With the need to drive process efficiency, some leaders in the molecular lab are turning 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 Three Ps: purpose, process, and people. Broadly, Lean is viewed as a method to drive value, strip costs and wasted effort, streamline operations, and continuously optimize processes through collaboration. At a time when molecular testing, especially, high-volume testing, is in dire need of increase efficiency, taking a cue from the rapid production of manufacturing makes sense.
Yet, molecular testing often resembles less manufacturing a product, per se, than it does providing a service—one that changes, depending on patient needs. Can Lean principles help molecular labs drive value? And if so, where do Lean principles best apply?
One textbook example of a successful Lean implementation 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 the opportunities and challenges Lean.
The application of Lean, here, has been largely successful, due in part to two factors: never viewing Lean as merely a multi-step program with a deadline, but as a paradigm for continuous improvement; and 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 work flow, 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 reside—to improve efficiency and remove 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.
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, environmental services. We 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 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 approach. For example, before 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 understand 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 a vastly improved workflow, 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 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 challenges. For example, Dr. Longshore says that, while Lean has been helpful for optimizing processes 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."
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