How Reducing the Number of Touches Per Tube in Processing Slashes Errors and Boosts Staff

Productivity

Family

Charles Layton

William Layton Christopher Layton

Lionel Layton others others             Willis Layton

Bud Layton        others others           Dean Layton

Bea  David    At

Bea                                                                                                                           David 

White Paper Available

ARUP SpecimenProcessing LeanCase Study

http://aruplab.com/Testing‐Information/Quality‐

Compliance/white_papers/Specimen‐processing‐case‐study.pdf

History and Background

Wikimedia Commons – Public Domain

Old Specimen Processing Layout Individual Workstations

IndividualWorkstations

Long rows of processors

Processing management at the end of the row

Time wasted in walking

Project Objectives

Improve workflow and accuracy.

More efficiently utilize space.

Team

Formed team that included management staff, line‐level supervisors, and selected 

members of the workforce from both Specimen Handling and 

Exception Handling.

House of LeanSpecimen Processing PODs

Quick Changeover

Standardized Work Single Piece Flow Kaizen

Quality at Source

5S System Visual Plant Layout

POUS

Cellular/FlowPull/Kanban TPM

ValueStreamMapping

Continuous Improvement

House of LeanSpecimen Processing PODs

Quick Changeover

Standardized Work Single Piece Flow Kaizen

Quality at Source

5S System Visual Plant Layout

POUS

Cellular/FlowPull/Kanban TPM

ValueStreamMapping

Continuous Improvement

Old Processing Flow

Courier Manifest

Place Boxes Is there a Circle CloseOn Conveyor Carrier Check Ambients &

at Truck List in the Box? BuckleT1 T9 T10

Convey Box Are there Check ApplyUp, Over and Refrigerated Gel Packs Time of DayDown Slide Samples? Label

T8 T11

Scan Boxes Are there Add Print BarcodeWhile on Frozen Dry Ice & Place on Box

Chute Specimens or BillP1 T7 T12

Stack Boxes Are There Scan and ManifestFrom Ambient Bin BoxesChute Specimens? Specimens 2……n

T2 T6

Place Box Are There Check w/ Lead Stack withonto Special to Set Aside Mates

Workstation Needs? or ProcessT3 T13

Scan Answer Manage Box Screen FIFO

Questions TowerP2 Q2 Q3 T14

Gather UnbuckleMating BoxBoxes

Q1 T4 T5

T = TouchesQ = QualityP = ESP Process

Workflow Manifest

Find Assure Box Repeat forBox is Boxes

Group Empty 2…..nT1 T9

Find Box Complete Samples Communicatewith Carrier 2……n Close out ofCheck List from Box Sequence No.

T2

Initial Place Bag in CompleteBuckle Appropriate Sequence

Temp. BinT3 T8

Check Mark Bag Close outBox Scan w/ Shipment

Icon Sequence No. TrackingT7

Create New Scan or Hand offSequence 10 Key SequenceNumber Bag at end of Shift

T6

Write Sequence RemoveNo. on Carrier Bag(s)

Check List from BoxT5

Print UnbuckleLabel & Open

BoxT4

T = TouchesQ = QualityP = ESP Process

Specimen Processing

Get Bag(s) Ctrl S Print Labels (2)from Input Temp, Test, Master

Woprkflow Bins Sample Type SpecimenT1 T8

Retrieve Input Match PrintedPacking Patient label with

List Identifier Packing ListT2

Separate Is the Sample Input Client No. Check for TRK IDUnder Infectious? into Blue Line ifHood Client Field Non-TRK

Back to Count Write Match up Work Samples Test ID's on Printed Label w/

Station Packing List Container LabelsT3 T9

Input Check Place SpecimenCustomer and Electronic in STC or

SP Counts Blue Line BinsT10

Organize Scan Check Screenby Bag for Red

Client Count BoxesT4 T7

Match Place Samples Place STC'sSamples w/ in Order with on TrackPacking List Packing List

