News, Analysis, Trends, Management Innovations for
Clinical Laboratories and Pathology Groups

Hosted by Robert Michel

News, Analysis, Trends, Management Innovations for
Clinical Laboratories and Pathology Groups

Hosted by Robert Michel
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Swedish Hospital Uses Lean to Advance Patient Care and Lab Services

With the theme of a “Lean Laboratory Supporting Lean Healthcare,” attendees at Lab Quality Confab this morning in Atlanta, Georgia, heard the remarkable story of Stockholm, Sweden-based St. Göran Hospital’s  Lean journey to improved clinical outcomes and better customer service for its patients. This 250-bed hospital serves 21,000 inpatients and 200,000 outpatients annually.

This story had added intrigue because it is healthcare delivered to the public in Sweden’s single-payer health system, provided by a privately-owned hospital! St. Göran Hospital is owned by Capio, a for-profit company that provides hospital, radiology, laboratory, and other healthcare services in eight European countries. Thus, it demonstrates how private sector Lean-based innovation and execution is advancing patient care in Sweden. In fact, St. Göran Hospital was sold to Capio by the Swedish health system at the beginning of this decade specifically to be a demonstration site to show other healthcare providers in Sweden how private sector initiative could produce innovation that improves the quality of care while lowering the cost of care.

In his presentation at Lab Quality Confab this morning, Tom M. Pettersson, Ph.D., Head of Development, for Capio Diagnostics/Unilabs at St. Görans Hospital, shared how Lean methods are being used to boost performance in each of the clinical departments, which then do inter-disciplinary Lean improvement projects as integrated teams. Step one, earlier this decade, was to make over the laboratory with an exhaustive application of Lean methods and principles. During this phase, process-ordered production was instituted throughout the laboratory, along with targeted automation solutions. At the same time, staffing was reorganized and laboratory staff satisfaction became a regularly measured attribute. The result was a significant contribution to clinical care through shortened turnaround times, improved quality, and significant reductions in errors.

But what captured the audience’s attention was Pettersson’s fascinating explanation of how, at the next phase, laboratory services played a role in improving work processes in the primary care and inpatient care continuums. Again, Lean methods and techniques were used to realign processes to respond to the voice of the customer while improving outcomes. Pettersson spoke at length about how this was accomplished in the Emergency Department (ED), in a project originally launched in 2005.

Lean techniques were used to address five targeted problems in the ED:

1.   We do too few things in parallel-this increases waiting time and reduces value.

2.   The best competences examine too few patients and that too late.

3.   Lack of coordination and routines.

4.   Working hours of doctors not synchronized with patient flows.

5.   There is much distractions and waste (Muda) in doctors’ work

These problems are common to emergency departments in hospitals in this country. What distinguishes the ED at St. Goran’s Hospital from most of their American hospital peers is how the use of Lean methods has improved the performance of its emergency department. Pettersson explained how the following six Lean approaches were utilized to change work flow through the ED, with impressive gains in patient throughput, outcomes, and reduced costs:

1.   Link activities-to recognize problems early.

2.   Activities in parallel-to gain time.

3.   Pull-next step in chain is prepared to receive the patient.

4.   Visualize-everyone sees what must be done.

5.   Takting (takt time) the flow-improve the working environment.

6.   Standardize-that we can see problems to solve (waste to eliminate).

What captured the audience’s attention was the range of solutions that were inspired by use of these Lean methods. For example, like most hospitals, C discharged the vast majority of its patients daily during the late morning and early afternoon-a batch mindset that has been changed. Now the hospital has a continuous flow of patients into and out of wards across the day and the evening. This has helped the emergency department move patients more effectively from presentation to treatment and either discharge or admit.

This is just one example of how Lean-inspired thinking lead to an unorthodox, but highly-effective solution to a problem common in most hospitals across the globe. That’s been the theme in presentations this morning, which included the laboratory profession’s first public look at the “smart room” developed at University of Pittsburgh (UPMC) . There will be more to come on events unfolding at this week’s Lab Quality Confab.


