Assessing and Improving Operations
Reviewer: Richard E. Horowitz, M.D. (see Reviewers page)
Revised: 15 June 2013, last major update June 2013
Copyright: (c) 2012-2013, PathologyOutlines.com, Inc.
Work Flow Analysis
- Synonyms: process analysis, flow charting, time-motion study, function sequencing; this is the best way to learn how your laboratory operates
- How to do work flow analysis:
- Direct observation by Laboratory Director and/or Chief Tech of one work station at a time, for a representative time span
- Include every step in the testing process
- Assess all involved personnel, equipment, functions including machine set-up time, reagent storage, batching, when work arrives, how work is done, how results are reported, breaks, back-up personnel and equipment, interactions with others in the laboratory, distance to storeroom, to computer terminal, availability of terminals, etc.
- Simple observation and charting of above and reviewing it with the involved personnel can lead to remarkable efficiencies
- It is essential to perform a work flow analysis for the entire laboratory before embarking on a major new program like installation of a laboratory computer, a collaborative venture or before designing a new laboratory or when assigned to a new laboratory
- The critical evaluation of the work flow analysis will result in improved efficiency by eliminating duplication, improving staffing and scheduling of personnel, better space and equipment utilization, better computer interfaces, improved reagent and supply management
- Other project management techniques
- Gannt Charts - a simple bar chart showing tasks, projects, start-up and completion dates; overlapping bars show interrelationship of the various tasks
- PERT Charts - Program Evaluation and Review Technique: a method for setting time goals, particularly for research and development projects
- CPM - Critical Path Method: defines the tasks that need to be done, analyzes the sequence in which the tasks must be completed and estimates the time needed for completion; the method uses a diagram which consist of "nodes" representing activities connected by arrows showing the relationships among the activities
How to Assess a Laboratory
- Is management system evident
- Is an organizational chart visible?
- Are policy and procedure manuals evident?
- Safety, environment, cleanliness, order
- Good lighting, air quality, noise levels
- Scheduling system
- Teamwork and motivation
- Are performance goals and achievements posted and visible?
- Space utilization, movement of materials, products
- Well labeled storage
- Crowding, use of hallways
- Maintenance of equipment and tools
- Are preventive maintenance schedules posted and visible?
- Levels of inventory?
- Has there been a work flow analysis?
- Commitment to quality and customer satisfaction
- Are customer surveys and QA data displayed?
- Is there a complaint management program?
Signs and Symptoms of Poor Laboratory Operations
- Recurrent overload crises
- Supervisors are unable to handle their sections
- Excessive overtime
- Prolonged turnaround time
- Delays due to low supplies
- Skilled workers doing menial tasks
- Supervisors doing bench work
- Excessive traffic, noise, crowding, talking
- Too many phone calls
- Too many STATs
- Complaints, external
- Complaints, internal
- Too many notices or rules posted in the laboratory
- Too many forms
- Frequent equipment failure
- Excess employee turnover
- Decreasing productivity (Productivity = Output/Input)
- Total Tests/FTE or Billable Tests/FTE or WLU/FTE or Billable Tests /Total Labor Expense
- Decreasing efficiency
- Total Revenue $/Test or /Admission or /Month
- Total Expense $/Test or /Admission or /Month
How to Change a Laboratory
- Identify current dissatisfactions or perceptions
- Independently verify and validate those perceptions and dissatisfactions and confirm that change is necessary
- Examine the various possible changes and choose the ideal one
- Define the IDEAL: What are the components? What space, equipment, personnel, supplies, etc., are needed to achieve the IDEAL?
- What are the implications and consequences of the IDEAL (on the laboratories personnel, on other programs and activities)? What are the costs? Where are the areas of resistance to change? Could the IDEAL be modified and still achieve the desired result?
- How can IDEAL be implemented? Who will communicate and direct the changes? What needs to be done? What is the time frame?
- How will the change be evaluated? By whom? According to what standards? Over what period of time?
- Note: to minimize the need to change, there should be an ongoing, monthly evaluation of operations; this is the equivalent of QC in chemistry - it is QC of the management of the laboratory; it is the sine qua non of operational success and needs to be incorporated into the monthly staff meeting with review of marketing, finance, space and equipment, human resources, productivity, efficiency, and bottom line (achievement of goals)
How to Change People
- In order to change a laboratory, people must change - very difficult
- Any suggestion or request to change implies that what is currently being done is inadequate or "bad"
- People generally think of themselves as "whole" or 100%
- Change takes a hunk out of that self perception, perhaps 20%
- Leadership must fill in the gap with 20% of something new
- Resistance to change can be reduced by:
- Leadership support
- Getting everyone involved in decision making
- Sell change as decreasing difficulties
- Sell change as increasing opportunities and experience
Other "Systems" for Improving Lab Operations
- Obsolete: TQM, CQI, Quality Circles, Benchmarking
- Currently in Vogue: PDSA, DMAIC, Lean, Six Sigma and RCA
- PDSA is used by Systems Engineers "Plan-Do-Study-Act"
- DMAIC is "Define, Measure, Analyze, Improve, Control"
- Lean was first implemented at Toyota Motors in Japan as a means for creating more value for customers by eliminating waste; the goal is to create processes that need less human effort, less space, less capital, and less time to make products and services at far less costs and with fewer defects; Lean empowers employees to improve the processes
- Six Sigma is a business management strategy, initially implemented at Motorola, that seeks to improve quality by identifying and removing the causes of defects (errors) and variability in manufacturing and business processes (six sigma refers to six standard deviations or 3.4 errors/million)
- Root Cause Analysis (RCA) is a problem solving method which identifies the root causes of problems or events; the practice of RCA is predicated on the belief that problems are best solved by attempting to correct or eliminate multiple root causes, as opposed to merely addressing the immediately obvious symptoms; there is usually more than one potential contributing factor that causes any given problem
End of Laboratory Administration > Operations > Assessing and Improving Operations
This information is intended for physicians and related personnel, who understand that medical information is often imperfect, and must be interpreted in the context of a patient's clinical data using reasonable medical judgment. This website should not be used as a substitute for the advice of a licensed physician.
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