Labs Look to Lean Engineering to Transform Operations

With reimbursement challenging revenue in already constrained budgets, laboratories are increasingly looking for financial stability through cost savings achieved with added operational efficiencies. For many laboratories committed to developing long-term strategies, rather than short-term fixes, lean engineering principles are successfully transforming operations.

Lean, a management system first pioneered by Toyota Motor Corporation in the 1990s, is a production system based on the principles of continuous process improvement, elimination of waste, and worker engagement. Today the concept of lean is synonymous with identifying and removing waste from operations, while promoting value to the customer, explains Bohdan Oppenheim, Ph.D., a systems engineering professor at Loyola Marymount University (Los Angeles) and developer of the university’s graduate certificate program in Lean Healthcare Systems.

Managers and directors from Kaiser Permanente Southern California have been participating in Loyola’s graduate certificate program and are bringing lessons learned to Kaiser’s Southern California regional laboratory, which performed 59.1 million tests in 2014.

“We started to be intrigued in lean as an organization by its potential to increase quality and reliability and decrease costs,” Michael Kanter, M.D., regional medical director of quality and clinical analysis at Southern California Permanente Medical Group (SCPMG), tells DTET. “As we were considering pilots in various areas, I was struck that perhaps more so than in health care in general, the laboratory is most like manufacturing, where lean had a lot of success.”

“[Lean] involves a long-term philosophy of investing in the development of teams of individuals and equipping them with the tools necessary to identify and reduce waste/ defects within a system,” writes Susan Novak-Weekley, Ph.D., a director at SCPMG Regional Reference Laboratories in North Hollywood, Calif., in a June 2014 commentary on the role of lean in the future of clinical microbiology laboratories, published in the Journal of Clinical Microbiology. “Lean eschews the idea of quick-fix solutions to serve short-term goals in favor of a more sustained approach to process improvement.”

Staff participation, experts say, is imperative to both eliminate waste and improve quality of care. This long-term commitment is seen through a labor management partnership [(L+M)P] that is in place for the whole Kaiser organization, Novak-Weekley explains, not just within the laboratory. One Kaiser group participating in the certificate program identified 139 best practices that would streamline operations in clinical laboratories, potentially generating savings of $15 million.

“If the culture of lean is not guided and nurtured appropriately, laboratorians quickly learn that most of these initiatives will eventually disappear,” writes Novak-Weekley, who says that reasons for failure include: not obtaining the complete support of leadership, failure to create a blameless environment, fears relating to job security, and focus on cost reduction rather than quality improvements.

Takeaway: By taking a long-term view of the need to collaboratively work to eliminate waste and improve quality, lean doctrine can be successfully applied to lab operations.

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