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Lab Space Planning and Facilities Design

September 25, 2008
Wayne D. Mercer, PhD
Senior Consultant, Operations Management

© 2008 Chi Solutions, Inc. Proprietary and Confidential.

Lab Space Planning and Facilities Design

How to Apply Lean to Your Lab
Before You Call the Architect and Contractor

Wayne D. Mercer, Ph.D.
Senior Consultant, Operations Management
[email protected]

1

© 2008 Chi Solutions, Inc. Proprietary and Confidential.

Presentation Objectives
ƒ Describe the elements of a design project.
ƒ Describe how to plan a design project for a clinical laboratory.
ƒ Describe some key features of effective lean design.
ƒ Present some examples of using lean to improve operational
efficiency.
ƒ Describe some things to avoid.
ƒ Present a limited case study of using lean to design a core laboratory.
ƒ Answer any questions that you may have.

2

© 2008 Chi Solutions, Inc. Proprietary and Confidential.

Lab Design Requires a Multidisciplinary Approach
Lean Six Sigma Tools
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Lean - Reduction of waste
Standard work processes
Single piece workflow
FMEA
SIPOC
DMAIC
DMAVI
5S
Visual management systems
Mistake avoidance
Work balancing
Value stream map

Operational Requirements
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Multiple disciplines
Meet service requirements
Reduce expenses
Flexibility for growth
Flexibility for new requirements

Design/Engineering Activities
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Site selection
Space programming
Sub-block adjacencies
Workstation requirements
Work cell design
Facility/building system surveys
Schematic design

© 2008 Chi Solutions, Inc. Proprietary and Confidential.

Clinical Pathology:
Multiple Disciplines with Highly Automated and Manual Procedures

4

© 2008 Chi Solutions, Inc. Proprietary and Confidential.

Anatomic Pathology:
Multiple Services with Technical and Increased Professional Components

5

© 2008 Chi Solutions, Inc. Proprietary and Confidential.

Support Space:
Phlebotomy/FNA, Teaching, Staff Amenities, Offices, Admin Support

6

© 2008 Chi Solutions, Inc. Proprietary and Confidential.

Application of Lean Six Sigma to Design Projects
ƒ Applying DMAVI for the overall design process.
ƒ Identifying operational processes that need improvement through a
detailed operations review.
ƒ Using lean concepts for the actual facility layout.

7

© 2008 Chi Solutions, Inc. Proprietary and Confidential.

Lean Facility Design and Planning Process
Project Preplanning, Development of Balanced Scorecard Strategy
Review of System/Master Facility Strategic Plans

Strategic
Planning
Operations
Review

Strategy
Formulation

Analyze
Services

Analyze
Current
Equipment

Identify
Customer
Issues

Analyze
Current
Space

Analyze
Organization
Structure

Facility
Review

Analyze
Inventory
System

Develop High-Level Version of Design Notes and Operating Assumptions
Incorporate Technological Changes or New Requirements
Identify
Key
Affinities

Future
Layout

Analyze
Current
Process Flow

Identify
Supporting
Activities

Identify
Workstation
Requirements

Calculate
Needed
Space

Develop
Future
Process Flow

Identify
Constraints

Create
High-Level
Space Plan(s)

Evaluate Space
Plan Options
Develop Floor Plans
and Cost Estimates

Schematic Design

8

© 2008 Chi Solutions, Inc. Proprietary and Confidential.

A Lean Approach to Pre-Design Activities:
Develop a Project Plan

ƒ Define the purpose and scope of project
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Design of new lab vs. renovation
System consolidation and savings opportunities
Prepare for volume growth (e.g., outreach)
Limited reconfiguration (e.g., install automation)

9

© 2008 Chi Solutions, Inc. Proprietary and Confidential.

A Lean Approach to Pre-Design Activities:
Develop a Project Plan

ƒ Timeframe
ƒ When will the project start and when is it expected to be completed?
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Do you need interim solutions?

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Allow sufficient time for:
ƒ Operations reviews
ƒ Strategy formulation
ƒ Development of high-level space plan options
ƒ Schematic design

ƒ Recognize that laboratories are complex environments to design
ƒ Consider impact of other major activities (e.g., LIS upgrades/
changeovers)

10

© 2008 Chi Solutions, Inc. Proprietary and Confidential.

