Using Six Sigma and Lean Principles to Improve Laboratory ...

1 1 Using Six Sigma and Lean Principles to Improve Laboratory OperationsBig Bang Makeover of the Clinical Laboratory : Key Lessons for Work Flow, Analyzers, and Service Improvements Atlanta, GAPurpose/Objectives Purpose: To provide an overview of Using Six Sigmaand Lean Principles in chartering, designing and implementing a full scale Lean projectin a large Laboratory setting. Objectives: Understand how each phase of DMAICwas used to execute a full scale Lean design effort Understand which keyLeantoolswere used in measure/design/implementation Understand how interactionsof physical, process, technological, and organizational changes contribute to a large scale Lean Who we are Why Improving Lab Operations is Important to Quest Diagnostics The Journey Key LearningsWho we are Focus: Patients Growth People Vision: Dedicated People Improving the Health of Patients Through Unsurpassed Diagnostic Insights Company Background 40,000+ Employees 900+ Clinical Scientist PhDs/MDs Patient Service Centers Rapid Response to Esoteric Laboratories 145 million patient encounters annually Values.

2 Quality, Integrity, Innovation, Accountability, Collaboration, Leadership Six Sigma /Lean Journey 2000?2008 Patient Anxiety tests not of technical of night technical potential blood ergonomic staff equipment supply utilizationWhy Improving Lab Operations is Important to Quest DiagnosticsThe Journey4 The Journey Integrating Six SigmaThree MajorSix SigmaProcess MethodologiesDesignImprovementManagement Complex project required adequate training/developmentDMADVDMAICLeanMeasur ement Systems IntegrationDEFINE (Project Charter) Business Case Problem Statement Project Scope/SIPOC Project Goals VOC/CTQs ResourcesUsing DMAIC & Lean to Define Patient Anxiety tests not of technical of night technical potential blood ergonomic staff equipment supply utilization5 Using DMAIC & Lean to Define ProjectDelivery of the Specimens to Spec Proc DeptSpecimens Picked Upat Client or PSCS pecimen CollectionSIPOC & Project ScopeSpecimens Removed from bags and Logged into LISS amples Aliquoted & Labeled for Technical AreasSamples Prepared for Testing & Loads BuiltSamples TestedResults Releasedin LISS amples Banked and StoredScope expanded and spanned from specimen collection to result releaseAtlanta LabDEFINE (Project Charter)

3 Project ScopeCross functional team included local & national resourcesAtlanta LabSteering Committee-Regional VP-Managing Director-Six Sigma VP-Process Owners-Lean MBB-IT/Facilities/Safety/HR/Finance/Purc hasingField Operations-Patient Service Centers-LogisticsLab Operations-Processing-Clinical-AP-Microb iology-MedicalOther Resources-Six Sigma BBs & GBs-Facilities Manager-Safety Officer-Medical Director-IT Manager/Director-HR Director-Medical Director -Materials Management-Customer Service Director-Architect-Construction Manager-ContractorDEFINE (Project Charter) Project ResourcesUsing DMAIC & Lean to DefineProjectProject Manager6 Extensive Data Collection Plan/Baseline MeasurementsMEASURE Origin of Work Streams logistics Mode & Arrival Profile Pre-Analytical, Analytical & Post Analytical Process Steps Current Floor Plan (CAD)

4 Inventory Turns Productivity Safety Records Quality Metrics Service MetricsUsing DMAIC & Lean in Measure Product Family Matrix Current State VSMs Daily Testing Volumes Lead Time Cycle Time Batch Sizes Staffing by Dept/Shift WIP Uptime Rework % Information FlowUneven & late inflow limits capacity utilizationMEASURE logistics Arrival ProfileUsing DMAIC & Lean in MeasureHourly Volume versus Hour of Operation1st hr2nd hr3rd hr4th hr5th hr6th hr7th hr8th hr9th hr10th hr11th hr12th hr13th hr14th hr15th hr16th hrHourVolume7 Developing the Product Family Matrix was the FoundationMEASURE Product Family MatrixUsing DMAIC & Lean in MeasureList the Prep steps (manual dilution, auto dilution, titration, centrifugation etc)Prep specimens Aliquot specimens Specimen Integrity checkSort department specimensDynamic load buildManually Build worklist Set up instrumentation, controls and reagentsDelivery of specimensShift performedWorklist NameFUTURE PRODUCT FAMILYF amily Product NameDepartment Name (Current)Questions: Who, What, Where, When, How, How often, With what?

5 Organize and re-supply work areaInstrument shut downManual or auto bank specimensFind additional specimen if QNSP rint Pending listResult Release Mode: Manual release results (by batch or accession)Result Entry Mode (into LIS)% Repeat RunsExtra specimen workup ( ultra centrifugation, dilution etc)Check QC, Accuracy, Outliers for repeats and Sample integrity (LIH)Run and monitor instrumentLoad Specimens and QC on to InstrumentSpecimens placed in instrument Rack Testing performed manually or automatedBubble Diagrams used to develop Product Family MatrixMEASURE Product Family MatrixUsing DMAIC & Lean in Measure8 Current State Value Stream Maps identified opportunities to use Lean strategiesMEASURE Current State Value Stream MapsUsing DMAIC & Lean in MeasureCurrent State Layout Design was used to evaluate flow at a high levelMEASURE Current State Floor PlanUsing DMAIC & Lean in Measure9 Current State Spaghetti Diagrams were used to evaluate movement of specimens.

