combining lab automation solutions with the best rapid process … · 2017-04-02 · version 1.0 15...

Version 1.0 1

Chris ChristopherVice President Global Customer Solutions

Copyright © 2009 Siemens Healthcare Diagnostics. All rights reserved.

1111111111111Combining Lab Automation Solutions with the Best Rapid Process Improvement Tools

Page 2 Siemens Healthcare Diagnostics

Grounding

Automation is playing an important and strategic role in all regions of the world.

Global Drivers:

EMPLOYEE SAFETY - PRODUCTIVITY – Predictable TAT

Regional Drivers:Japan & Korea (early adopters) – lab consolidation U.S. – skilled labor shortagesEurope – consistent turn around times / process improvementCanada – standard work processLatin America – quality Asia Pacific – most of the above

Version 1.0 2


Grounding

Hospital Laboratory• 24/7 with variety

of peak workloads

• STAT demand

• Key Metrics: STAT TAT

• Backup Capability: High

HV Reference Laboratory• 16/6 with peak loads from 1500 to 0800 hours

• Little to No STAT demand• All work to be completed typically by 0700 hours

• Key Metrics: Pending W/L• Backup Capability: Low

Distinct Markets for Lab Automation


Primary Purpose of This Session

To share with you facts, findings, and information on Lab Automation with a viewpoint of how to use Rapid Improvement Events to integrate automation into a clinical lab setting.

Version 1.0 3


Learning Objectives

Provide a quick Review of Lab AutomationPerformance Drivers Creating Demand Types of Automation

Discuss in more detail Rapid Improvement EventsShow the Origin (Lean - Six Sigma) How to Apply the RIE Process in preparation for automation

Format: workshop / open discussion


Intro: The Diagnostic Process Continuum

Pre-AnalyticalPost-Analyticalprepare order

transport to lab

collect sample

accession sample

centrifuge

decap tubes

pre-sort/aliquot

transport to analyzer

pay invoices

order supplies

technical validation

manage inventory

store samples

dispose of waste

post-sort

transmit test results

AnalyticalTargets for Lab Automation

Version 1.0 4


Universal Performance Drivers for Automation

Eliminate Errors / Improve Worker SafetyImprove Productivity / Optimize WorkforceDecrease overall TAT by Eliminating Wait TimesForecast Predictability – High Confidence when Test Results will available (reduce variance in the process)

““Strive to get Performance to the Next LevelStrive to get Performance to the Next Level””

From your experience, what are some of the goals and/or drivers for lab automation?


Adult ICU's AM Chemistry ProfilesReceived 0400 to 0700

Reported by 0800Weekly beginning 6/11/00

90.9

89.6

82.8

86

87.3

92.6

91

88.8

92.4

95

90.5

92.6

90.3

93.8

94.8

93.1

94.8

98.6

93.494.1

96.896.9

98.7

97

92.6

95.9

92.3

88.6

93.7

86

84.5

9594.5

95.695.8

86.5

94.4

96.7

97.6

72.4

97.4

87.1

91.7

93.8

88.4

95.9

94.5

84.3

92.5

87.8

88.6

94.9

77.9

80.8

84.785.2

84.5

86.6

91.892.292

81.3

85.8

88.5

91.8

83.6

88.9

96.1

98.1

94.6

85.7

91.7

89.7

91.991.3

96.9

97.9

81.3

90.9

98.9

97.1

91

89.3

96.1

97.1

88.5

98

87.3

92.7

89.8

90.7

96.5

94

97

93.5

94.5

9695.5

92.6

91.3

95.395.2

90.1

92.8

95

97.4

93.3

92.1

96.8

93.9

83.3

96.8

92.6

91.6

99.6

94.2

88.2

95.595.9

96.8

98.9

97.5

98.8

93.9

87.5

91.1

86.9

95

92.5

85.7

96.1

94.5

90.4

82.9

86.4

89.1

94

88

75.1

73.6

90.4

95.8

97.8

98.8

97.397.7

93.7

95

94.2

95.395.1

94.394.1

98.498.497.997.7

97.2

9695.8

98.898.498.6

99.399.299.1

9796.3

97.29898

98.3

99.599.599.1

98.297.5

98.5

97.5

9999.399.299.3

96.897

98.6

97.598

96.6

98.498.297.8

96.9

98

96.9

97.9

99.4

97.4

94.8

97.4

98.5

99.498.8

97.6

96.6

98.3

70

75

80

85

90

95

100

Date

%

GO LIVE

% Morning Workload Reported by 0800% Morning Workload Reported by 0800

20022002 20032003 20042004 2005200520012001

Automation Benefit – “Predictable TAT”

