Contributing lab leaders: John Longshore, PhD, FACMG
With the need to drive process efficiency, some leaders in the molecular lab are starting to turn to a set of principles that have driven value in manufacturing environments: Lean. The Lean strategy is, in large part, based on three principles, the so-called Three Ps: purpose, process, and people. Broadly speaking, Lean methodologies are used to drive value, strip costs and wasted effort, streamline operations, eliminate waste and continuously optimize processes through collaboration. At a time when molecular testing, especially, high-volume testing, is in dire need of increased efficiency, taking a cue from the rapid production of lean manufacturing makes sense.
Yet, molecular testing often resembles less the manufacturing of a product, per se, than it does providing a service—one that changes, depending on patient needs. Can Lean manufacturing principles help improve molecular lab performance and drive value? And if so, where do Lean principles best apply to deliver significant benefits?
Dr. John Longshore, PhD, FACMG, shares his experiences of how applying lean manufacturing principles can really improve laboratory productivity and efficiency with the ultimate goal of creating a lean laboratory environment.
One textbook example of successfully implementing lean methodologies comes from Atrium Health. Three years ago, under the direction of Dr. John Longshore, director of Molecular Pathology, the health system consolidated seven decentralized molecular labs into a single core lab—centering Lean principles at the heart of this sea change. For lab leaders, this transformation offers a vital glimpse of the opportunities and challenges of the Lean laboratory environment.
Implementing lean principles, here, has been largely successful, due in part to two factors. Firstly, never viewing Lean as merely a multi-step program with a deadline, but as a paradigm for continuous improvement; and secondly, applying Lean where it specifically benefits the lab. Dr. Longshore outlines his approach: "I think there are four big principles that have gone well for us: consolidating the workflow, cross-training our staff, continuing to challenge their skills, and controlling utilization of the testing services that we offer."
In this way, the task for lab leaders is not to shoehorn manufacturing strategies into the lab, but to uncover where opportunities for Lean in the lab best reside— for example, to improve efficiency and operational performance while removing wasted efforts. This is a task that requires considerable collaboration; Lean is most successful as a "bottom-up" strategy, where stakeholders at all levels suggest opportunities for efficiency.
I think there are four big principles that have gone well for us consolidating the workload, cross-training our staff, continuing to challenge their skills and controlling utilization of the testing services that we offer.
Now people who participated in the design process were not necessarily experts in laboratory testing. We had security guard, nurses, pharmacists, environmental services. We had an architect. So we wanted a group of non experts to take a look at our testing processes and principles and ask why we were doing things in certain ways, because we tend to be entrenched in our processes in the way we do things in the lab. And it's very hard to implement change if you're not constantly asking yourself or is this the best way to do things.
Atrium's approach to designing their core lab is telling: "Now, people who participated in the design process were not necessarily experts in laboratory testing," says Dr. Longshore. "We had security guards, nurses, pharmacists, and environmental services. We even had an architect. We wanted a group of non-experts to take a look at our testing processes and principles, and ask why we were doing things a certain way." He says that, because laboratorians can become entrenched in their own laboratory processes, the best way to foment positive change is to have stakeholders question those very processes, asking, "Is this the best way to do things? How can we do better?"
This kind of bottom-up strategy is a significant change for labs, which have traditionally been very medical-director-driven—where the ethos, "It's my lab. I make the rules," can dominate.
Yet, Atrium has demonstrated the workability and potential benefits of this lean lab approach. For example, before the construction of Atrium's 29,000-square-foot core lab, Dr. Longshore's team built a full-scale footprint of the lab out of cardboard, so that stakeholders could literally move through the space, examine their workflows, and provide input for improvement. Moreover, Dr. Longshore has made considerable efforts to cross-train his staff, ensuring that technologists not only have a thorough understanding of lab processes, broadly but that they can thrive in their areas of expertise.
The result? In comparison to Atrium's previous labs, the core lab has vastly improved the flow and standard of work, supply chain, and efficiency with regard to how the lab moves equipment, supplies, and samples, says Dr. Longshore. By educating his staff about, and engaging them with, Lean principles, Dr. Longshore created a collaborative group mentality, where employees felt empowered to advocate for positive change. Any lab, regardless of the situation—or whether they formally implement Lean principles—could stand to benefit from such an approach.
Lean requires a paradigm shift in thinking, which comes with its own sets of unique challenges involved. For example, Dr. Longshore says that, while Lean has been helpful in process optimization and the supply chain, the overall management structure remains a challenge.
"The vast majority of work has been done in a manufacturing environment for Lean. [The lab is] not truly a production environment, where we are making a product. We are providing a service. I think that has been a little bit of a challenge in trying to establish concepts like standard processes and standard work. They may be great in a manufacturing environment, but may not lend themselves so well to a medical laboratory."