Robert Michel
Dark Daily Editor

Innovative Labs Combining Lean and Automation in Clever Ways

There’s a hot new trend emerging among a handful of the nation’s more sophisticated and tightly-managed laboratories. These innovators have hit on a “lab operation home run!” They are combining Lean process improvement methods with the latest-generation automation solutions and highly-automated analyzers. As a result, they are achieving mind-blowing, amazingly fast turnaround times while simultaneously boosting med tech productivity and slashing operational costs. At the same time, such labs are avoiding the pitfall of “automating bad work practices.”

These pioneering laboratories are demonstrating that laboratory automation has come of age-particularly when the laboratory uses Lean Six Sigma methods to configure an instrument footprint and specimen flow through the lab, thus taking maximum advantage of automated systems and analyzers. This is a radical change from just five and eight years ago, when lab automation was less capable and most labs knew very little about Lean and Six Sigma approaches.

At the University of Texas Medical Branch (UTMB) in Galveston, Texas, the hematology department was among the first labs to explore the benefits of digitized images, produced by automated systems. It was a beta site for the early automated microscope that is now often seen in hematology labs. Process improvement methods, including Lean techniques, were used to re-engineer work flow so that the performance of automated analyzers and digitized slide images was moved to a very high level of throughput and quality. At this year’s Lab Quality Confab in Atlanta on September 24-25, UTMB Automation Supervisor Laurie Emanuel will present a case study on how her laboratory has combined automation, middleware, digital imaging, and process improvement methods to deliver faster, higher-quality results, even as the number of med techs needed in the department’s analytical line declined from three to just one.

Combining new, sophisticated automation systems with the Lean mindset is transforming the histology laboratory at Avera McKennan Hospital and University Health Center in Sioux Falls, South Dakota. Exciting new automation solutions are arriving in histology and this laboratory, proficient in Lean techniques, is developing unique work flow and work process approaches that are already exceeding industry norms for turnaround time, productivity, quality, and cost-effectiveness. Leo Serrano, Director of Laboratory Services at Avera, will be sharing these secrets at Lab Quality Confab.

Another area where automation is beginning to alter long-standing work processes is microbiology. At BC Biomedical Laboratories in Surry, British Columbia, the microbiology laboratory installed a new automated specimen processing/preparation system, then watched in dismay as work backed up at the instrument (Proving the truth of that industrial engineering adage: “Don’t automate bad work processes.”). According to Scott Henwick, M.D., Clinical Director, Microbiology at BC Biomed, the micro team then turned to the help of an experienced veteran of Lean. Microbiology workflow was reconfigured to incorporate the best applications of “pull,” takt time, and small batch/single piece workflow. Those simple changes unlocked the productivity of the automated system and the micro lab is posting continuous improvements in all important metrics. Dr. Henwick will discuss this case study at Lab Quality Confab in a session titled: “Why Automation Bollixed Efficient Workflow in Microbiology and How Lean Fixed It.”

These three examples embody this new trend of innovative laboratories combining, blending, and integrating automation solutions with Lean, Six Sigma, and process improvement principles. Laboratory managers, pathologists, and others wanting to understand this powerful new opportunity in lab management will find the second annual Lab Quality Confab on Quality Management in Diagnostic Medicine to be a comprehensive resource. Lab Quality Confab will take place on September 24-25, 2008 at the Hilton Hotel in Atlanta, Georgia.

More than 50 sessions and topics will be presented, covering the full range of laboratory and pathology operations, ranging from specimen collection and courier logistics to using Lean with automation in the high-volume core laboratory. Poster sessions will take place, and national awards and prizes totaling $6,000 will be awarded. To see topics, speakers, and all the events at Lab Quality Confab, visit

To register for Lab Quality Confab, visit

Finally, laboratory vendors are waking up to this highly-productive intersection of matching their automated systems and sophisticated analyzers with Lean, Six Sigma, and similar process improvement techniques. At Lab Quality Confab, management master classes will be conducted on these topics by experts from Ortho-Clinical Diagnostics , Siemens Diagnostics , Sysmex , BD Diagnostics , Abbott Diagnostics , and Beckman Coulter , among others.

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