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In Focus
The Lean Healthcare Institute methodology is designed specifically for the pathology and diagnostic laboratory. Instead of learning about Lean through exercises that only apply to a manufacturing environment, LHI uses real cases from laboratory operations. Learn More |
Product & Services Guide 2011
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Greetings!
Thanks for being a subscriber and following the Nexus News. Visit us for ideas on management and continuous improvement programs for the lab. Also, access article archives for past issues at the Nexus News Archives. |
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When Automation Goes Bad
Brian Jackson, September 27, 2011
In the summer of 1997 I was touring a reference lab facility in the Denver area. They had recently installed a total lab automation (TLA) system which was all the rage at the time. With the new system, the medical technologists were concerned about quality while management was excited about becoming "cutting-edge" (the supervisors were caught in the middle and were looking forward to the weekends). The system, which essentially linked the major analyzers together with a conveyer belt ("track system") cost in the range of 1 million dollars. For that cost, the lab was able to save the time involved in transporting specimens, which was about 1% of the overall labor time involved in lab testing. So, for 1 million bucks, they saved 1% of the labor. This didn't seem to make sense to me, but the news was actually worse than that: the new track was prone to jams, disconnects and random incidents of failure. As a result, the lab had to hire 4 FTE to maintain the track.
A bad investment? Probably. There are different sides to the argument. One might say that the goal wasn't to save labor time, or improve on turnaround times (with which the track didn't help), but rather to create consistency. If there is one thing that automation can accomplish it is this: creating a standardized process. It sounds obvious, but automation does have a funny way of doing the same thing, the same way, every time (except when it breaks-down).
In the fifteen years since, we at Nexus have seen all kinds of automation in the clinical and pathology laboratory, from "islands" of automation, to automated processing systems, to assisted slide screening devices and even slide makers that also stain. We also have seen little boxes resembling a Nintendo that actually perform STAT testing at the bedside. Some of these systems have gone bad, and some have provided a payoff like a lottery winning ticket. Making the right bet does involve some luck (i.e., not buying a lemon), but at Nexus we have found that your chances are better with the following in mind:
- Improve the process first: automation is only one part of the value chain: the process must support the automation
- Don't be an early adapter - it is fun to be the first on your street to get the iPhone or Android, but in the lab, a bad decision has serious ramifications
- Research - find impartial, data driven comparisons on the automation class (Nexus and others provide this information)
- Purchase a Lean-enabling device over one that isn't (more information at the LHI site)
- Provide a detailed RFP that requires the vendor to prove its products value and provides integration services to your lab's workflow
- After buying, control the process through continuous improvement - always remember that automation isn't the answer, only one step toward an improved operation
Read the Full Article
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Nexus Event Schedule Remaining in 2011
G-2 Lab Institute 2011, October 19-21 in Arlington
AABB (American Association of Blood Banks) October 22-25 in San Diego
AMP 2011 Annual Meeting, November 17-19 in Grapevine, Texas
Partnerships
Market research partners are being sought for anatomical pathology, molecular diagnostics and general clinical chemistry studies. Contact Nexus for more information (honorariums typically provided): Click to Contact Nexus |
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Service in Focus: Systems Improvement
In management science and operations improvement, a 'system' is defined as a set of elements (especially processes) that are working in concert to accomplish a goal. A system can be a chemistry lab or a manufacturing line. It can also be 2nd grade math class, the Alabama football program and the body's circulatory system. Regardless of the function, the system must first be recognized, its goals understood and current situation quantified before it can be improved upon. Here are two examples:
- A system that is relatively easy to optimize is the Wal-Mart checkout lane. The system is easy to understand (customer's pay for goods), the goal is straightforward (fast and efficient checkout while not missing anything), and the process can be measured. Systems engineers have made careers out of optimizing this relatively easy system through queuing theory, technology (like self-service kiosks) and peak-load staffing.
- A system that is more complex is the airline security system. Although it can be quantified and optimized to some degree, the basic problem starts with the goals of the system. According to the TSA website, the TSA has "established a multi-dimensional strategy to reconcile the requirements of the mandate (to screen all passengers and baggage), the security needs of passengers, and the needs of a U.S. economy that relies on an air cargo industry. Talk about a mandate. So, in addition to screening us for sharp objects, they must support the U.S. economy...
In the Six Sigma methodology it is generally understood that the most important aspect of a project is the Define phase, for without a well-defined problem, there can be no solution. So it is in Lean and other systems improvement projects. Click to request more information... |
Tools of the Trade: See the Problem
Identifying waste (in a laboratory process or any business process) is an important step in the continuous improvement philosophy. Without visualizing the opportunities, it is hard to fix them. Value stream mapping (VSM) is an important tool to understand the steps in the workflow and their relationship to people, information and resources. Although the method was popularized with the Toyota Production model (and Lean), it is generally an old practice in a new, improved skin. An older, but effective method was simply to "staple yourself to the order", or (in the lab) "be the tube". By following the tube through each sequential process, the manager can truly see the bottlenecks, extra processing, backtracking and other opportunities that occur. |
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