Doing More with Less:
Lab Improves Speed and Efficiency without Adding Staff

By Jeff Seiple
Administrative Director of the Laboratory<
Holy Spirit Health System
Camp Hill, PA

The Holy Spirit Health System microbiology lab was struggling with the same staffing challenges many microbiology labs face every day – an aging workforce with a shortage of skilled resources to replace them. The lab needed a solution to elevate productivity, improve staff utilization and compress time-to-result.
Like so many hospital labs across the country, we struggle with workflow, turnaround times, training and competency in an age when tests are becoming more and more complex, as well as staff shortages and environmental and quality assurance monitoring. However, from my perspective, the key to solving all of these problems was improving our efficiency. There is no point in addressing validation, monitoring and staff competency if the system itself is inefficient. Thus, I set the goal to fix efficiency first, then reevaluate the lab’s other challenges. I knew that improved efficiency, achieved by implementing a more practical workflow plan and getting the most out of our equipment, would make our other challenges much easier to solve.

On the surface, it looked like we simply needed more hands, but hiring new staff was not an option for us in addressing the workflow and efficiency problems at our lab. In fact, even if we could hire, there is a shrinking population of skilled lab scientists to pull from. We simply had to find another option.

About Holy Spirit Health System
Holy Spirit Health System is a 319-bed facility that serves patients in Camp Hill and Harrisburg, Pennsylvania, the state capital. Our hospital has seen its footprint grow dramatically in the last decade. In 2003, Holy Spirit Hospital opened a start-of-the art cardiac facility: The Ortenzio Heart Center.  Holy Spirit Health System includes a regional outpatient network of six family health centers, one internal medicine office, a general surgery practice, a cardiothoracic surgery practice, a pediatric practice and women's health center with two convenient locations. The network also offers emergency and urgent care at the John R. Dietz Emergency Center, with the latest technology and medical workspace and board-certified emergency physicians. The hospital also has a Level III Neonatal Intensive Care Unit on-site and is a regional leader in laparoscopic surgery. Holy Spirit is one of the only hospitals in the state that offers the da Vinci Si® surgical robot for gynecology, gynecologic oncology, urology, urogynecology and cardiothoracics.

LEAN and the Lab
I had seen the benefits of LEAN in other areas of healthcare throughout my career, so I was eager to apply this discipline to our lab.  I knew that if we decided to apply LEAN process improvement to the lab, we would go with bioMérieux’s Performance Solutions LEAN Lab service. I based this on my past experience with bioMérieux. The organization stands for quality so I couldn’t imagine that bioMérieux would do LEAN any differently than they do everything, and that’s with a commitment to excellence.

In many ways, the modern microbiology lab is facing the “perfect storm” of challenges. We turned to a LEAN lab approach to help us cope with two competing demands that face nearly all labs today: an aging workforce with a shortage of skilled lab scientists to replace them and the need to increase productivity and turnaround times, while at the same time decreasing errors – in other words, to do more and better work with fewer resources. On the surface, this might seem impossible, but we’ve managed to do exactly that: we have increased productivity, customer service and satisfaction and decreased our turnaround time.

Working with Consultants Who Understand Microbiology and the Modern Lab
Early in the partnership, we identified three key problems and mapped out solutions for each:

  • Maximize resources and automation of the lab to improve efficiency
  • Greatly reduce or eliminate errors, and re-work of redundant processes
  • Train key personnel and staff on LEAN principles and establish a core knowledge of best practices

The first step in this process for us was the acquisition of bioMérieux’s PREVI® Isola, automated plate streaking system for microbiology specimen processing . This pre-analytical microbiology automation station has improved our efficiency, workflow and standardization and allowed us to free up valuable staff for analysis and plate reading. It has improved our productivity with greater consistency, fewer repeat cultures and more isolated colonies to work from.

As part of this acquisition, our microbiology lab underwent a LEAN Lab Assessment. The LEAN  team came in and walked through the entire process with our staff to put them at ease and to explain LEAN and the implementation of the “Kaizen” continuous improvement principles. The LEAN team immediately impressed all of us in the lab at Holy Spirit. There are a lot of consultants meandering through a hospital at any given time, but very few of them are trained and experienced microbiologists who inherently understand the unique demands of the hospital lab. This was the team we wanted – they understood us instantly and didn’t need us to bring them up to speed on the day-to-day workings of a large hospital laboratory.

As with any complex and iterative process, I knew there were inefficiencies in our operations, but sometimes it takes an outsider to provide the clarity that you can lose when you are very close to a process. So, I wasn’t surprised by the LEAN assessment report. What surprised me was how well our staff embraced the recommended changes and how enthusiastic they have been as we continue to apply LEAN continuous improvement principles to problems that they may have once thought were unsolvable.

Once we finished with the microbiology lab, we went back and applied LEAN to the entire lab. Again, the biggest surprise for me has been our staff’s reaction. With each new achievement and celebration, the staff embraces LEAN more and more and moves onto another problem.

This is what is really impressive about LEAN: there’s no end to the process, you just keep going and going and improving and improving. A system as dynamic as a hospital lab grows and changes on a constant basis. The LEAN Kaizen principles brought into our lab are ideal for such a fluid and dynamic process. They are also ideal for team building. Kaizen is built on the principle of shared responsibility for the quality. Everyone has the opportunity to suggest a solution. With each new challenge, a team is formed to formulate a solution and to design the implementation of that solution. There’s a lot of trial and error but you always emerge better than you were at the beginning of the process. This is why I think our staff has been so supportive of LEAN. They own the process and they feel empowered to improve the quality of their work.

Most people want to do excellent work. Apathy becomes a problem when team members feel there is no solution or they have no voice. The bioMérieux LEAN system has changed all of this for the better.

The Proof is in the Results
While staff satisfaction was a fantastic benefit from our LEAN assessment, it was not our primary goal and is far from the only improvement we have seen. We have seen a decrease in our turnaround times, which has improved patient outcomes and is very much appreciated by our clinicians.

On the patient satisfaction side, one of the most significant problems with lab inefficiency is the need to repeat blood draws from patients. And, as anyone in healthcare knows well, nothing is more frustrating for patients than repeated sticks. An efficient lab optimizes each blood draw so that stick redundancy is minimized. Patient satisfaction in this regard has improved dramatically as a result of this improvement.

We have also reduced our time from order to collection, particularly for stat tests. I’ve personally received feedback from nearly every department in the hospital. In fact, a peer of mine who is an administrator in another department just asked me about LEAN because he wants to apply it to his process.

Conclusion
Our lab is reporting increased productivity, reduced staffing levels and a higher level of customer service and satisfaction. We no longer worry about hiring more staff because we don’t need them. We’ve optimized our workload and matched staff to our peak demands and achieved great improvement without a single new hire. We consistently deliver faster turnaround times and provide lab results on morning charts prior to physician rounds.

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