A Lean Approach to Pre-Design Activities:
Develop a Project Plan

ƒ Perform strategic review of capital equipment requirements
ƒ Replacement cycle
ƒ Will replacement be part of design project?
ƒ Prepare for growth needs
ƒ Volume
ƒ New or replacement technology
ƒ Consider impact of workstation consolidation
ƒ Are you planning on automation?

11

© 2008 Chi Solutions, Inc. Proprietary and Confidential.

A Lean Approach to Pre-Design Activities:
Develop a Project Plan (cont.)

ƒ Develop a Lab Design Project Team and Executive Steering Committee
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Senior Management
Medical Director(s)
Lab Staff
Design and Construction
Facilities
Strategic Planning Department
IT, Telecom
Biomed/Tube System Engineering
Materials Management
Real Estate Manager
HR

Identify additional resources needed
ƒ Lab Consultants
ƒ Architect/Engineering

12

© 2008 Chi Solutions, Inc. Proprietary and Confidential.

A Lean Approach to Pre-Design Activities:
Develop a Project Plan (cont.)

ƒ Financial issues and business plan development
ƒ Cost per SF ranges from $250 to $1,350 with median of ~$500
ƒ
50,000 SF Lab @ $500/SF = $25,000,000
ƒ Return on Investment (ROI)
ƒ Many projects will have acceptable ROI of two to five years due to
operational savings
ƒ Consider life of building to calculate FTE savings
ƒ
75K per year X 20 years = $1.5 million over life of facility
ƒ Consider financial impact of alternative use of space

13

© 2008 Chi Solutions, Inc. Proprietary and Confidential.

Using Lean Effectively for Design Projects
ƒ Identify customer requirements through interviews and applying
service metrics as part of a balanced scorecard approach.
ƒ Identify/classify lean opportunities by performing an operations review.
ƒ Develop the facility plan to meet customer requirements and to
minimize wasted space and personnel movement.

14

© 2008 Chi Solutions, Inc. Proprietary and Confidential.

Balanced Scorecard Approach:
Cost Is Important and So Are Other Factors!

Strategy

People

ƒ System Strategic
Care/Business Plans

ƒ Institutional Culture
ƒ Effective Utilization of Human
Resources

ƒ Maintain/Improve Service
Quality

ƒ Work Environment and Safety

ƒ Master Facility Plan

ƒ Staffing Shortages in the Lab
Industry

Service

Financial

ƒ Test Menu Standardization
and Completeness

ƒ Opportunity for Expense
Reduction

ƒ Leverage Use of New
Technology

ƒ Optimal Use of Available
Capital

ƒ Meet Service Requirements of
Medical Staff

ƒ Minimize Project Risks

15

© 2008 Chi Solutions, Inc. Proprietary and Confidential.

Customer Requirements Drive Service Model
Document:
ƒ Any service deficiencies
ƒ New requirements
ƒ Define/measure service metrics
ƒ Specimen collection and results
reporting processes

Identify/interview key customers:
ƒ ED
ƒ ICUs
ƒ Nursing Floors
ƒ Outpatient PSC
ƒ Outreach
ƒ Specialty Clinics

16

© 2008 Chi Solutions, Inc. Proprietary and Confidential.

Schematic Design Notes:
Customer Requirements/Specimen Collection
ƒ

Currently, accessioning for outpatients is performed at both the main
specimen processing area and at some patient service centers (PSCs). It is
assumed that this activity can be fully performed at the PSCs with minimal
necessity for accessioning activity space in the core lab and to improve
billing/collection processes (e.g., ABN compliance).

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Bedside bar code scanners/printers will be employed for specimen collection
and to accomplish positive patient ID goals.

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Phlebotomy and nursing staff should send specimens using as small a batch
as possible to facilitate continuous workflow and improve turnaround time.

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A pneumatic tube system with a diameter of six inches will be used to
transport specimens and blood products to/from patient service areas and the
lab.

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A direct connection is desirable to key service areas such as Transfusion
Services, Emergency Department, Operating Rooms, Labor and Delivery, and
Intensive Care Units of the hospital.

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The core laboratory should provide an absolute turnaround time of 30 minutes
for selected automated tests. Current performance is 90% completion at 60
minutes.
17

© 2008 Chi Solutions, Inc. Proprietary and Confidential.

