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© 2008 Chi Solutions, Inc. Proprietary and Confidential.
Lab Space Planning and Facilities Design
September 25, 2008Wayne D. Mercer, PhDSenior Consultant, Operations Management
© 2008 Chi Solutions, Inc. Proprietary and Confidential.1
Lab Space Planning and Facilities Design
How to Apply Lean to Your Lab Before You Call the Architect and Contractor
Wayne D. Mercer, Ph.D.Senior Consultant, Operations [email protected]
© 2008 Chi Solutions, Inc. Proprietary and Confidential.2
Presentation ObjectivesDescribe the elements of a design project.
Describe how to plan a design project for a clinical laboratory.
Describe some key features of effective lean design.
Present some examples of using lean to improve operational efficiency.
Describe some things to avoid.
Present a limited case study of using lean to design a core laboratory.
Answer any questions that you may have.
© 2008 Chi Solutions, Inc. Proprietary and Confidential.3
Lean Six Sigma ToolsLean - Reduction of wasteStandard work processesSingle piece workflowFMEASIPOCDMAICDMAVI5SVisual management systemsMistake avoidanceWork balancing Value stream map
Operational RequirementsMultiple disciplinesMeet service requirementsReduce expensesFlexibility for growthFlexibility for new requirements
Design/Engineering ActivitiesSite selectionSpace programming Sub-block adjacenciesWorkstation requirementsWork cell designFacility/building system surveysSchematic design
Lab Design Requires a Multidisciplinary Approach
© 2008 Chi Solutions, Inc. Proprietary and Confidential.4
Clinical Pathology:Multiple Disciplines with Highly Automated and Manual Procedures
© 2008 Chi Solutions, Inc. Proprietary and Confidential.5
Anatomic Pathology:Multiple Services with Technical and Increased Professional Components
© 2008 Chi Solutions, Inc. Proprietary and Confidential.6
Support Space:Phlebotomy/FNA, Teaching, Staff Amenities, Offices, Admin Support
© 2008 Chi Solutions, Inc. Proprietary and Confidential.7
Application of Lean Six Sigma to Design ProjectsApplying DMAVI for the overall design process.
Identifying operational processes that need improvement through a detailed operations review.
Using lean concepts for the actual facility layout.
© 2008 Chi Solutions, Inc. Proprietary and Confidential.8
Lean Facility Design and Planning Process
AnalyzeServices
AnalyzeCurrent
Equipment
AnalyzeCurrent
Process Flow
IdentifyCustomer
Issues
AnalyzeCurrentSpace
AnalyzeOrganization
Structure
FacilityReview
AnalyzeInventory
System
OperationsReview
FutureLayout
StrategyFormulation
Develop High-Level Version of Design Notes and Operating AssumptionsIncorporate Technological Changes or New Requirements
IdentifyKey
Affinities
IdentifySupportingActivities
IdentifyWorkstation
Requirements
DevelopFuture
Process Flow
IdentifyConstraints
CalculateNeededSpace
CreateHigh-Level
Space Plan(s)
Develop Floor Plansand Cost Estimates
Evaluate SpacePlan Options
Project Preplanning, Development of Balanced Scorecard StrategyReview of System/Master Facility Strategic Plans
Strategic Planning
Schematic Design
© 2008 Chi Solutions, Inc. Proprietary and Confidential.9
A Lean Approach to Pre-Design Activities:Develop a Project Plan
Define the purpose and scope of project
Design of new lab vs. renovationSystem consolidation and savings opportunitiesPrepare for volume growth (e.g., outreach)Limited reconfiguration (e.g., install automation)
© 2008 Chi Solutions, Inc. Proprietary and Confidential.10
A Lean Approach to Pre-Design Activities:Develop a Project Plan
Timeframe
When will the project start and when is it expected to be completed?
Do you need interim solutions?
Allow sufficient time for:Operations reviewsStrategy formulation Development of high-level space plan optionsSchematic design
Recognize that laboratories are complex environments to design
Consider impact of other major activities (e.g., LIS upgrades/ changeovers)
© 2008 Chi Solutions, Inc. Proprietary and Confidential.11
A Lean Approach to Pre-Design Activities:Develop a Project Plan
Perform strategic review of capital equipment requirements
Replacement cycleWill replacement be part of design project?
Prepare for growth needsVolumeNew or replacement technology
Consider impact of workstation consolidation
Are you planning on automation?
© 2008 Chi Solutions, Inc. Proprietary and Confidential.12
A Lean Approach to Pre-Design Activities:Develop a Project Plan (cont.)
