Concepts for Lean laboratory organization

J Med Biochem 2010; 29 (4) DOI: 10.2478/v10011-010-0036-5 UDK 577.1 : 61 ISSN 1452-8258 J Med Biochem 29: 330 –338, 2010 Review article Pregledni ~lanak CONCEPTS FOR LEAN LABORATORY ORGANIZATION KONCEPT ORGANIZACIJE LEAN LABORATORIJE Gabriele Halwachs-Baumann Department for Laboratory Medicine, Central Hospital Steyr, Steyr, Austria Summary: In the last decades, hospital laboratories are beset on all sides by demands to lower the costs of laboratory procedures and at the same time to provide (i) more rapid and usable services, (ii) a broader spectrum of parameters, and (iii) process a higher frequency of specimens. These demands are voiced by patients, physicians, hospital administrators, and governmental agencies. Thus, laboratory management is required to decrease costs, increase efficiency, and promote customer satisfaction under the consideration of quality to be of primary importance. Beside the main task of a laboratory (i.e. the analysing of patient specimens, interpretation of results, expert advice for clinicians), quality management, education of technicians and medical staff, research and development, and development of economic strategies are important duties and responsibilities. A lean laboratory organisation is an important condition to cope these duties. Lean laboratory concepts have to include the preanalytical, analytical and postanalytical period. Strategic planning decisions have to be based primarily on information derived from the external environment and have to be long-term. Lean laboratory concepts always have a holistic view, including medical demands and economic aspects. An example will be shown of how lean laboratory concepts influence the organisation, efficacy and performance of a hospital laboratory. Keywords: automatization, Lean laboratory Kratak sadr`aj: U poslednjih nekoliko decenija, bolni~ke laboratorije suo~ene su sa zahtevima za smanjenje tro{kova laboratorijskih postupaka i istovremeno i) pru`anje br`ih i dostupnijih usluga i ii) obra|ivanje {ireg spektra parametara i iii) ve}e frekvencije uzoraka. Ovi zahtevi poti~u od pacijenata, lekara, bolni~kih uprava i vladinih agencija. Tako se od uprave laboratorije o~ekuje da snizi tro{kove, pobolj{a efikasnost i omogu}i zadovoljstvo klijenata, pri ~emu kvalitet ima presudnu ulogu. Pored glavnih poslova laboratorije (npr. analiziranje uzoraka pacijenata, tuma~enje rezultata, stru~no savetovanje klini~ara), va`ni zadaci i odgovornosti ti~u se upravljanja kvalitetom, edukacije tehni~ara i medicinskog osoblja, istra`ivanja i razvoja, kao i razvijanja ekonomskih strategija. Organizacija »Lean« laboratorije va`an je uslov za uspe{no obavljanje tih zadataka. Koncept »Lean« laboratorije mora obuhvatiti preanaliti~ki, analiti~ku i postanaliti~ku fazu. Strate{ke odluke o planiranju moraju biti dugoro~ne i pre svega zasnovane na informacijama iz spolja{nje sredine. Koncept »Lean« laboratorije uvek podrazumeva holisti~ki pristup, koji uklju~uje medicinske zahteve i ekonomske aspekte. Bi}e dat primer na koji na~in koncept »Lean« laboratorije uti~e na organizaciju, efikasnost i delatnost bolni~ke laboratorije. Klju~ne re~i: automatizacija, »Lean« laboratorija Introduction Address for correspondence: Univ. Prof. Prim. Dr. Gabriele Halwachs-Baumann Department of Laboratory Medicine Central Hospital Steyr Sierningerstrasse 170 4400 Steyr, Austria Phone: +43 (0)5055466 25300 Fax: +43 (0)5055466 25304 e-mail: gabriele.halwachs-baumannªgespag.at Laboratory testing is an integral part of the decision-making process, and results of laboratory testing often strongly influence medical diagnoses and therapy. In about 65% of cases the clinical Abbreviations: GDP: gross domestic product, STAT: short turn-around time; POCT: point of care testing, FTE: full time equivalent J Med Biochem 2010; 29 (4) 331 laboratory is essential for the determination of diagnosis (1, 2). In contrast to this, the costs for laboratory diagnosis are nowadays only 1.5–2.5 % of the total health expenditures (3, 4). That means a reduction of cost of about 2 percent points in the last ten years (i.e. in the mid nineties the laboratory costs were about 3.5–5 % of the health expenditures) (5–7). Since health expenditures all over the world increase continuously (Table I), politicians and thus the management of hospitals demand reduction of cost. Irrespective of the low share of expenses the hospital lab is often blamed for costs too much, and outsourcing to an outside lab seems to be the solution to that problem. Although that might bring a short-dated benefit, for longer periods the expenditures can be expected to rise, due to increasing consequential charges at clinical departments (longer hospitalization of patients, increasing application of blood products, etc.) and increasing STAT and POCT services. To avoid this undesirable development, the challenge for the lab and hospital is to evaluate critically the situation and to remedy systemic problems inside the hospital, so that they would be able to compete with outside labs. Along the pressure to contain cost and operate efficiently, regulatory requirements, health-care trends and technological/equipment advances significantly influence changes in clinical laboratories (8, 9). Beside the main tasks of a laboratory (i.e. the analysing of patient specimens, interpretation of results, expert advice for clinicians), quality management, education of technicians and medical staff, and research and development are important duties and responsibilities. In a 2004 study (8) the top five reasons impacting change in the clinical laboratory were the need to (10): 1. reengineer workflow 2. decrease turnaround times 3. reduce errors in testing or reporting 4. have availability of qualified staff 5. increase outreach. So the lab manager has the problem of squaring the circle: to process a higher frequency of specimens and a broader spectrum of parameters and at the Table I Total expenditure on health (% GDP) in some OECD member states (www.oecd.org) 1998 (% GDP) 2008 (% GDP) Austria 10.0 10.5 Germany 10.2 10.5 Slovenia 7.9 8.3 Slovak Republic 5.7 7.8 United Kingdom 6.7 8.7 United States 13.4 16.0 same time reduce costs, but comply with the increasing demand for quality and reduced turnaround time. And all that has to be performed by less staff. Lean Laboratory Organization is an important condition to cope with this »lab paradox«. What does »Lean Laboratory Organization« mean? »Lean Laboratory Organization« is based on »Lean Thinking«, a management system whose origins lie in post-World War II Japan. At that time Toyota developed the Toyota Production system, with its pillars of »Just in Time« and »Built-in-Quality« (11). The goal of Lean Thinking is »the endless transformation of waste into value from the customer’s perspective«, where waste is »anything that does not add value to the final product or service, in the eyes of the customer«, and value is »the capabilit (...truncated)