BRIGHAM AND
WOMEN’S HOSPITAL
LEAN TOOLS IN THE CLINICAL LABORATORY
Rapid-improvement phlebotomy, streamlined processes and short-
ened laboratory turnaround time.”
The kaizen also identified ways to manage
patients’ expectations and improve patient flow.
events enhance Streamlining phlebotomy
A “take a number” system allowed patients to
anticipate their wait time. Those patients need-
laboratory performance A team made up of Clinical Excellence process ing urine testing had their specimens collected
improvement leaders, laboratory staff, and GE in the interval between arrival and blood draws.
As plans advanced to automate the Clinical lean experts conducted a value stream mapping The team also introduced a flow coordinator
Laboratories, Brigham and Women’s Hospital session in November 2007. Then they per- role, responsible for escorting patients from the
faced growing specimen volumes in constrained formed five kaizen rapid-improvement events waiting area to the drawing stations, instead of
space amid concerns about technician retention over the next six months, each focusing on having the phlebotomists walk to the waiting
and recruitment. specific process areas. area and call for patients. The team also took
The hospital staff worked with the One kaizen addressed wait times in the several steps to make the phlebotomists’ work
Performance Solutions consulting group of GE outpatient phlebotomy clinic, a small space with more efficient. These included:
Healthcare and the hospitals’ Center for Clinical five drawing stations. Patients arrive without > Eliminating non-value-added tasks, such as
Excellence as a part of a Lean Skills Transfer appointments and are seen on a first-come, duplicative sample container labeling.
engagement to assess laboratory performance first-served basis. Wait times were inconsistent: > Reconfiguring one station that had been reserved
and design process improvements at all key some patients were seen almost on arrival, but for patients susceptible to fainting by installing a
steps in the value stream, from the time the others waited 30 to 40 minutes, or longer. chair that can be used for all patients.
patient arrives to provide a specimen until the lab The analysis found an imbalance between
report is complete. demand and staffing, especially early in the Improving laboratory workflow
The effort brought about rapid and significant day. Patients arriving before the actual opening Four kaizens addressed various aspects of
improvements in key measures of quality and time caused a backlog that had a ripple effect laboratory sample handling and processing
consistency. For example, in just six months, lasting into the morning. To address that, workflow. The critical metrics included cycle
average wait times in phlebotomy decreased the team decided to open the center 30 min- time from logging of the specimen to entry of
from 14-17 minutes to 4-5 minutes. In addition utes earlier and increase staffing during the the result to the Laboratory Information System,
processing in the laboratory for specific tests morning hours. measured for average time and percent compli-
(see table) now meets cycle time goals more ance with cycle time goals.
than 90 percent of the time. The team made a variety of changes in
“While our volumes were growing, we were Brigham and Women’s Hospital, staffing and procedures to eliminate issues that
also planning for laboratory automation,” says Boston, MA caused processing bottlenecks. Data gathered
Dr. Milenko Tanasijevic, the Director of Clinical > 777-bed teaching affiliate of Harvard Medical School during the process made it possible to optimize
Laboratories. “We wanted to optimize work- > 44,000 annual inpatient admissions staff levels to meet demand.
flow first, rather than automate suboptimal > 950,000 annual ambulatory visits In addition, instead of having individual
processes. Lean offered a unique set of tools > 4,000 laboratory specimens and 200-250 phlebotomy technicians perform all specimen processing
draws per day
that allowed our staff to break processes down steps, the Lean participants devised a team-
into discrete steps to discern between non- > 12,000+ employees; 3,000 physicians, fellows based approach, reducing technician travel
and residents
value-added and critical, value-added steps. > $400 million annual research budget distance significantly. The group also reconfig-
“We achieved significant improvements > 11 consecutive years on US News & World Report ured workspace layouts and co-located equip-
in patient satisfaction, reduced wait times in Honor Roll ment for efficiency.
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To prevent delays during peak-demand For example, before the kaizens, 50 to 60
hours, the Lean team shifted tasks not directly percent of patients waited more than the goal
related to specimen processing to off-peak of 10 minutes, whereas five months later the
times. They speeded up handoffs from specimen time goal was being met or surpassed more
processing to chemistry by using audible signals than 96 percent of the time. The results are
to tell chemistry technicians when specimens encouraging other outpatient phlebotomy cen-
are ready for analysis. To avoid loss of capacity ters at off-site locations to adopt changes this
during staff overlap times at shift transitions, team piloted.
they assigned specific duties to technicians The hospital staff also used the GE Change “We achieved significant
arriving and leaving. Acceleration Process (CAP) to help the staff improvements in patient
Also, the team applied a 5S process in the adapt to and embrace quick and sometimes
satisfaction, reduced
chemistry laboratory to organize workspaces dramatic changes in their work processes.
and improve efficiency by eliminating non-
wait times in phlebotomy,
value added steps in specimen processing. In Sustaining momentum streamlined processes and
essence, 5S is a Lean tool used to transform The benefits of Lean and the kaizen have shortened laboratory
workspaces by stabilizing processes and mak- lasted well beyond the original engagement. For turnaround time.”
ing them visible. 5S starts with a cluttered place example, after the first 5S project, the hospital > Milenko Tanasijevic, MD, MBA,
Director of Clinical Laboratories Division
and turns it into a highly organized and efficient staff undertook two more such activities in other Departmentof Pathology
work area with clear visual cues indicating any areas of the chemistry laboratory. Brigham and Women’s Hospital
variation to the process and creating a base “Lean and the kaizens have enabled us
from which to make additional improvements. to brainstorm solutions and actually go out
LEAN IN THE LABORATORY BRIGHAM AND WOMEN’S HOSPITAL
Phlebotomy Average Wait Time: Target Lidia DeMartino,
Throughout the Lean projects in the laboratory
identification and idea generation to trying out Senior Medical Technologist
and phlebotomy clinic, dashboards are reported
proposed changes in the laboratory.” Chemistry Laboratory
weekly so that staff members could see prog- Brigham and Women’s Hospital
Dorothy Goulart, MS, RN, Director of
ress against the critical metrics. Laboratory
Performance Improvement with the Center
management and staff who took part in the
for Clinical Excellence, observes, “We have
kaizens held regular meetings to review the
had success with facilitating design sessions
metrics and address operating issues.
and involving staff and managers in problem
“It’s especially satisfying to see how the
solving, but we were challenged to consistently
staff is taking on responsibility,” says Lidia
implement and sustain changes. By combin-
DeMartino, Senior Medical Technologist. “They
ing change acceleration, Lean and kaizen
are more closely tied to the processes now.
event approaches, we have been able to
We’ve seen more than one case of people
strengthen our institution’s ability to achieve
who worked on the kaizens finding more ways
tangible results while building new capabilities
to make improvements and eliminate waste. “By combining change
and knowledge.”
They’re more empowered and accountable.” acceleration, Lean and kaizen event
Using Lean tools to make processes more approaches, we have been able to
visible to staff and patients was a key tenet
strengthen our institution’s
in working across the value stream. Surveys
showed that phlebotomy patient satisfaction
ability to achieve tangible results
increased by more than 20 percentage points
while building new capabilities
after the kaizen improvements. and knowledge.”
The Brigham and Women’s Hospital staff > Dorothy Goulart, MS, RN,
Director of Performance Improvement
has sustained improvements in laboratory Center for Clinical Excellence
cycle time and phlebotomy patient wait time. Brigham and Women’s/Faulkner Hospitals
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