Develop a Lab Design Project Team and Executive Steering Committee
Senior ManagementMedical Director(s)Lab StaffDesign and ConstructionFacilitiesStrategic Planning DepartmentIT, TelecomBiomed/Tube System EngineeringMaterials ManagementReal Estate ManagerHR
Identify additional resources needed Lab Consultants Architect/Engineering
© 2008 Chi Solutions, Inc. Proprietary and Confidential.13
A Lean Approach to Pre-Design Activities:Develop a Project Plan (cont.)
Financial issues and business plan development
Cost per SF ranges from $250 to $1,350 with median of ~$500 50,000 SF Lab @ $500/SF = $25,000,000
Return on Investment (ROI)Many projects will have acceptable ROI of two to five years due to operational savings
Consider life of building to calculate FTE savings75K per year X 20 years = $1.5 million over life of facility
Consider financial impact of alternative use of space
© 2008 Chi Solutions, Inc. Proprietary and Confidential.14
Using Lean Effectively for Design ProjectsIdentify customer requirements through interviews and applying service metrics as part of a balanced scorecard approach.
Identify/classify lean opportunities by performing an operations review.
Develop the facility plan to meet customer requirements and to minimize wasted space and personnel movement.
© 2008 Chi Solutions, Inc. Proprietary and Confidential.15
Balanced Scorecard Approach:Cost Is Important and So Are Other Factors!
PeopleInstitutional CultureEffective Utilization of Human ResourcesWork Environment and SafetyStaffing Shortages in the Lab Industry
ServiceTest Menu Standardization and CompletenessLeverage Use of New TechnologyMeet Service Requirements of Medical Staff
FinancialOpportunity for Expense ReductionOptimal Use of Available CapitalMinimize Project Risks
StrategySystem Strategic Care/Business PlansMaintain/Improve Service QualityMaster Facility Plan
© 2008 Chi Solutions, Inc. Proprietary and Confidential.16
Customer Requirements Drive Service Model
Document:Any service deficienciesNew requirementsDefine/measure service metricsSpecimen collection and results reporting processes
Identify/interview key customers:EDICUsNursing Floors Outpatient PSCOutreachSpecialty Clinics
© 2008 Chi Solutions, Inc. Proprietary and Confidential.17
Schematic Design Notes:Customer Requirements/Specimen Collection
Currently, accessioning for outpatients is performed at both the main specimen processing area and at some patient service centers (PSCs). It is assumed that this activity can be fully performed at the PSCs with minimal necessity for accessioning activity space in the core lab and to improve billing/collection processes (e.g., ABN compliance).
Bedside bar code scanners/printers will be employed for specimen collection and to accomplish positive patient ID goals.
Phlebotomy and nursing staff should send specimens using as small a batch as possible to facilitate continuous workflow and improve turnaround time.
A pneumatic tube system with a diameter of six inches will be used to transport specimens and blood products to/from patient service areas and the lab.
A direct connection is desirable to key service areas such as Transfusion Services, Emergency Department, Operating Rooms, Labor and Delivery, and Intensive Care Units of the hospital.
The core laboratory should provide an absolute turnaround time of 30 minutes for selected automated tests. Current performance is 90% completion at 60 minutes.
© 2008 Chi Solutions, Inc. Proprietary and Confidential.18
Lean Opportunities in the Lab:Identification of Waste in Specimen Processing
Waiting: Specimens in receiving area awaiting sorting
Over Processing: Taking requisitions in/out of bags
Transportation: Unnecessary walking to deliver specimens
Over Production: Process/sort several buckets before passing them on
Inventory: Buildup of specimens due to simultaneous delivery bycouriers
Moving: Back/forth physical movement due to poor workstation layout
Fixing Defects: Mislabeled/improperly labeled tubes
© 2008 Chi Solutions, Inc. Proprietary and Confidential.19
Operations Review:Reduce Over Processing/Improved Efficiency Will Reduce TAT, # Workstations
First member of processing staff removes requisition from specimen bag.
Same staff member returns requisition to specimen bag.
Next processor has to repeat removal.
© 2008 Chi Solutions, Inc. Proprietary and Confidential.20
Typical Results
6 minutes25 minutesTime to process 10 requisitions before
testing
20 steps34 stepsNumber of steps
before specimen is available for testing
New ProcedureCurrentItem
Effective use of triage
Elimination of unnecessary/redundant activities
Change in order of processing steps
Put problem requisitions aside
Perform patient registration in billing area
© 2008 Chi Solutions, Inc. Proprietary and Confidential.21
Use of bar code-based software system for specimen storage and retrieval
Operations Review:Identification of Inefficient Processes for Specimen Storage and Retrieval
© 2008 Chi Solutions, Inc. Proprietary and Confidential.22
Operations Review:Identification of Inefficient Processes Due to Design and Organization
Differential area is >60 feet away from automated hematology area
Manual testing reported to a different supervisor than the automated testing areas
You may have to consider changing organizational reporting structures
© 2008 Chi Solutions, Inc. Proprietary and Confidential.23
Operations Review:Use of Techniques to Improve Efficiency/TAT
Develop paperless systems
Use of auto-verification
Revision of delta criteria
This laboratory went from less than 30% of Chem Panel results within 60 minutes to more than 90% in 30 minutes or less without track-based automation systems!