T5 T6 T11

T = Touches Ctrl C toQ = Quality Clear out P = ESP Process Bag

34 Touches

14 Touches 9 Touches 11 Touches

PODS Process Flow

T1 T1 T1 P5 Q2

T2 P1 T2 P5 T6

Separate Under Hood

P2 P4 T7

Back toWork

StationT2 T3 Q1 Q3

T3 T6 T4 T5 T8

P3 P1 P4 P6

T4 T5 P2 P3

Touches: 2 Touches: 6 Touches: 8

Bagfrom bag and client number

from box is

box

or electronic modeCtrl C to

Clear out

Packing List

Assure box

Empty

Courier Flow

Do 'arrival scan' ofboxes as they are

in order

Place Boxes In waiting area

Count Boxes

Team Manifester/Processor Specimen Processing

Get Bags from Print Labels (2) Match PrintedCommunity bin or Master Label with

front of row Specimen Packing List

Match up Packing Input Temp, Test, Printed Label w/Retrieve Ctrl S

Container Labels

Infectious? Patient in STC or

List Sample Type

Is the Sample Input Place Specimen

Blue Line BinIdentifier

Check ScreenSamples Test ID's on for Red

Write Count

Place STC'scount on bag samples in order with on Track

Match and placeWrite sample

the Packing List

SP Counts

Scan or 10-key Enter either manual

Scan or 10-key InputCustomer andbag number

Box ID number

Scan box

Either continue if

processing with teamneeded or begin

waiting area tothe team stations

Remove bags

Unbuckle

Bring boxes from

removed from vehicle

Print label for

ID to open the

paperwork folder

box and shipment

and courier checklist

& open

community bins

Boxes2……n

Write or affix label Put the bagsof Box ID number

each temperaturereceived in ESP

in the

Repeat forEnter # of bags of

on each bag

16 Touches

Courier ProcessBefore and After

Courier Manifest

Place Boxes Is there a Circle Close

On Conveyor Carrier Check Ambients &

at Truck List in the Box? Buckle

T1 T9 T10

Convey Box Are there Check Apply

Up, Over and Refrigerated Gel Packs Time of Day

Down Slide Samples? Label

T8 T11

Scan Boxes Are there Add Print Barcode

While on Frozen Dry Ice & Place on Box

Chute Specimens or Bill

P1 T7 T12

Stack Boxes Are There Scan and Manifest

From Ambient Bin Boxes

Chute Specimens? Specimens 2……n

T2 T6

Place Box Are There Check w/ Lead Stack with

onto Special to Set Aside Mates

Workstation Needs? or Process

T3 T13

Scan Answer Manage

Box Screen FIFO

Questions Tower

P2 Q2 Q3 T14

Gather Unbuckle

Mating Box

Boxes

Q1 T4 T5

T = Touches

Q = Quality

P = ESP Process

T1

T2

Courier Flow

Do 'arrival scan' ofboxes as they are

in order

Place Boxes In waiting area

removed from vehicle

2 Touches

14 Touches

Single Piece Flow and Point-of-Use Storage

Reduced touches by 53%

New process:• 16 touches

Old process:• 34 touches

House of Lean

Quick Changeover

Standardized Work Single Piece Flow Kaizen

Quality at Source

5S System Visual Plant Layout

POUS

Cellular/FlowPull/Kanban TPM

ValueStreamMapping

Continuous Improvement

Old Specimen Processing Layout Individual Workstations

IndividualWorkstations

New Team Layout with PODs of Four

Floor PlanBefore After

Lab LayoutOld Layout116 Seats

New Layout159 Seats

Spaghetti DiagramsEfficiency Analysis

Non‐POD POD

Lab LayoutOld layout:116 seats

New layout:159 seats

Increased seats by 37%

House of Lean

Quick Changeover

Standardized Work Single Piece Flow Kaizen

Quality at Source

5S System Visual Plant Layout

POUS

Cellular/FlowPull/Kanban TPM

ValueStreamMapping

Continuous Improvement

Problem Solving at the Source in PODS

Problem SolvingAt the Source

Quality at the SourceSupport in Pods

• Problem solving at the source was emphasized with editors, EH, and T3s in the PODs.

– Editor ratio: 1:16

– Exception Handling ratio: 1:8

– Tech 3  ratio: 1:16

Quality Features and Benefits

• In POD editors• Immediate problem resolution• In‐POD Exception Handling• Fewer not‐ins• Improved quality• Reduced movement and waiting• Improved employee rapport

Quality at Source Metrics

• Editor metrics: reduced edit time from 6 to 8 hours to 1 to 2 hours– 4x improvement

• Exception Handling metrics: increased early resolution from 30 to 3000/month– 100X improvement

House of Lean

Quick Changeover

Standardized Work Single Piece Flow Kaizen

Quality at Source

5S System Visual Plant Layout

POUS

Cellular/FlowPull/Kanban TPM

ValueStreamMapping

Continuous Improvement

Standardized Work

• Introduced solid modeling software to develop standardized work stations.

• Used 5S methods to make the best use of the reduced space.

Smaller Shared WorkstationsCurrent Station

New StationCurrent Stations Side by Side

New Stations Side by Side

Shared Supplies

TemperatureDrawers

Width =10’

Width = 7’ 10.5”

Standardized Work Metrics

Reduced processing stations from 60 linear inches to  47.  

21% reduction

Specimen Processing PODsProcess Improvement Summary

• Objectives and realized benefits:– Reduce handling steps– Increase productivity– Reduce wait time– Improve quality– Increase space utilization– “Cherry picking”

House of LeanSpecimen Processing PODs

Quick Changeover

Standardized Work Single Piece Flow Kaizen

Quality at Source

5S System Visual Plant Layout

POUS

Cellular/FlowPull/Kanban TPM

ValueStreamMapping

Continuous Improvement

Summary of Non POD vs. POD Metrics

Non‐POD

34 touchesYB on floor

Quality:Early Except ResolutionEdit time

Space utilization:116 work stations

POD

16 touchesYB on floor

Reduced by 50%Quality:

Early Except Resolution 100XEdit Time Reduced 4X

Space utilization:159 work stations

Wikimedia Commons – Public Domain

White Paper Available

ARUP SpecimenProcessing LeanCase Study

http://aruplab.com/Testing‐Information/Quality‐

Compliance/white_papers/Specimen‐processing‐case‐study.pdf

How Reducing the Number of Touches per Tube in Processing Slashes Errors and Boosts Staff 

Productivity

Q&A