Lean Opportunities in the Lab:
Identification of Waste in Specimen Processing
ƒ Waiting: Specimens in receiving area awaiting sorting
ƒ Over Processing: Taking requisitions in/out of bags
ƒ Transportation: Unnecessary walking to deliver specimens
ƒ Over Production: Process/sort several buckets before passing
them on
ƒ Inventory: Buildup of specimens due to simultaneous delivery by
couriers
ƒ Moving: Back/forth physical movement due to poor workstation layout
ƒ Fixing Defects: Mislabeled/improperly labeled tubes

18

© 2008 Chi Solutions, Inc. Proprietary and Confidential.

Operations Review:
Reduce Over Processing/Improved Efficiency Will Reduce TAT, # Workstations

First member of processing
staff removes requisition from
specimen bag.

Same staff member returns
requisition to specimen bag.
Next processor has to repeat
removal.

19

© 2008 Chi Solutions, Inc. Proprietary and Confidential.

Typical Results
Item

Current

New Procedure

Number of steps
before specimen is
available for testing

34 steps

20 steps

Time to process 10
requisitions before
testing

25 minutes

6 minutes

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Effective use of triage

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Elimination of unnecessary/redundant activities

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Change in order of processing steps

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Put problem requisitions aside

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Perform patient registration in billing area

20

© 2008 Chi Solutions, Inc. Proprietary and Confidential.

Operations Review:
Identification of Inefficient Processes for Specimen Storage and Retrieval

Use of bar code-based software system for
specimen storage and retrieval

21

© 2008 Chi Solutions, Inc. Proprietary and Confidential.

Operations Review:
Identification of Inefficient Processes Due to Design and Organization

ƒ

Differential area is >60 feet
away from automated
hematology area

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Manual testing reported to a
different supervisor than the
automated testing areas

ƒ You may have to consider changing organizational reporting structures

22

© 2008 Chi Solutions, Inc. Proprietary and Confidential.

Operations Review:
Use of Techniques to Improve Efficiency/TAT

ƒ Develop paperless systems
ƒ Use of auto-verification
ƒ Revision of delta criteria

This laboratory went from less than
30% of Chem Panel results within 60
minutes to more than 90% in 30
minutes or less without track-based
automation systems!

23

© 2008 Chi Solutions, Inc. Proprietary and Confidential.

Equipment Consolidation:
Chemistry/Spec Chem/Tox/Endocrinology/Immunology
(2) Roche 917
(4) DPC ImmuLite
(1) Abbott Axsym
(2) Roche Elecsys
(1) Beckman Array
(1) Biorad Variant
(3) Abbott TDX

(2-3) Automated Chem

(2) Abbott IMX

(2-4) Immunoassay

(1) Nova 5
(1) Nova 16
(1) AVL
(1) ABL
(1) Abbott Commander
(1) Biosite Triage

24

© 2008 Chi Solutions, Inc. Proprietary and Confidential.

ID

N01 01
00 00
02 -0 2
00 00
03 -0 3
00 00
04 -0 4
00 00
05 -0 5
00 00
06 0 6
00 00
07 -0 7
00 00
08 -0 8
00 00
09 -0 9
00 00
10 -1 0
00 00
11 -1 1
00 00
12 -1 2
00 00
13 -1 3
00 00
14 -1 4
00 00
15 -1 5
00 00
16 -1 6
00 00
17 -1 7
00 00
18 -1 8
00 00
19 -1 9
00 00
20 -2 0
00 00
21 2 1
00 00
22 -2 2
00 00
23 -2 3
00 00
-2
40
0

M

# TESTS

System Capacity Analysis
2500

2000

1500

1000

500

0

TESTS
CAPACITY

25
© 2008 Chi Solutions, Inc. Proprietary and Confidential.

Turnaround Time Analysis
Accession Time (Min)
Time to First Result (Min)

Centrifuge & Transport (Min)
Est Analysis Time (Min)

Production Delay Time (Min)
Review / Release Time (Min)

45.0
40.0
35.0
30.0
25.0
20.0
15.0
10.0
5.0
0.0
0500-0600

0600-0700

0700-0800

0800-0900

26

0900-1000

1000-1100

1100-1200

© 2008 Chi Solutions, Inc. Proprietary and Confidential.

Sub-Block Design:
Consider Impact of Automation/New Technologies
Typical system of two or three Chemistry analyzers and two Immunoassay
analyzers requires 800-1,500 SF for equipment only.

27

© 2008 Chi Solutions, Inc. Proprietary and Confidential.

