and then attacking the operations in between. A key practice of implementing Lean in the lab is to "be the sample." Samples are closely followed, sometimes even videotaped, to evaluate their progression in the lab.

According to Shorr, laboratorians often find that batch processing leads to numerous wait times, actually increasing the period before a result can be generated. "If a sample wanders around and then waits, no one's benefiting," Hegarty explained.

By following a sample through the lab, Lean thinkers can identify and alleviate these processing hindrances, taking complex processes and breaking them down into manageable components.

The next goal is to standardize work. "When everybody does everything the same way, that improves the training, quality and management positions in the laboratory," Hegarty said. "Lean means cleaning up and organizing processes. Most laboratories can really benefit from that."

Trimming the Fat

Lean implementation can take anywhere from 12 to 16 weeks, depending on the facility, Hegarty explained. Lean usually is brought into the lab by senior management or administration. Often the lab director, lab manager or the administrative director will "champion" the development.

Ronald Brown, MA, CLDir(NCA), MT(ASCP), laboratory director, Evergreen Healthcare, Kirkland, WA, decided to adopt Lean principles at his facility because he was "convinced that traditional continued quality improvement and total quality management were not successful in creating sustainable breakthrough quality improvement."

He recommended hiring a contractor to scope the project, and examining several vendors. Brown admitted the startup can be expensive, but is worth it in the long run. "We paid in excess of $200,000 for the consulting, training and software to perform our first project," he said. "Since then, we have operated independently of the vendor and had a great return on our investment."

Lean can be brought into the lab independently as well. Remmel's organization began after their parent corporation adopted the philosophy. "The only expense is the tech time of rewriting procedures," she said. "The value stream mapping of our laboratories has saved us money, not the other way around."

Remmel told ADVANCE the process is not overly complicated, just time consuming. Lean is not always welcomed with open arms, however. "Initially, lab employees were reluctant," Remmel said, "but once they started to feel the benefit of the changes, they were eager to address more concerns and the ideas started to flow."

Evergreen also experienced initial resistance from employees. "It is critically important that the lab has a clear vision and consistently communicate that vision to the staff," Brown noted. "Employees rightfully are skeptical about management teams running in different directions with the 'flavor of the month' approach to lab management."

"This is a big change for everybody," Hegarty said. "It's tough—its not easy stuff—but it's fast-paced, has a huge impact and you will see results quickly."

After Lean has been successfully implemented in the lab, Hegarty recommends Six Sigma, another management tool set, as the next step. She described the two philosophies as slightly different but synergistic. "Lean really is focused on getting rid of waste and streamlining processes. Six Sigma tools really attack variation in processes and standardizes tools and methods."

Weighing the Results

When asked if negative effects occur from running a laboratory as a business, the universal answer was "no."

"Health care is in crisis because it has always existed in a 'bubble' with little business accountability," Brown said. "Viewing the laboratory as a manufacturing entity is a big paradigm shift, but has given us breakthrough results."

Remmel agreed, saying, "Looking at a laboratory as a profit center is a much better way to run it rather than as a cost center. We use less manpower to achieve more results. We have a lab that is cleaner and more presentable with less contamination problems. We have been able to do more with less."

Hegarty has seen improvements in turnaround time, labor utilization, streamlining processes, space use, reduction of errors and labor savings in Lean labs. The next step? Hegarty told ADVANCE that improved capacity means bringing more tests into the lab that were being sent out—adding to savings and generating revenue.

Brown has had more concrete results at Evergreen. "We've created a culture in our laboratory of looking at everything we do in terms of waste and variation," he said. "We've saved more than $1 million in costs and avoided more than $4 million in unnecessary construction."

Brown said, "Only time will tell if our outcomes are sustainable, [but] our customers love our improved performance."

You Can Do it

If you're thinking of implementing Lean, Remmel offered this suggestion: "Be patient. Make it simple. Change is hard for most people, so introduce it in a positive, easy to understand fashion."

Brown advised laboratories to bring Lean to their facility. "No one will come to you and offer you money to Lean your lab," he said. "Leadership in this environment requires that we have the skill set to scope projects and successfully present to our executive teams."

"I'm very happy to see opportunities like CLMA—Dade's CaseLab and the AACC—Bayer Diagnostics Executive Lab Management program. We are entering an era where the 'rich get richer and the poor get poorer' with respect to lab resources. If we don't rapidly evolve, we will not survive in this competitive new world of health care," Brown added.

Hegarty believes Lean will have huge ramifications, not just on the lab. "It's really going to take over all aspects of health care eventually," she said, "and it needs to."

Reference

1. Lean Enterprise Institute: Welcome Letter. Available at: www.Lean.org. Last accessed Sept. 24, 2004.

Kerri Penno is an editorial assistant at ADVANCE. She can be reached at kpenno@merion.com.