6 People and materialsMEASURE Spaghetti MappingUsing DMAIC & Lean in and Eliminate/Reduce Time- and Eliminate/ReduceNon-Value Added Steps Value in Process (WIP) set-up time(Cross Training is often implemented) Complexity/Increase a physical working environment that complements/supports the flow of work, is safe, clean and encourages the efficient and timely flow of specimens, supplies, ideas and a working environmentthat forces all process steps to be open and visible. Integration of Lean Objectives10 Future state focused on reduction of NVAANALYZE/DESIGN Ideas for Future StateUsing DMAIC & Lean in AnalyzeNot every good idea could be implemented within the timeframeANALYZE/DESIGN Prioritization MatrixOver 300 projects were identified as blue sky opportunities & then prioritized:What is Predecessor?

7 Is this a BB, GB or Nike Project? Score Processor to other Activity (Yes/No)2IT Resource Needed H (1) M (3) L (5)3$ Cost -H (1) M (3) L (5)6 Ease of Implementation -H (5) M (3) L (1)10 Business $ Impact -H (9) M (3) L (1)Product FamilyImprovement OpportunityWeighting63 Green Belt & Black Belt Projects were prioritized with anticipated cost/benefitUsing DMAIC & Lean in Analyze11 Framework for detailed designANALYZE/DESIGN Major design elements selectedUsing DMAIC & Lean in Analyze Improve logistics Inflow Implementation of alternate front end specimen processing system Conveyance Automated Sort Aliquot Cell Design by Product Family including 5S & Lean Supply Chain (PFEP) High priority IT enhanced systems projects Organizational changes to support automationUtilized internal and external resource expertise to validate the automated sorter/aliquoter equipment requirementsANALYZE/DESIGN Process ModelUsing DMAIC & Lean in Analyze logistics inflow/hr by work stream Processing req/hr/FTE by work stream # & type of specimens Aliquots per specimen Aliquoter & sorter specimens/hrANALYZE/DESIGN Process Model12 Using DMAIC & Lean in Analyze900 Items Inventoried Equipment Criteria Sheet was utilized to document requirements in a future state designANALYZE/DESIGN Equipment Criteria SheetSLP was used to design at a product family level.

8 Cell level & bench levelANALYZE/DESIGN Systematic Layout PlanningUsing DMAIC & Lean in Analyze13 Final workstation design incorporated ergonomic recommendationsANALYZE/DESIGN Ergonomic/Safety EvaluationUsing DMAIC & Lean in AnalyzeCompany wide 2002-2005 OSHA recordables were evaluated. Data evaluated current state workstation designs and the benefits of future state processing work cell design, including future stateintegration of conveyance and automated sort/aliquot equipment. External resource conducted analysis including posture, motion, force, duration & frequency of hands, wrists, elbows, shoulders, neck,back & legs. Final design recommendations integrated both the recommended workflow design changes and ergonomic design elements. Modifications for workstation height, reach, and process functions were made and included in the final CabinetASAspiratorBBalanceBPSB eckman Power SupplyCCentrifuge (Floor Model)CACabinet (Under Counter)C2 Centrifuge (Table Top)COConveyorCTCartCWCell WasherCYCytofugeKEYIMPLEMENT/ Improve Detailed Equipment Inventory was used to develop move planUsing DMAIC & Lean in Improve1700 Items were catalogued to be movedDept.

9 NumberKeyArchetectural #Elevation #Equipment IDDepartmentCell Name/SectionComponents25000SH2179 BClin ChemImmulite Section 1 Shelf250032179BE14105 Clin ChemImmulite Section 2(1) Immulite250042179BE14106 Clin ChemImmulite Section 3(2) Immulite250052179BE14107 Clin ChemImmulite Section 4(3) Immulite250062179BE20108 Clin ChemImmulite Section 5(4) Immulite250072179BE20109 Clin ChemImmulite Section 6(5) Immulite250082179BE19110 Clin ChemImmulite Section 7(6) Immulite250092179BE19111 Clin ChemImmulite Section 8(1) Dynex250102179BE19112 Clin ChemImmulite Section 9(2) Dynex250112179BE13 Clin ChemImmulite Section 10 Workbench25012Q2179BE13 Clin ChemImmulite Section 10 CRT25012Q2179BE12 Clin ChemImmulite Section 10 CRT14 Using DMAIC & Lean in Improve Equipment Criteria Sheet was tied to Numbers on Architectural PlansEquipGroup NameRoom Name / NumberEquipment Generic NameQuantityManufacturerModel (lbs)Depth (in)

10 673 ImmunologyImmunology / 2179 Tcentrifuge1 IECC entra MP410021674 ImmunologyImmunology / 2179 Tcentrifuge1 BeckmanAllegra 612027675 ImmunologyImmunology / 2179 Tcentrifuge1 BeckmanAllegra 612027676 ImmunologyImmunology / 2179 Tcentrifuge1 VanguardV6500<2512 IMPLEMENT/ Improve Equipment Inventory SheetCoordination was essential everyone had responsibilitiesIMPLEMENT/ Improve Hourly Move ScheduleUsing DMAIC & Lean in Improve15 IMPLEMENT/ Improve IT Project ManagementUsing DMAIC & Lean in ImproveSystem Updates New front end processing system Implementation Interface enhancements Label modifications Measurement tools (Lean Six Sigma Utility Report)Infrastructure Changes/Upgrades Data-line/Cabling strategies Hardware changes Phone System Coordination52 miles of CAT5E Cable installed enabling faster data transfer and increased capacityProjects tracked monthly to ensure coordination & on time completionIMPLEMENT/ Improve GB/BB Project PlanUsing DMAIC & Lean in Improve165S ownership is at a sub-department level this concept was launched in 2005 and refined during & following constructionIMPLEMENT/ Improve 5S DisciplineUsing DMAIC & Lean in ImproveSortresulted in disposing of 18 cubic yardsof unneeded items.