Building a Lean Pathology Lab, Pt. I

This case study series kicks off with a discussion of the planning process.

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There is so much talk of Lean as it relates to the lab industry in the literature and at conferences these days that one may wonder what's so magical and wonderful about Lean that so many profess to practice it in one form or another. Our lab had two unique opportunities to design a Lean lab. First, the clinical laboratory moved from its cramped, compartmentalized quarters into a new space with state-of-the-art analyzers and an updated floor plan. The second opportunity came when the hospital decided that after a decade of sending out pathology specimens that it would once again house a full service pathology department. The thought process and decisions for floor plans and equipment were vastly different than that of the clinical laboratory. There was no template to follow since it had been so long since a pathology department existed at Catholic Medical Center (CMC). This article is the first in a series that will explore how decisions were made concerning floor plan, equipment choices, pathology laboratory information system choices and morgue space design and equipment. Ultimately, and perhaps most importantly, we want to share our results: What has been the result of over a year of planning and implementation to achieve a fully functioning Lean Pathology Department? How did Lean work for us?

About Catholic Medical Center

CMC is a 330-bed, full-service healthcare facility located in New Hampshire's largest city, Manchester. It is host to 25 subspecialties, the largest of which is the New England Heart Institute, one of the premier cardiac treatment facilities in New England. The hospital has an estimated 110,000 patients per year and the Obstetrics facility, aptly named The Mom's Place, averages over 900 births per year. The Emergency Department has about 37,000 visits in a year's time. The cardiac surgeons perform approximately 450 cardiac surgeries per year. There are 11 primary care physician practices and an affiliation with the Norris Cotton Cancer Center, a full service oncology practice. CMC is a thriving, mid-sized community hospital.


 The implementation team at CMC.

Lab Implementation

Prior to May 2007, CMC did not have a hospital-run laboratory. The laboratory was managed by a commercial vendor, maintaining only a stat lab and a blood bank on site; everything else was sent to the main vendor laboratory for testing about 40 minutes away. Pathology testing was completely outsourced.  May 2007 was the starting point to bring full service laboratory services back to CMC. In less than two years after the laboratory implementation, the facility moved into a new lab on a different floor and, as of FY 2010 the lab's 84 FTEs have processed over 736,000 billable tests. The laboratory is also responsible for 7 Patient Service Centers (PSC) including an Oncology service. The PSC's alone saw 58,869 patients in FY2010.

Pathology Project Defined

Based on the typical volumes of pathology testing that were being sent out, a decision was made to explore the possibility of bringing a Pathology service back to CMC. Part of the plan involved moving the Clinical Lab from its existing space to a new location on a different floor of the hospital. The plan required the space allocated for Pathology to be completely gutted and rebuilt to specifications that could accommodate a full service Pathology laboratory. The administration at CMC was completely committed to the project and it was placed on a high priority list of projects for funding. A budget was established as well as a business plan that involved projections based on current pathology send outs, staffing estimates, budgets for construction and equipment procurement.

Continued on page 2...

Building a Lean Pathology Lab, Pt. I

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This is to address Jo Ann's concerns about not consulting staff prior to launching the design of the new lab. During the year and a half that it took to plan this project, I did not have any staff to consult. I did not go into this blind, however, and took every opportunity possible to consult friends, both old and new. I was a frequent poster on the Histonet Listserv and spoke to at least 100 different Histotechnologists, PA's, Cytotechnologists, Pathologists, vendors and pretty much anyone who would listen to me.

I took special care to make sure I asked to people who were doing the work, day after day, what they would do if they were designing the ideal lab. The result of their combined and sometimes consensus answers was the CMC lab illustrated in the article.

The remaining articles about the technical areas and processes are written exclusively by staff. They are the ones that are making it work now and that are planning the process changes to face the future.

Stephen Feher,  Pathology Supervisor,  Catholic Medical CenterSeptember 16, 2010
Manchester, NH

I think it's commendable that you are approaching a refurb with Lean in mind, however I noticed that your "core" team does not include any technical-level staff members as a working Lean group should. Your core team is too top heavy in supervisors and managers, and, of course, the necessary Lean knowledge experts and your architectural/vendor team members, as needed. Perhaps Part 2 introduces this grp before the project's completion? If not, I wonder how new staff could introduce a suggestion for change once all the changes have been implemented already? Would they feel as if they could not do this for fear of retribution since so much time was spent by mgmt-level staff working on the Lean project before they came? How many and how long ago have your managers/supervisors actually produced work in a functioning Pathology lab so as to understand the day-to-day problems and issues? I read in the article that at one point you interviewed staff... but is there or was there no way new staff could be brought into the "core" team to contribute their knowledge of the science, background in the field and experiences working in poorly organized labs? It's important for a Lean project - in order to be implemented effectively, to receive "buy-in" by all levels of the org. affected - from Admin. to the line worker in the dept. that is the focus of the project!
This would have been very helpful if not essential to the type of "brainstorming" created by your core group. In essence, the staff are the ones you will depend upon to produce accurate work in this "new" lab & are the best ones to offer advice and suggestions about how to set up a process in which to best do this efficiently (minimizing waste) and they may have contributed to a Lean core team in their previous job or have considerable experience in highly functioning, but poorly organized labs and are eager to contribute suggestions for improvement based on their familiarity with the Lean, in general or from projects implemented in other depts.

Jo Ann  Tertiary care hospitalAugust 24, 2010
South central PA


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