I’m glad that Ted had a positive impression of the lab. He writes (and posted a lot of pictures) about what he saw that was surprising to a non-lab person:
First, there is a work room right off of the lab floor. It seems out of place relative to the other conference rooms on another floor, but it is there by design. Staff can problem solve in a safe area that’s close to the work. Visual systems are used to alrt the team to important metrics.
The two formerly separated machines are now in the same room. One performs chemistry evaluations, the other hematology. Why is this important, I asked, if the types of tests are totally different? The answer is that the lab is cross training staff to operate both machines, which allows for leveling of the load.
Ted is right. A traditionally laid out hospital lab has sub-departmental silos. This is not unlike a traditional functional factory layout. There are historical reasons for the silos in factories (machines used to be run off of drive belts, so similar machines had to be grouped together, regardless of the overall flow) as there are in laboratories (chemistry and hematology were separate academic fields, so it was natural that they occupied different rooms).
As lab testing has become more automated, the testing areas are often still kept pretty separate… until Lean process flow analysis helps the lab identify that a cross-functional automated testing area, or “cell,” can be created, an area that now houses instruments that used to be in their separate sub-departments. Modern medical technologists are typically cross-trained or at least have the skills and education to run multiple types of testing machines. The main “value add” of the technologists is in reviewing and interpreting the results of the testing (loading the tube into the machine isn’t particularly skilled work).
When labs move to the cellular layout, the department typically moves from a “one person, one machine” staffing model to one where a technologist (or two, depending on workloads) can walk a standardized work pattern, loading and unloading different instruments and reviewing results as they come out. Manual testing work is typically isolated into an area that is staffed separately during a day (technologists are still cross-trained and able to work in either area). The advantage of this new standardized work is that the routine flow of specimens and testing in the automated cell is no longer interrupted by manual work or specimens/results that require more detailed interpretation.
The general approach might seem familiar to those of you from manufacturing settings… but it is certainly implemented in a way that’s keeping with the mission and setting of a hospital. One key difference between a manufacturing “cell” and a lab “cell” is that lab specimens tend to only go through one test instrument, unlike a factory cell where a product would be machined or assembled in all (or almost all operations).
There are many examples that Ted cites where the process was improved to reduce walking and specimen travel distances — also very classic benefits of a “lean lab.” I’m glad that it also felt like a “lean” place in terms of environment and the focus on the customer/patient.
Updated: Here is a book review, by Dr. Ted Eytan, of Getting the Right Things Done: A Leader’s Guide to Planning and Execution.
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