Today’s lab leaders must continuously seek ways to improve efficiencies, maximize quality, and reduce costs. The Surrey Memorial Hospital lab set out in pursuit of these goals—although the challenge at first looked daunting.
"To be honest, we were rather skeptical at first," says Sherrie Warren, Operations Manager at Lower Mainland Labs. "You’ve done something one way for so long that you’re not confident someone can come along and change it so dramatically." She and her team realized that careful preparation was key.
First, longer-term goals had to be established. These included maximizing performance through balanced workloads, refined sample and workflow, and reagent optimization. Improved process efficiency was also sought through the LEAN process.
To make matters more challenging, institutional-level variables also needed to be accounted for. First, the Surrey ER grew from 25 beds to 100 beds, accompanied with an increased lab test volume of approximately 15%. This included extensive tumor marker crossover. Furthermore, Surrey Memorial needed to efficiently configure a new space for their lab, to find the most productive way for equipment to function while leaving room for future demand.
With so many moving parts, a systematic approach was needed. They first reached out to Roche to help plan the process. Right away, several incremental steps were put in place to initiate and measure the process of change.
The Surrey Memorial lab took a big-picture view of what quality actually meant for the institution. They arrived at six key pillars that defined quality:
Now, the task remained of how to turn those pillars into actionable results for the lab.
The next question Surrey had to ask was, “How do we know if quality has improved?” This required the ability to measure quality both before and after implementation.
Three metric categories were first determined: LEAN/process improvement, quality, and cost, supplemented with specific goals where applicable:
Increase auto-verification, while reducing overall process steps and time spent archiving/retrieving samples
50% reduction in repeat testing, doubling of auto-verification, and elimination of manual archiving and scanning
Ensure predictable TATs, while reducing repeat testing and manual aliquots
10% reduction in repeat testing and 50% reduction in manual aliquots
Increase workload units per paid hours, while managing growth and utilizing space efficiently
General improvements derived from previous two metrics
Once the metrics were selected, the Surrey Memorial Hospital lab worked in partnership with Roche to implement process and automation solutions that led to measurable results.
The results met goals across the majority of criteria, creating significant boosts in efficiencies.
The new Roche lab system made a significant difference in both the pre- and post-analytical realm, reducing pre-analytical touchpoints from 37 process steps to 22—a decrease of 41%.
For the analytical process, the previous Beckman/Ortho infrastructure required 44 process steps. The new system reduced it to 10—a decrease of 77%.
After implementation, the rate of auto-verification nearly tripled—from 10% to 28% of total tests automatically verified.
The previous regime of manual process work took a toll on staff time and resources. For example, simply loading and unloading centrifuges took 88 minutes per day. Automation decreased manual centrifugation, transport, racking, and archiving from 950 events to 0 events—a savings of 4 hours/day.
Manual aliquoting also decreased from 431 events to 35 events per 24 hours—a savings of 4.2 hours/day.
Previously, TAT consumed significant amounts of time. For example, glucose tests could take up to 50 minutes, while Bilirubin could take up to 1 hour and 5 minutes. Automation improved TAT for all tests by an average of 10 minutes, while others like ferritin and TSH improved by 45 minutes.
Efficiently using the new Surrey Memorial Hospital lab space remained imperative. The new Roche analyzer resulted in a 42% decrease in square footage footprint. The reduction had additional benefits of requiring a less complicated and extensive wiring diagram, saving on ancillary installation costs.
One of the things that surprised Warren and her team the most was something they weren’t looking for. "While we sought an increase in auto-verification, we also got a decrease in errors," Warren says. "Decreasing manual aliquoting did more than save us time. We made fewer mistakes and improved quality."
Before the Surrey Memorial Hospital lab embarked in its milestone efficiency program, Roche stated their intentions succinctly: “We strive to support you in streamlining your operation, allowing you to realize cost savings outside of the purchase of instruments and associated materials.”
On a more personal level, Warren now sees a tangible difference in daily operations. "Before, everyone in the chemistry department was running around, looking for specimens and reagents," she recalls. "Now, people are calm, sitting at their instruments, doing their work. In fact, more people are applying for jobs in our department than ever before because they can sense the increase in satisfaction among these workers."
The reliability and increased capacity that Roche brought to Surrey Memorial has also had a ripple effect throughout the Surrey hospital system. "We’re now able to take on an increased load of more than 200 outpatient samples per day from our smaller, regional partners," Warren states. "Now, these sites can focus more on their inpatient work and reduce their TAT."
With the proper steps—defining quality, establishing metrics, and measuring results—the Surrey Memorial Hospital lab was able to maximize its partnership with Roche, delivery of "critical to quality" services, and the health of its bottom line.