Version 1.0 5


Types of Automation that Changes Workflows

Track

Pre-AnalyticalWork Station

Work Cells

Total Lab Automation


Track Systems

Sample Transport/DeliverySorting System

Primary Functions:

Unidirectional Track with Bypass Lane

Version 1.0 6


Pre-Analytical Workstation

Multi-discipline

Features may include Centrifugation, Cap Removal, and Sorting for

different instruments and Departments

Requires LIS Interface to Maximize Productivity

Manual Transport to Analyzer

Accessionin Lab

Centrifuge De-Cap SortAliquot

Impact: Central Processing

Manual


Ex: Pre-Analytical Workstations without Centrifuge

PathFinder

• Multi-discipline – Features Cap Removal, Alliquoting, and Sorting for

different instruments and Departments• Requires LIS Interface to Maximize Productivity• Free Standing • Requires Manual Transport to Analyzer

Version 1.0 7


Work Cell Evolution

Analytical Consolidation via common Sample Transport

Data Management of All Components

LIS Connectivity

Accession Centrifuge De-Cap Sort

Transport ReviewData

Sort &Store

Analyze

Work Cells come in a variety of features…some optional, others are not.


Types of Work Cells

In brief, Work Cells link a variety of instruments and components via automatic transport and data management in order to optimize workflow processes for the laboratory.

Example for Hematology:

The above Work Cell is comprised of a hematology analyzer, a slide maker & stainer, transport systems and a data management system.

Sysmex HST-N

Version 1.0 8


Automated Work Cells

Examples with Centrifugation

Siemens StreamLabBeckman Coulter Power Processor


Early TLA Approaches

Version 1.0 9


Combining Lab Automation with Best Practice Rapid Improvement Events

Moving forward, we will briefly review a few popular Quality Management Tools and Practices and Explore RIE


Learning Objectives

Provide a quick Review of Lab AutomationPerformance Drivers Creating Demand Types of Automation

Discuss in more detail Rapid Improvement EventsShow the Origin (Lean - Six Sigma) How to Apply the RIE Process in preparation for automation

Format: workshop / open discussion

Version 1.0 10


Discussion… my personal experience

“A lab installed automation without optimizing workflows before the hardware arrived.”

What are the likely outcomes to the 3 goals below? … and Why?

ProductivityProductivity EfficiencyEfficiency CostsCosts


Lean & Six Sigma

What is Lean? Lean [1] refers to a collection of principles and methods that focus on the systematic identification and elimination of non-value added activity (waste) involved in producing a product or delivering a service to customers. Two common methods used in Lean are value stream mapping and kaizen rapid process improvement events.

What is Six Sigma? Six Sigma [2] is a rigorous methodology that utilizes information (management by facts) and statistical analysis to measure and improve an organization’s performance, practices, and systems. The Six Sigma DMAIC (Define, Measure, Analyze, Improve, Control) method is a system for improving existing processes that fall below specifications.

[1] James Womack, Daniel Jones, and Daniel Roos coined the term "Lean" in their 1990 book The Machine that Changed the World to describe the manufacturing paradigm (often referred to as the Toyota Production System) developed by the Toyota Motor Company based on principles pioneered by Henry Ford.

[2] Six Sigma methods were first developed by Motorola and Allied Signal, and were refined and popularized by General Electric in the mid-1990s.

Source: http://www.epa.gov/lean/improvement-methods.htm

Version 1.0 11


Value Stream Mapping

Value Stream Mapping (VSM). Value stream mapping refers to the activity of developing a visual representation of the flow of processes, from start to finish, involved in delivering a desired outcome, service, or product (a “value stream”) that is valued by customers. VSM examines information flows and systems, as well as the flow of the product or service product through an agency’s processes. Benefits of VSM include:

Increasing the understanding of actual decision-making processes Identifying sources of non-value added time and activities

What’s Involved in VSMa 2–5 day VSM workshop are two maps—a map of the “current state”

of targeted processes and a “future state” map of the desired process flow — and an associated implementation plan for future process improvement activities.


Lean and Six Sigma efforts identify and eliminate unnecessary and non-valued added process steps and activities that have built up over time.


Kaizen “Rapid Improvement Events”

Kaizen Events. Kaizen is a combination of two Japanese words that mean “to take apart”and “to make good.”

Kaizen refers to an approach to continuous improvement that is founded on the belief that small, incremental changes routinely applied and sustained over a long period result in significant performance improvements.

Kaizen focuses on eliminating “waste” in a targeted system or process of an organization, improving productivity, and achieving sustained improvement. Kaizen activity is often focused in the form of rapid improvement events (sometimes called a kaizen blitz), which bring together a cross-functional team for two to five days to study a process and begin implementation of process changes.