Sub-Block Design:
Consider Impact of Automation/New Technologies
Typical system of two to four Hematology analyzers with slide maker/
stainers requires 300-500 SF for equipment only.
ƒ Design for flexibility…Manufacturers are adding new capabilities to
automated hematology systems (e.g., HbA1c).
ƒ Consider use of task-targeted automation (e.g., digital hematology).

28

© 2008 Chi Solutions, Inc. Proprietary and Confidential.

Identification of Inefficient Processes Due to Design

An open lab is not the same thing as a lean-designed lab!

29

© 2008 Chi Solutions, Inc. Proprietary and Confidential.

Change of Process

30

© 2008 Chi Solutions, Inc. Proprietary and Confidential.

Change of Process

31

© 2008 Chi Solutions, Inc. Proprietary and Confidential.

Change of Process
Change of process may be needed!
The STAT lab was removed after the work was
integrated into the automated system.

32

© 2008 Chi Solutions, Inc. Proprietary and Confidential.

Sub-Block Design:
Use of Lean Techniques for Supply Storage

33

© 2008 Chi Solutions, Inc. Proprietary and Confidential.

Schematic Design Notes:
Core Laboratory

ƒ The laboratory will use online data storage and strive to be paperless.
ƒ Automated equipment interfaces will use auto-verification, and the
Delta check criteria will be revised to be consistent with linear ranges
and medical necessity.
ƒ Supplies will be stored within the laboratory areas to operate for up to
a 72-hour period. They will be replenished daily by Materials
Management using reorder points that will be reviewed quarterly.
ƒ High density storage systems will be used to store supplies within the
lab storeroom.
ƒ The cold room or refrigerators will be rear-loading with glass doors in
front to facilitate supply rotation.
ƒ A bar code-based specimen management system will be used. This
will be performed automatically on the automated chemistry/
immunoassay system and the automated hematology system. Other
sections will use a PC workstation equipped with suitable software.

34

© 2008 Chi Solutions, Inc. Proprietary and Confidential.

Process Maps
ƒ

ƒ

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A critical component of
applying lean tools to
Start
laboratory design begins
with the mapping of the
entire laboratory process
from specimen collection to
result reporting.
This should be initially be
performed at a high level,
but should include all major
customer interactions, major
input activities or events,
and major reporting
activities.

Receive

Type & Screen

Pickup

Sort

Load onto
Machine

Drop off to
Testing area

Yes
Review

Positive?

Manual Reiew
(test history)

Enter
Data
(IT)

Spin

Antibody
Identification

No
Release
result
(IT)

The process review may also
reveal design issues that
have to be addressed.

Label Unit

Electronic
Crossmatch

Manual
Crossmatch

Issue

End

35

© 2008 Chi Solutions, Inc. Proprietary and Confidential.

Core Laboratory: Analysis of Current Workflow
Start

Outreach

Hospital

Micro

Receive and
Timestamp

Sort

Blood
Gas?

STAT?

Routine?

ED?

OR/
CATH?

Super
STAT?

STAT?

Routine?

UA &
Blood
Cultures?

BLD/PCR/
Serology?

Routine?

Process
(see individual
process maps)

Three departments sort in a total of eleven different ways:
ƒ Sorting and time stamping = Key non-value added steps
ƒ Duplication of functions = Increased need of staffing/inefficient allocation of staffing
ƒ Increased risk of errors = Impediments to improved quality care

36

© 2008 Chi Solutions, Inc. Proprietary and Confidential.

Core Laboratory: Current Space Layout
Main Hospital Corridor
Training

Special
Hematology

Clinical Trials

Empty Space

Empty Space

Storage
Send Out

Office

Chemistry

Send
Out

POCT

Side Corridor

Training
Hematology
Fluids
Diff Area

Cold
Storage

Offices

Specimen
Processing
LPCH

LPCH
UA

Hematology

Phlebotomy

Coagulation

Specimen Processing
SHC

Offices

Storage

Internal Corridor
Specimen Processing
Micro

37

© 2008 Chi Solutions, Inc. Proprietary and Confidential.

Specimen Receiving/Processing
Specimen
Processing
Bench

Specimen Receiving
Staff cannot see all
sides of the tube
station from their
workstation

Blood Gas
Bench

Tube
Station
Specimen receiver
sits here
Pneumatic tubes
arrive here

38

© 2008 Chi Solutions, Inc. Proprietary and Confidential.