© 2008 Chi Solutions, Inc. Proprietary and Confidential.24
(2-3) Automated Chem
(2-4) Immunoassay
Equipment Consolidation:Chemistry/Spec Chem/Tox/Endocrinology/Immunology
(2) Roche 917(4) DPC ImmuLite(1) Abbott Axsym(2) Roche Elecsys(1) Beckman Array(1) Biorad Variant(3) Abbott TDX(2) Abbott IMX(1) Nova 5(1) Nova 16(1) AVL(1) ABL(1) Abbott Commander(1) Biosite Triage
© 2008 Chi Solutions, Inc. Proprietary and Confidential.25
System Capacity Analysis
0
500
1000
1500
2000
2500
MIDN-01
0001
00-020
002
00-030
003
00-040
004
00-050
005
00-060
006
00-070
007
00-080
008
00-090
009
00-100
010
00-110
011
00-120
012
00-130
013
00-140
014
00-150
015
00-160
016
00-170
017
00-180
018
00-190
019
00-200
020
00-210
021
00-220
022
00-230
023
00-240
0#
TEST
S
TESTS CAPACITY
© 2008 Chi Solutions, Inc. Proprietary and Confidential.26
Turnaround Time Analysis
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
45.0
0500-0600 0600-0700 0700-0800 0800-0900 0900-1000 1000-1100 1100-1200
Accession Time (Min) Centrifuge & Transport (Min) Production Delay Time (Min)Time to First Result (Min) Est Analysis Time (Min) Review / Release Time (Min)
© 2008 Chi Solutions, Inc. Proprietary and Confidential.27
Sub-Block Design:Consider Impact of Automation/New Technologies
Typical system of two or three Chemistry analyzers and two Immunoassay analyzers requires 800-1,500 SF for equipment only.
© 2008 Chi Solutions, Inc. Proprietary and Confidential.28
Typical system of two to four Hematology analyzers with slide maker/ stainers requires 300-500 SF for equipment only.
Design for flexibility…Manufacturers are adding new capabilities to automated hematology systems (e.g., HbA1c).
Consider use of task-targeted automation (e.g., digital hematology).
Sub-Block Design:Consider Impact of Automation/New Technologies
© 2008 Chi Solutions, Inc. Proprietary and Confidential.29
Identification of Inefficient Processes Due to Design
An open lab is not the same thing as a lean-designed lab!
© 2008 Chi Solutions, Inc. Proprietary and Confidential.32
Change of Process
Change of process may be needed!
The STAT lab was removed after the work was integrated into the automated system.
© 2008 Chi Solutions, Inc. Proprietary and Confidential.33
Sub-Block Design:Use of Lean Techniques for Supply Storage
© 2008 Chi Solutions, Inc. Proprietary and Confidential.34
Schematic Design Notes:Core Laboratory
The laboratory will use online data storage and strive to be paperless.
Automated equipment interfaces will use auto-verification, and the Delta check criteria will be revised to be consistent with linear ranges and medical necessity.
Supplies will be stored within the laboratory areas to operate for up to a 72-hour period. They will be replenished daily by Materials Management using reorder points that will be reviewed quarterly.
High density storage systems will be used to store supplies within the lab storeroom.
The cold room or refrigerators will be rear-loading with glass doors in front to facilitate supply rotation.
A bar code-based specimen management system will be used. This will be performed automatically on the automated chemistry/ immunoassay system and the automated hematology system. Other sections will use a PC workstation equipped with suitable software.
© 2008 Chi Solutions, Inc. Proprietary and Confidential.35
Process MapsA critical component of applying lean tools to laboratory design begins with the mapping of the entire laboratory process from specimen collection to result reporting.
This should be initially be performed at a high level, but should include all major customer interactions, major input activities or events, and major reporting activities.
The process review may also reveal design issues that have to be addressed.
Receive Sort Pickup
SpinDrop off toTesting area
Load ontoMachineType & Screen
Review Positive? Manual Reiew(test history)
Yes
Release result(IT)
Enter Data(IT)
No
Start
ElectronicCrossmatch
AntibodyIdentification
Manual CrossmatchLabel Unit
IssueEnd
© 2008 Chi Solutions, Inc. Proprietary and Confidential.36
Core Laboratory: Analysis of Current Workflow
Three departments sort in a total of eleven different ways:Sorting and time stamping = Key non-value added steps
Duplication of functions = Increased need of staffing/inefficient allocation of staffing
Increased risk of errors = Impediments to improved quality care
Start
MicroOutreach Hospital
Receive and Timestamp
BloodGas? STAT? Routine? Routine?STAT?Super
STAT?OR/
CATH?ED?UA &Blood
Cultures?Routine?BLD/PCR/
Serology?
