consolidating bjc’s diagnostic labs for process efficiency · • this was then simulated using...

Consolidating BJC’s Diagnostic Labs for Process Efficiency

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Consolidating BJC’s Diagnostic Labs for Process Efficiency

Behind the scenes, laboratories process hundreds of diagnostic samples every day in order to deliver critical information to physicians who rely on the results to make clinical decisions for their patients. This all happens without a lot of attention or recognition, but plays an important part in the hospital ecosystem and affects costs, length of stay, and patient outcomes. Diagnostic tests are a critical part of patient care and influence more than 70 percent of healthcare decisions.

Over the years, technological advances and automation have made tests easier to use and more accurate, and have led to more precise and timely results. There are over 4,000 different diagnostic tests available today. Diagnostic tests are performed close to 7 billion times each year in the United States and they influence most of the dollars that are spent on healthcare delivery. An inefficient lab quickly becomes the bottleneck for your whole hospital, and drives costs out of control. Diagnostic labs need to deliver the highest quality test results, at the lowest cost, within the shortest time frame.

Rodney Mullins, MBA, PMPPerformance Improvement Manager at BJC HealthCare

Operations Manager with over 25 years experience in Manufacturing, Healthcare and Process Improvement.

Diagnostic Testing Preventing Inefficiency


THE CHALLENGE

BJC Diagnostic Lab ChallengeOver time, BJC met the constantly increasing demand for diagnostic tests by building small diagnostic labs, each with limited capacity throughout the hospital. As a result their labs were scattered throughout the 1000+ bed hospital and housed across multiple buildings. As one lean practitioner stated “there was a ton of waste” in the system. Having the labs distributed throughout the hospital resulted in inefficiencies and waste. For example:

• Lost or misdirected samples

• Delays in processing

• Excess staffing at slow periods during the day

• Complicated logistics.

BJC wanted to consolidate all their labs into a single centralized lab to prevent diagnostic testing bottlenecking the entire system and drive overall hospital efficiency. This would be a multi-million dollar construction project, every aspect of the design had to be rigorously tested.


Consolidating BJC’s Diagnostic Labs into a Single Location

During BJC’s campus renewal, one of the key projects was to consolidate their clinical labs into a single location in order to streamline processes and reduce waste.

There were several areas of concern for the design team:

• What is the best layout for work stations?

• How will the new lab design handle the ebb and flow of volumes over the course of the day?

• To what extent will staff roles and responsibilities in the lab need to change?

• Will there be enough space for the full complement of lab staff that will need to work there?

• How many staff will need to be on each shift throughout the day?

Designing the new Diagnostic Lab for Process Efficiency

Once the team had an outline of what the square footage was going to be, they went to work designing the workstation layout for the lab with process in mind.

• The team used a Value Stream Mapping exercise with each lab to understand the workload that would need to be integrated in the consolidated diagnostic lab.

• They conducted a 5-day Lean Rapid Improvement Event (RIE) to develop a proposal.

• This was then simulated using LeanHDX to estimate staffing needs. Meanwhile, the team was challenged by the lab director to create an even more efficient process flow and reduce hand-offs and associated waste (inventory, waiting, opportunities for error).

• The team regrouped for a 2-day “mini” RIE to develop an improved lab design.

• The second lab layout was also tested using LeanHDX, and shown to be a superior layout design.


Selecting the Optimal Diagnostic Lab Design

The two proposed lab designs were simulated in LeanHDX assuming there would be only 250 test arrivals per hour, that’s the lowest anticipated hourly demand level. The travel times of the “water spider” (the ‘go fetch’ person, the key team member who would travel throughout the lab collecting and sourcing equipment) and the impact on sample delays were used as the criteria to evaluate performance of each proposed lab layout.

In both lab designs, the “water spiders” traveled approximately equivalent distances, but because of a better layout in lab design 2, the samples experienced a 37% reduction in delays (from 35 to 22 minutes) at the sort station. This was done without any additional expenditure on equipment or staff.

Lab design 2 was the clear winner.

1 2

Using the extensive analytical results LeanHDX provided on queuing and travel times, the second lab design was selected. The second design was going to:

P reduce walking time

P improve staff productivity

P allow additional flexibility in staffing levels

The two proposed lab layouts:

Driving Operational Efficiency in the Diagnostic Lab


These all tie directly to immediate operational cost savings for BJC.

• Consolidated work spaces and proximity to each other in order to reduce travel time in the lab.

• Relocated the runner home base to provide better visibility and reduce distance traveled.

• Rearranged work space proximities to reduce waste during low-volume times of the day. Created flexible work spaces to handle peak volumes.

• Reassigned some tasks in order to reduce the number of hand-offs and transportation time.

• Considered additional investment in automatic inventory feeders in order to guarantee FIFO inventory management.

• Created single-piece flow that is based on a pull model.

The Outcomes:

Results from the improved layout included reduced walking time, fewer staff hours needed, reduction in inventory levels, and shorter turnaround time for lab results.

Having decided on layout 2 as the optimal layout design for the lab, the design team went on to test operational and staffing changes as well, including the following:

By varying the number of “water spiders” between 3 and 7 staff members, BJC were able to understand the trade-off between staffing expense and service level (aka. sample delay times). The charts below represent the implications at the lowest demand level of 250 samples per hour. This trade-off followed the same pattern regardless of demand level, though the delays experienced by the samples increased proportional to demand.


Determining the Right Staffing Levels The final piece of analysis BJC conducted with LeanHDX was to determine how many staff would be needed to run the lab.

The staff requirements depended on the level of demand, which fluctuates throughout the day, between 250 and 580 samples per hour.

The last scenario comparison that was done was to look at the number of “water spider” staff required at each level of hourly demand. The decision about how many staff to hire for the new lab is a management decision, depending on the organization’s tolerance for sample delays relative to expense. For example, the chart below shows that as the number of samples being processed rise, the delays experienced rise quickly, especially at the “Sort station” which is the rate-limiting bottleneck in the sample handling process.

LeanHDX is the Perfect Software for Lab Design


Integrating LeanHDX into BJC’s lab redesign project has let BJC confidently move forward to building their new multi-million dollar consolidated diagnostic lab. They have the evidence they need to know that they are building a diagnostic lab that will drive process efficiency.

“For the project that needs to consider layout and process efficiency LeanHDX is the perfect software. It was rapid, intuitive to use and let us evaluate multiple scenarios until we identified the right one. LeanHDX is the perfect partner for your Lean led design study.”

Rodney Mullins, MBA, PMPPerformance Improvement Manager at BJC HealthCare

Design spaces with your process in mindLead the way with evidence based healthcare facility designs that eliminate waste and maximize performance.

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consolidating bjc’s diagnostic labs for process efficiency · • this was then simulated using...

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