Core Laboratory
Concept of Future Schematic Layout
Storage

Urinalysis

Hematology Coagulation

Chemistry

Send
Out/
Research

POCT

Processing
Tube
Note: This layout is intended to show relative positions and is not to scale.

39

© 2008 Chi Solutions, Inc. Proprietary and Confidential.

Schematic Design Notes:
Core Laboratory
ƒ

Physically reorient the floor plan of the core laboratory so that key service areas
such as phlebotomy and specimen receipt are adjacent to the main corridor
connecting the ED and nursing floors.

ƒ

Plan the core laboratory so that specimen processing is tightly integrated into the
overall operation, and eliminate the current use of multiple processing areas.

ƒ

Current production is based on at least 11 different categories and/or workflow
processes. These will be simplified to employ First In/First Out (FIFO) for all
specimens (except those for blood gas determinations) and use automation and
sufficient equipment to meet projected TAT requirements.

ƒ

Organize the core laboratory sections by specimen type to the greatest extent
possible.

ƒ

The tube systems will be relocated within the core lab to facilitate improved
workflow processes.

ƒ

Automated equipment interfaces will perform the “specimen received” function vs.
performing this procedure manually in accessioning.

ƒ

Develop the overall floor plan of the testing sections to ensure a smooth workflow
with adequate storage areas and space for future growth.

ƒ

An absolute TAT goal of 30 minutes will be used for all tests on the STAT menu.

40

© 2008 Chi Solutions, Inc. Proprietary and Confidential.

Core Laboratory: Future Space Layout
Main Hospital Corridor
Blood
Culture

Specimen
Processing

Send Out

Phlebotomy/FNA

Side Corridor

Manual/
Special Test
Hematology

POCT

Clinical
Trials

Blood
Gases

UA

Coag
Call Center
Chemistry/
Immunoassay

Hem Diff
Body Fluids
Offices

Core Lab
QA

Rest
Training
Rooms

Special
Hematology

Waste
Holding
Area

Flammable
Storage

Lab Coats

Supv/Review Stations

Freezer
Storage

Cold
Storage

Rest
Rooms

Storage

Internal Corridor
- Not

41

to Scale -

© 2008 Chi Solutions, Inc. Proprietary and Confidential.

What Happens Next:
Architectural Design, Engineering, and Construction

42

© 2008 Chi Solutions, Inc. Proprietary and Confidential.

Summary
ƒ

Develop a project plan with a realistic schedule.

ƒ

Form an Executive Steering Committee to get support for your project.

ƒ

Develop a balanced scorecard for your department with maximum input from
customers to ensure your department meets their needs.

ƒ

Analyze your current operation in terms of processes used and workflow, and
develop metrics.

ƒ

Identify lean opportunities as process and/or design issues, and develop
solutions for the process issues as interim improvements.

ƒ

Use lean strategically, not in isolation!

ƒ

Develop a strategic plan for instrumentation that considers new or changing
technologies and use of automation.

ƒ

Develop a strategic plan to meet service requirements and use these
requirements, to develop a set of schematic design notes with operating
assumptions and specifications for the architect to use.

43

© 2008 Chi Solutions, Inc. Proprietary and Confidential.

Acknowledgements
Chi Solutions, Inc.

Graphics and Picture Credits

ƒ

Earl Buck, MP(ASCP)

ƒ

AdvanDx

ƒ

Toni Burger, MBA, MT(ASCP)

ƒ

Barbara Ratner Rendering

ƒ

Shannon Donahue

ƒ

CellaVision AB

ƒ

Hans Froehling, DBA, CMBB

ƒ

CUH2A

ƒ

Nora Hess, MBA, MT(ASCP)

ƒ

Jonathan Hillyer Photography

ƒ

Mike Kachure

ƒ

Lord, Aeck & Sargent

ƒ

Kathy Murphy, Ph.D.

ƒ

X-Nth

ƒ

Dan Rajkovich, MPA, MT(ASCP)

ƒ

Karla Yurgaites

…And especially to our clients who allowed photography of their
laboratories and to their staff who appeared in the pictures.

44

© 2008 Chi Solutions, Inc. Proprietary and Confidential.

Thank You!
Questions and Answers

45

© 2008 Chi Solutions, Inc. Proprietary and Confidential.

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