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
Describe the elements of a design project.
Describe how to plan a design project for a clinical laboratory.
Describe some key features of effective lean design.
Present some examples of using lean to improve operational
efficiency.
Describe some things to avoid.
Present a limited case study of using lean to design a core laboratory.
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
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
Multiple disciplines
Meet service requirements
Reduce expenses
Flexibility for growth
Flexibility for new requirements
Design/Engineering Activities
3
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
Applying DMAVI for the overall design process.
Identifying operational processes that need improvement through a
detailed operations review.
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
Define the purpose and scope of project
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
Timeframe
When will the project start and when is it expected to be completed?
Do you need interim solutions?
Allow sufficient time for:
Operations reviews
Strategy formulation
Development of high-level space plan options
Schematic design
Recognize that laboratories are complex environments to design
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
Perform strategic review of capital equipment requirements
Replacement cycle
Will replacement be part of design project?
Prepare for growth needs
Volume
New or replacement technology
Consider impact of workstation consolidation
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.)
Develop a Lab Design Project Team and Executive Steering Committee
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
Lab Consultants
Architect/Engineering
12
© 2008 Chi Solutions, Inc. Proprietary and Confidential.
A Lean Approach to Pre-Design Activities:
Develop a Project Plan (cont.)
Financial issues and business plan development
Cost per SF ranges from $250 to $1,350 with median of ~$500
50,000 SF Lab @ $500/SF = $25,000,000
Return on Investment (ROI)
Many projects will have acceptable ROI of two to five years due to
operational savings
Consider life of building to calculate FTE savings
75K per year X 20 years = $1.5 million over life of facility
Consider financial impact of alternative use of space
13
© 2008 Chi Solutions, Inc. Proprietary and Confidential.
Using Lean Effectively for Design Projects
Identify customer requirements through interviews and applying
service metrics as part of a balanced scorecard approach.
Identify/classify lean opportunities by performing an operations review.
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
System Strategic
Care/Business Plans
Institutional Culture
Effective Utilization of Human
Resources
Maintain/Improve Service
Quality
Work Environment and Safety
Master Facility Plan
Staffing Shortages in the Lab
Industry
Service
Financial
Test Menu Standardization
and Completeness
Opportunity for Expense
Reduction
Leverage Use of New
Technology
Optimal Use of Available
Capital
Meet Service Requirements of
Medical Staff
Minimize Project Risks
15
© 2008 Chi Solutions, Inc. Proprietary and Confidential.
Customer Requirements Drive Service Model
Document:
Any service deficiencies
New requirements
Define/measure service metrics
Specimen collection and results
reporting processes
Identify/interview key customers:
ED
ICUs
Nursing Floors
Outpatient PSC
Outreach
Specialty Clinics
16
© 2008 Chi Solutions, Inc. Proprietary and Confidential.
Schematic Design Notes:
Customer Requirements/Specimen Collection
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).
Bedside bar code scanners/printers will be employed for specimen collection
and to accomplish positive patient ID goals.
Phlebotomy and nursing staff should send specimens using as small a batch
as possible to facilitate continuous workflow and improve turnaround time.
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.
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.
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
Waiting: Specimens in receiving area awaiting sorting
Over Processing: Taking requisitions in/out of bags
Transportation: Unnecessary walking to deliver specimens
Over Production: Process/sort several buckets before passing
them on
Inventory: Buildup of specimens due to simultaneous delivery by
couriers
Moving: Back/forth physical movement due to poor workstation layout
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
Effective use of triage
Elimination of unnecessary/redundant activities
Change in order of processing steps
Put problem requisitions aside
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
Differential area is >60 feet
away from automated
hematology area
Manual testing reported to a
different supervisor than the
automated testing areas
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
Develop paperless systems
Use of auto-verification
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.
Design for flexibility…Manufacturers are adding new capabilities to
automated hematology systems (e.g., HbA1c).
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
The laboratory will use online data storage and strive to be paperless.
Automated equipment interfaces will use auto-verification, and the
Delta check criteria will be revised to be consistent with linear ranges
and medical necessity.
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.
High density storage systems will be used to store supplies within the
lab storeroom.
The cold room or refrigerators will be rear-loading with glass doors in
front to facilitate supply rotation.
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
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:
Sorting and time stamping = Key non-value added steps
Duplication of functions = Increased need of staffing/inefficient allocation of staffing
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
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.
Plan the core laboratory so that specimen processing is tightly integrated into the
overall operation, and eliminate the current use of multiple processing areas.
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.
Organize the core laboratory sections by specimen type to the greatest extent
possible.
The tube systems will be relocated within the core lab to facilitate improved
workflow processes.
Automated equipment interfaces will perform the “specimen received” function vs.
performing this procedure manually in accessioning.
Develop the overall floor plan of the testing sections to ensure a smooth workflow
with adequate storage areas and space for future growth.
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
Develop a project plan with a realistic schedule.
Form an Executive Steering Committee to get support for your project.
Develop a balanced scorecard for your department with maximum input from
customers to ensure your department meets their needs.
Analyze your current operation in terms of processes used and workflow, and
develop metrics.
Identify lean opportunities as process and/or design issues, and develop
solutions for the process issues as interim improvements.
Use lean strategically, not in isolation!
Develop a strategic plan for instrumentation that considers new or changing
technologies and use of automation.
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
Earl Buck, MP(ASCP)
AdvanDx
Toni Burger, MBA, MT(ASCP)
Barbara Ratner Rendering
Shannon Donahue
CellaVision AB
Hans Froehling, DBA, CMBB
CUH2A
Nora Hess, MBA, MT(ASCP)
Jonathan Hillyer Photography
Mike Kachure
Lord, Aeck & Sargent
Kathy Murphy, Ph.D.
X-Nth
Dan Rajkovich, MPA, MT(ASCP)
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.