Sort
Process(see individualprocess maps)
© 2008 Chi Solutions, Inc. Proprietary and Confidential.37
Core Laboratory: Current Space Layout
Internal Corridor
HematologyDiff Area
Training SpecialHematology Clinical Trials Empty Space Empty Space Storage
Send Out Office
Training
UA
Fluids
Hematology
Cold Storage
Coagulation
Specimen Processing
LPCH
Chemistry SendOut POCT
Specimen ProcessingSHC
LPCH
Main Hospital Corridor
Side
Cor
ridor Offices
Offices StoragePhlebotomy
Specimen ProcessingMicro
© 2008 Chi Solutions, Inc. Proprietary and Confidential.38
Specimen Receiving Staff cannot see all sides of the tube station from their workstation
Specimen Receiving/Processing
Tube Station
Pneumatic tubes arrive here
Blood Gas Bench
SpecimenProcessingBench
Specimen receiver sits here
© 2008 Chi Solutions, Inc. Proprietary and Confidential.39
Core LaboratoryConcept of Future Schematic Layout
Note: This layout is intended to show relative positions and is not to scale.
Storage
Hematology ChemistrySendOut/
ResearchUrinalysis
Tube
Coagulation
Processing
POCT
© 2008 Chi Solutions, Inc. Proprietary and Confidential.40
Schematic Design Notes:Core Laboratory
Physically reorient the floor plan of the core laboratory so that key service areas such as phlebotomy and specimen receipt are adjacent to the main corridor connecting the ED and nursing floors.Plan the core laboratory so that specimen processing is tightly integrated into the overall operation, and eliminate the current use of multiple processing areas.Current production is based on at least 11 different categories and/or workflow processes. These will be simplified to employ First In/First Out (FIFO) for all specimens (except those for blood gas determinations) and use automation and sufficient equipment to meet projected TAT requirements.Organize the core laboratory sections by specimen type to the greatest extent possible.The tube systems will be relocated within the core lab to facilitate improved workflow processes.Automated equipment interfaces will perform the “specimen received” function vs. performing this procedure manually in accessioning.Develop the overall floor plan of the testing sections to ensure a smooth workflow with adequate storage areas and space for future growth.An absolute TAT goal of 30 minutes will be used for all tests on the STAT menu.
© 2008 Chi Solutions, Inc. Proprietary and Confidential.41
Core Laboratory: Future Space Layout
- Not to Scale -
Hem DiffBody Fluids
Training
SpecialHematology
Clinical Trials
Send Out
UAHematology Coag
Specimen Processing
Chemistry/Immunoassay
Offices
Phlebotomy/FNA
Blood Gases
Supv/Review Stations
Call Center
Lab CoatsCore Lab QA
POCT
Blood Culture
Manual/ Special Test
Internal Corridor
Main Hospital Corridor
Side
Cor
ridor
Cold Storage
Rest Rooms
FreezerStorage
Waste Holding
Area
Flammable Storage
Rest Rooms Storage
© 2008 Chi Solutions, Inc. Proprietary and Confidential.42
What Happens Next:Architectural Design, Engineering, and Construction
© 2008 Chi Solutions, Inc. Proprietary and Confidential.43
SummaryDevelop a project plan with a realistic schedule.
Form an Executive Steering Committee to get support for your project.
Develop a balanced scorecard for your department with maximum input from customers to ensure your department meets their needs.
Analyze your current operation in terms of processes used and workflow, and develop metrics.
Identify lean opportunities as process and/or design issues, and develop solutions for the process issues as interim improvements.
Use lean strategically, not in isolation!
Develop a strategic plan for instrumentation that considers new or changing technologies and use of automation.
Develop a strategic plan to meet service requirements and use these requirements, to develop a set of schematic design notes with operating assumptions and specifications for the architect to use.
© 2008 Chi Solutions, Inc. Proprietary and Confidential.44
Acknowledgements
Chi Solutions, Inc.Earl Buck, MP(ASCP)
Toni Burger, MBA, MT(ASCP)
Shannon Donahue
Hans Froehling, DBA, CMBB
Nora Hess, MBA, MT(ASCP)
Mike Kachure
Kathy Murphy, Ph.D.
Dan Rajkovich, MPA, MT(ASCP)
Karla Yurgaites
Graphics and Picture CreditsAdvanDx
Barbara Ratner Rendering
CellaVision AB
CUH2A
Jonathan Hillyer Photography
Lord, Aeck & Sargent
X-Nth
…And especially to our clients who allowed photography of their laboratories and to their staff who appeared in the pictures.