Laboratory Space RedesignLaboratory Space Redesign

AMC Lab Redesign Team

Mayo Conference on Quality

AMC Lab Redesign Team

Mayo Conference on Quality

Our TeamOur Team

• Ann Tompkins – Lab

• Tim Schneider – Facilities

• Aaron DeVries – Finance

• Theresa Horvei – Lab

• Peggy Drennan – Clinic Nursing

• Justin Bushaw – Network Services

• Justin Sherman – PI

• Ann Tompkins – Lab

• Tim Schneider – Facilities

• Aaron DeVries – Finance

• Theresa Horvei – Lab

• Peggy Drennan – Clinic Nursing

• Justin Bushaw – Network Services

• Justin Sherman – PI

Project CharterProject Charter

• Purpose:• The purpose of this project is to reduce the turn

around time from order request to reported results.• This was within our control

• The current layout segmented lab into pods, reducing efficiency

• Benefits:• Quicker diagnosis and treatment for patients• Increase patient, physician, and staff satisfaction• Staff retention

• AMC Strategic Plan Alignment:• Improve quality, safety, service while decreasing

costs.• Create value by meeting or exceeding patient

requirements

• Purpose:• The purpose of this project is to reduce the turn

around time from order request to reported results.• This was within our control

• The current layout segmented lab into pods, reducing efficiency

• Benefits:• Quicker diagnosis and treatment for patients• Increase patient, physician, and staff satisfaction• Staff retention

• AMC Strategic Plan Alignment:• Improve quality, safety, service while decreasing

costs.• Create value by meeting or exceeding patient

requirements

What Did We KnowWhat Did We Know

• Current lab design has each area (chemistry, hematology, serology, microbiology, blood bank and urinalysis) in a “pod” of its own.

• The location of the low volume test pods are closer to the specimen processing area, while highest volume tests are located further away

• Current lab design has each area (chemistry, hematology, serology, microbiology, blood bank and urinalysis) in a “pod” of its own.

• The location of the low volume test pods are closer to the specimen processing area, while highest volume tests are located further away

What Did We KnowWhat Did We Know• Workforce Shortage

• CLS professionals are desperately needed in the healthcare industry workforce.

• 46% of laboratories report taking 3-12 months to fill a vacancy

• Median age = 48 years • ~25% of workforce (73,000 ) will retire in

next 10 years. • Only 2 laboratorians enter the field for

every 7 that retire.

• Workforce Shortage• CLS professionals are desperately needed

in the healthcare industry workforce. • 46% of laboratories report taking 3-12

months to fill a vacancy • Median age = 48 years • ~25% of workforce (73,000 ) will retire in

next 10 years. • Only 2 laboratorians enter the field for

every 7 that retire.

What Did We KnowWhat Did We Know• Workforce Shortage

• In 2005, the National Accrediting Agency for Clinical Laboratory Science (NAACLS) summarized:

• Graduates needed/yr = 13,700• Actual graduates/yr = 4,445 • Yearly shortfall ~ 9,200

• Shortage will also come at the same time baby boomers retire and require more health care

• Workforce Shortage• In 2005, the National Accrediting

Agency for Clinical Laboratory Science (NAACLS) summarized:

• Graduates needed/yr = 13,700• Actual graduates/yr = 4,445 • Yearly shortfall ~ 9,200

• Shortage will also come at the same time baby boomers retire and require more health care

Desired OutcomesDesired Outcomes• This project is designed to create a

more efficient work space by:• Reduce motion within the laboratory

• Lower turn around time• Freeing staff to handle higher

volumes• Improve the staff morale

• Staff are overburdened • Reduce time spent on non patient care

related work• Primarily inventory

• This project is designed to create a more efficient work space by:

• Reduce motion within the laboratory • Lower turn around time• Freeing staff to handle higher

volumes• Improve the staff morale

• Staff are overburdened • Reduce time spent on non patient care

related work• Primarily inventory

The Lab Before The Lab Before

What Did We Know What Did We Know • August 2008:

• 430 chemistry samples per day• Key devices were not situated in proximity:

• Specimen drop off• Processing• Centrifuge• Chemistry analyzer• PC for resulting

• Resulted in staff spending a large portion of time criss-crossing lab

• August 2008:• 430 chemistry samples per day• Key devices were not situated in proximity:

• Specimen drop off• Processing• Centrifuge• Chemistry analyzer• PC for resulting

• Resulted in staff spending a large portion of time criss-crossing lab

* Only used a 5 day work week, no weekends

Tools UsedTools Used

•Gantt Chart

•Staff Surveying

•Spaghetti Diagrams

•Time Studies

•Project Budget

Gantt ChartGantt Chart

Employee SurveyingEmployee Surveying

No more

“Strongly Disagrees”

General shift to more positive responses on all questions!

