Can a decades-old idea from the auto industry breathe new life into laboratory management?
Lean production, or simply “lean,” is a systematic method for eliminating waste and streamlining processes. It is an idea worth revisiting at a time when social and digital media are driving fundamental changes in healthcare. Patients are increasingly better informed of treatment options, and their expectations have never been higher.
Healthcare growth areas such as human genetic and molecular diagnostics, new techniques for screening and early disease detection, monitoring chronic conditions, point-of-care and personal device testing all put further pressure on traditional laboratories. Meanwhile, the number of stakeholders with an interest in these services also challenges laboratories. They include healthcare workers, payers, providers, public agencies, and, increasingly, patients wanting ownership of their health records.
Laboratories have had to adapt and become more efficient. Funding models have changed to emphasize patient outcomes over traditional fee-for-service models. The need for operational efficiency comes at a time of shrinking budgets, escalating input costs, and tight resources.
It is increasingly challenging to manage a laboratory with legacy laboratory information management systems (LIMS). Sophisticated information systems are needed to support the logistics, measurement, planning, and analytics to create a responsive organization.
Consolidation is Not the Only Way
Healthcare systems across the world are pursuing consolidation strategies to improve efficiency. In the UK, the February 2016 Carter Report confirmed the success of consolidating pathology services, resulting in more efficient services in the English National Health Service (NHS). New technologies and scalable operations have brought significant savings to the NHS while quality has been maintained or improved.
Even greater efficiency gains are possible with an ongoing improvement program. Transforming laboratories into an agile and responsive pathology service capable of continuous improvement, however, requires new-generation software that captures and delivers real-time relevant information to support responsive, evidence-based decision-making.
Healthcare has generally been slow to adopt the techniques that have improved quality and safety in other industries. Many claim that medicine is too different and too complicated, and that advances in other industries are not applicable. Others argue that the prevalence of medical errors and a lack of processes, often only exposed by litigation, mandate that changes be made.
Lean Principles Can Revitalize Lab Services
Recently, there has been a surge in healthcare initiatives utilizing lean principles. They center on continuous improvement, but maintain respect for the rights of individual consumers. They address service and quality issues while containing healthcare costs that have been spiraling faster than the inflation rate in almost every country.
Some laboratories have adopted lean principles in response to increased demand. Lean is a systematic approach to process improvement, focusing on reducing variations and eliminating waste to balance the process or workflow. In the laboratory, lean principles create an opportunity to revitalize processes and improve service delivery.
Lean adoption brings its own challenges. Significant change faces inevitable resistance, as people fear losing their jobs or not coping with new requirements. Challenging preconceived and embedded beliefs about laboratory work requires uncomfortable critical thinking about the actual value to the customer of many routine or historically accepted tasks.
Determining the real value of each action reveals the most suitable protocols to achieve desired outcomes. You can design a process from end to end to optimize each step, taking advantage of automated platforms and parallel tracks to enable sorting and workload allocation. Standardizing processes reduces variation in outcomes and allows comparison and benchmarking across sites to continually improve efficiency.
Overcoming Resistance With Evidence
Lean initiatives can only overcome resistance to change with evidence that they work. This is now practical with modern information systems. Laboratories can monitor compliance with procedure and process, capture and analyze data to produce useful information, and enable better decisions in real time.
When improvements in turnaround times, costs, and the quality of test results are all captured, then enhanced operational performance can actually be proven. Reducing errors and faulty results reduces retesting, lowers costs, improves safety for patients and employees, and minimizes wastage of reagents and manpower.
However, this quantification requires built-in measurement of performance indicators and cost drivers. Accurate measurement proves to management and funders that interventions make the laboratory more efficient. Management dashboards that monitor real-time data relevant to the laboratory’s operational function and performance, and are flexible enough to enable responsive planning, also support more agile responses to changing circumstances.
Quantifying the actual cost, both fixed and variable, to perform tests enables better utilization of resources. Managing stock for just-in-time ordering and reducing reagent costs contribute to lower overheads. Software that captures and reveals each cost supports day-to-day management of processes and facilitates planning and budgeting. Understanding the volume of tests and expected demand allows logistic planning and staff management.
Most legacy LIMS in use today do not have these capabilities.
Demands to measure and understand performance call for a new breed of system, which InterSystems calls a laboratory business management system (LBMS). New-generation IT platforms that support the operational input requirements of laboratory processes and make the data visible via dashboards and easy-to-use analytics are essential to implement lean principles. Service-level agreements continue to demand improvement and require governance and robust technology that demonstrates compliance with the improvement cycle.
By standardizing existing processes, laboratories can reduce development times for new tests and streamline implementation processes. The laboratory can quickly increase its repertoire of tests to remain competitive with the least disruption to existing services. An LBMS with full traceability and audit capabilities will enable compliance with onerous accreditation processes and audits that may otherwise require weeks of preparation. This incorporates the assessment process in daily activities and is easily visible on the day of the accrediting authority visit.
Ultimately, pathology is often seen as a driver of medical cost that continues to receive a shrinking slice of healthcare budgets. There is an understandable fear that new technologies and tests – including personal genetic testing and new diagnostic molecules – could escalate costs.
Any service improvement must be evaluated against a clinical outcome that is measurable and quantifiable for the patient. This requires easy integration of laboratory results with the electronic patient record to support clinical decision-making and minimize over-ordering of tests.
Driving continuous improvement is essential for laboratory survival, as is the need for underpinning information analysis that supports laboratory management and empowers staff to contribute to sustainable service provision.
About the Author:
Dr. Gene Elliott MBChB, FC Path (micro), M Med (micro), MBA, is a Physician Executive for InterSystems and has practiced as a pathologist in both the private and public health sectors. Previously she was Head of the Department of Microbiology at the University of the Free State School of Medicine in Bloemfontein, South Africa. As part of her MBA, she focused on lean management and has spent more than 10 years practicing as a physician in both rural and urban settings before pursuing her specialization. Dr Elliott is based in Johannesburg, South Africa, and advises a wide range of organizations at a strategic level on clinical and operational matters.