Version 1.0 12


Setting the Stage: Eliminating Waste (muda)

…exploring Waste in today’s laboratory


Eliminating Waste (muda)

Transportation (moving products that is not actually required to perform the processing)Inventory (all components, work-in-progress and finished product not being processed)Motion (people moving or walking more than is required to perform the processing) Waiting (waiting for the next production step)

Give an example of each Waste that can be found in today’s laboratory

Version 1.0 13


Eliminating Waste (muda)

Over Production (production ahead of

demand)

Over Processing (due to poor tool or product

design creating activity)

Defects (the effort involved in inspecting for

and fixing defects)

Missed Market - manufacturing goods or

services that do not meet customer demand or

specifications

Give an example of each Waste that can be found in today’s laboratory


What is a “Rapid Improvement Event”?

Focus: Eliminate WasteKey Tool: Value Stream MapLook for: Consolidation of ProcessesPromote: Continuous Flow vs. BatchResources: Cross functional team

An organized and executable plan that optimizes a process by eliminating Waste using a team approach.

Version 1.0 14


RIE Process

Major Activities:The preparation The event The action plan

Preparation (most important)Scoping the problem – Pre-analytical to Post-analyticalChoosing the RIE core team – Supervisors, technologists, phlebotomistsVSM -- Collecting data on the performance of the current process Sorting the logistics for the event: venue, materials Identify Briefing facilitators Communicating widely about the event

http://www.institute.nhs.uk/quality_and_value/rie/rapid_improvement_events_-_an_overview.html


Scope Problem

Optimizing Pre-analytical Processes

Version 1.0 15


Scope Problem

Optimizing Pre-analytical Processes


RIE Process

EventWelcomes, introductions, ground-rules(1) Introduction to lean thinking: the 7 wastes, why reducing variation is good, why batching is bad, how to spot value-adding and non-value adding activities Discuss the process being looked at in the RIE, what’s in scope, out of scope. Review the ‘performance’ of the process at the moment: looking at the data

Version 1.0 16


RIE Lab Automation Example

EventStart the current state map Draw the process end to end, add data-line and maybe time-line showing how long each step takes, add detail on known problem steps or where most errors occur. Draw the physical lay-out of the work area Go see the real work area, get the current state map validated by the wider team, show it to people from completely different work areas for a fresh perspective.

Current State Before Automation



EventGo and implement obvious and easy improvements that may have come out of yesterday, go and pilot or experiment with others Start on future state map Part 1 : Divergent phase – new ground rule (This is akin to a creative brainstorm. Generate at least 100 ideas and much laughter) Part 2 : Convergent phase (Boil-down ideas by voting and more critical discussion) Further testing and refinement and validating of future state map

All Lab StaffRuthJoyJohn

March 2009Event Reports

BrendaJoyJoAnne

March 2009Autoverification/AutoreleaseLab Results

JohnTinaRuth

May 2009“Walkie Talkie” CommSystemfor Phlebotomy

TinaJohn

June 2009Standardized Phlebotomy Trays/Decentralized Carts

Nursing Ed.Ruth Maricel

April 2009Automation Training for Nurses

WhoDueItem

Just Do It

Version 1.0 17



Action PlanComplete future state map Start on its implementation there and then Develop a 30-day action plan to achieve completion of the rest of it Assign an owner of the plan and schedule bi-weekly or weekly reviews Prepare presentation to executive sponsor.

Ideal Future State


RIE Impact

0

5

10

15

20

25

Current Future Ideal

Eliminated 13 Steps from Current to Future State

Example of Delivered RIE Valuein ED collections / processing

Version 1.0 18


RIE – Ground Rules

The golden rules are:

No person may be criticized, only the process they work within. The whole point of an RIE is to honestly expose waste and inefficiencies. An honest and no-blame environment is essential. Everyone in the team must contribute honesty and be listened to without criticism.

All ideas are valid, if a suggestion makes the team laugh it probably has a grain of merit in it.

No-one is allowed to criticize an ideathe use of the phrase 'yes, but' is banned. Wacky, creative, outlandish suggestions are encouraged.


In Summary

Focus:Elimination of NVAA & Process Control

Design Strategies:STAT ManagementIntelligent Integration of Instrument InterfacesExpanded Role of InformaticsUser FriendlyDash Board Operation / Remote Monitoring

ImmunochemistryImmuno

chemistry

I/OStorageRetrieval

I/OStorageRetrieval

CoagCoag

HemoHemo

ChemistryChemistry

LASLAS

Future Lab Automation

Version 1.0 19


Accordingto plan

Behindschedule

Deadlineat risk

Dashboard

Real Time Measurement

0%

15%

will be…

Feature Rich


But…

U ‐ Turn

T ‐ Connection

… it won’t be successful without getting Rid of the MUDA first.

combining lab automation solutions with the best rapid process … · 2017-04-02 · version 1.0 15...

Documents