Spaghetti Diagram August 2008Spaghetti Diagram August 2008

Specimen Drop Off (start of process)

Chemistry Analyzer

Processing / Centrifuge

PC

Specimen Storage (end of process)

Spaghetti Diagram June 2009Spaghetti Diagram June 2009

Specimen Drop Off (start of process)

Chemistry Analyzer

Chemistry Processing / Centrifuge PC

Specimen Storage Drawer (end of process)

Tube Station

Spaghetti Diagram September 2009Spaghetti Diagram September 2009

Specimen Drop Off (start of process)

Chemistry Analyzer

Processing / Centrifuge

PC

Specimen Storage Drawer (end of process)

Inventory SystemInventory System• Par Excellence:

• Average AMC Lab on hand inventory:• $67,675.43

• Previous 7 months average

• Hours per week inventorying = 6 hours • $10,124/yr at $32.45/hr; .15 FTE

• Par Excellence savings examples:• St. Anthony's, St. Petersburg, FL (12%)• Mayo Clinic, Jacksonville, FL (21%)

• Par Excellence:• Average AMC Lab on hand inventory:

• $67,675.43• Previous 7 months average

• Hours per week inventorying = 6 hours • $10,124/yr at $32.45/hr; .15 FTE

• Par Excellence savings examples:• St. Anthony's, St. Petersburg, FL (12%)• Mayo Clinic, Jacksonville, FL (21%)

Projected Soft & Hard Dollar SavingsProjected Soft & Hard Dollar Savings• Soft Dollar Savings:

• Motion reduction = $22,360 (chemistry)• Motion reduction = $6,931 (rest of lab)

• Using a 31% reduction

• Hard Dollar Savings• Inventory reduction = $11,166 (Par Ex)

• Average of $8,121.05 & $14,211.84 (low & high estimates)

• Inventory labor hours = $10,124 (.15 FTE)

• Total Annual Savings = $50,581

• Soft Dollar Savings:• Motion reduction = $22,360 (chemistry)• Motion reduction = $6,931 (rest of lab)

• Using a 31% reduction

• Hard Dollar Savings• Inventory reduction = $11,166 (Par Ex)

• Average of $8,121.05 & $14,211.84 (low & high estimates)

• Inventory labor hours = $10,124 (.15 FTE)

• Total Annual Savings = $50,581

Project BudgetProject Budget

Expense TypeOriginalEstimate

Total Cost

Over (Under)Budget

Par Excellence $14,820 $12,313 $ (2,507)

Carts $38,624 $39,539 $ 915

Electrical/Data Upgrades $15,000 $11,348 $ (3,652)

Venting and Duct Work $ 2,000 $ 1,778 $ (222)

Wall Removal $ 6,500 $ 956 $ (5,544)

Plumbing/CO2 $ 2,000 $11,429 $ 9,429

Hazardous waste cabinet $ 1,200 $ 1,068 $ (132)

Misc. $ - $ - $ -

Totals $80,144 $78,430 $ (1,714)

ChallengesChallenges

• Scope creep• Unexpected data needs arose

• Concurrent pharmacy project• New data closet

• Facilities staff had many demands• Chapel project• End of 2008 spending

• AMC had surplus to spend, resulting in added work for facilities staff

• Contracted some work out

• Scope creep• Unexpected data needs arose

• Concurrent pharmacy project• New data closet

• Facilities staff had many demands• Chapel project• End of 2008 spending

• AMC had surplus to spend, resulting in added work for facilities staff

• Contracted some work out

Project Outcomes Project Outcomes • Successes:

• June 2009 design reduced motion on our highest volume tests by 65.2%

• Reduction in motion will allow us to better meet future capacity increases

• Potential to run up to 700 chemistry tests per day with existing staffing

• September 2009 changes resulted in further motion reduction of 28.4% from the June 2009 design

• Successes:• June 2009 design reduced motion on our

highest volume tests by 65.2%• Reduction in motion will allow us to better

meet future capacity increases • Potential to run up to 700 chemistry tests

per day with existing staffing• September 2009 changes resulted in further

motion reduction of 28.4% from the June 2009 design

Our New LabOur New Lab•Consolidated 2 sinks into 1 area

•2 processes into one area

•Millipore (filtering)

•Molecular cleaning

Our New LabOur New Lab

•Processing more open, June 2009 (top)

•New core lab (left)

Our New LabOur New Lab

• Low volume tests done outside of core lab (top)

•Processing motion reduced (left)

Our New LabOur New Lab

• Processing area located next to centrifuge and in front of tube system (not pictured) (left)

•Specimen drop off clearly identified (right)

•Core lab ‘opened’ Sept 2009

Lessons LearnedLessons Learned

• Site visits were beneficial:• St. Mary’s (OK to keep changing)• Mayo Florida (Cart design)• Eau Claire (Process on going)

• Communication with staff crucial• Gantt Chart• Surveying • Department Meetings

• Site visits were beneficial:• St. Mary’s (OK to keep changing)• Mayo Florida (Cart design)• Eau Claire (Process on going)

• Communication with staff crucial• Gantt Chart• Surveying • Department Meetings

Lessons LearnedLessons Learned

• Having key players at the table from the start was crucial, however we noticed two shortfalls:• IT should have been at table from start• Did not have bench techs at all team

meetings from start

• Detailed plan allowed administration to support the team moving forward

• Having key players at the table from the start was crucial, however we noticed two shortfalls:• IT should have been at table from start• Did not have bench techs at all team

meetings from start

• Detailed plan allowed administration to support the team moving forward

Questions?Questions?