Athens Hospital Improves Processes by Implementing Lean in Laboratory

(Georgia Tech Enterprise Innovation Institute: Atlanta) -- Debbie Guzman, laboratory director at Athens Regional Medical Center, says that implementing lean principles in a health care setting is especially challenging. Traditionally used in manufacturing, lean refers to an operational strategy derived from the Toyota Production System that focuses on eliminating waste while increasing value-added work to improve profitability, customer satisfaction, throughput time, and employee morale.

“People involved in health care are about hands-on care giving, comforting, and healing,” she says. “We needed someone to help us who understood our language.”

As part of the lean implementation, team members removed sliding doors from shelving and doors from storage cabinets to easily identify supplies.

Fortunately, Guzman found an excellent translator in Georgia Tech’s Enterprise Innovation Institute. Through its Healthcare Performance Group, project leaders work with health care professionals to conduct lean assessments, teach basic lean concepts, develop value-stream maps to analyze the flow of materials and information, develop quality systems, and implement rapid process improvement projects. 

“We wanted the Healthcare Performance Group to provide the training, the structure, and the facilitation for a period of time to do a 5S project in the lab. By using the 5S system—sort, straighten, shine, standardize, and sustain—we thought we could significantly improve the efficiency and effectiveness of the laboratory,” explains Jim Pirkle, Athens Regional’s associate director of quality services. “Originally we were going to begin the project in one area, but we wanted each of the section supervisors to be involved so it could be a whole lab culture change.”

After years of inventory accrual and process adaptation, the five sections of the lab—pathology, chemistry, hematology, microbiology, and blood bank—were in a physically dysfunctional environment. As the hospital expanded, team members had the opportunity to design a new lab that had the right supplies next to the right instruments, the appropriate amount of storage and counter space, equipment set up to facilitate testing processes, and work processes arranged to minimize excess steps.

“We wanted to address inventory control—having the right inventory in the right place and at the right time,” says Frank Mewborn, leader of the Healthcare Performance Group. “An example that everyone could understand and relate to was gloves. We had the team estimate the glove inventory and then we actually counted it. We found open boxes and unopened boxes all around the lab. The inventory was three times higher than the team predicted. It was an eye-opening exercise.”

While the overall goal was to help design a highly functional lab, the immediate project goals included making work space more efficient, reducing inventory and supply costs, decreasing process steps and complexity, and creating efficiencies in a timely manner. Participants included the lab director and supervisors, lab staff, and quality support staff from Athens Regional, as well as Mewborn, Tara Barrett and Kelley Hundt from Georgia Tech. Five teams of 21 people learned about lean and 5S methodologies, participated in brainstorming and planning exercises and completed an “eye-opening” walk-through of the entire laboratory.

“Typically when we do a project like this, we do it in a series. We’ll pick one small area of the lab and get it really shipshape and then use it as a model for the next area,” Mewborn recalls. “But Debbie wanted this to be a culture change in addition to a procedural change so we did all five areas simultaneously.”

In the first phase of the project, team members sorted the useful from the unnecessary. They evaluated the necessity of all supplies and equipment, cleared away trash and outdated equipment from the area, and removed sliding doors from shelving and doors from storage cabinets to easily identify supplies. Most important, each department developed a systematic and collaborative process for sorting obviously misplaced items from useful ones.

Team members also relocated supplies, acquired supply bins, and consolidated storage areas; set up a standard visual inventory system with red and green tape, and developed kanban cards to display the name of the supply, the name of the supplier, the desired number of units, and the item’s reorder point; and cleared trash away from the work area, thoroughly cleaned countertops, drawers, and cabinets, and removed redundant and unnecessary signage. Moving forward, Athens Regional has established a committee to focus on sustaining these improvements.

“Employees say this is now a much better place to work, and there is not as much clutter or confusion. In regard to patient safety, that’s a significant benefit,” Pirkle says. “As a result, we’ll have better patient outcomes as we become more accurate and timely.”

In particular, the 5S project increased the lab’s storage capacity by 64 percent, freed up counter space by 30 percent, and reduced body fluid processing times from 12 minutes to four minutes. Other results include reduced inventory and supply costs, decreased stock on hand, and greater clarity in the lab environment. Projected savings from reduced steps and time to complete work total more than $15,000.

“When the process is really lean, when you walk through the lab, everything is in its place. Everything is in the front and one person can go through the lines and know what needs to be ordered,” Guzman notes. “The biggest benefit of the project is that we now have some real lean champions in the lab.”

For more information on health care performance improvement services offered by Georgia Tech’s Enterprise Innovation Institute, contact Frank Mewborn, director of the Healthcare Performance Group at (706) 338-0072.