FMLA - Workflow Services

Case Study – Exalab

Hubert Palumbo - Florent Mulatero

2

Full Microbiology Lab Automation

Global solution based on building a close and

unique partnership with each laboratory

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Needs for Automation in Microbiology

Needs for Automation in Microbiology

Drivers for Automation

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Needs for automated solutions and …

� For a new Organization with a smoother flow,

� To decrease Turn Around Time,

� To better manage quality, traceability, accuracy of results & provide support for accreditation,

� To improve lab productivity and profitability,

� Training + design for a new layout (how many m²? , FTE?…).

5

Background on Workflow audits

� How many audits already performed in Europe ?

���� 60 workflow audits done

� Among them how many created sales afterwards?

���� 30 instruments sold ( ~2.2 m€) + other in progress

Increase consolidation of laboratories:

���� More & more expectations from our customers to be supported for designing and improving their lab workflow

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Content

� Customers expectations for a Lean Lab assessment (1/5)

� Before – After: proof of evidence with key figures (2/5)

� The Lean Lab in few words … (3/5)

� Key Messages (4/5)

� Tools (5/5)

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Background at Exalab

� March 2008 : Presentation of Workflow audit principle at the lab (equipped with SIRScan, API, BTA class, manual cytology)

� June 2008 : 1st Workflow audit done � recommendations provided

� End 2008 : sales & installation for: PREVI Isola + VITEK 2XL + BTA BC and TB, + PREVI Color Gram + 2 x UF 1000i

� March 2010 : Installation in a new building with increased activity (200 % more)

� November 2010 : another workflow audit to confirm improvements, plus KAIZEN approach in the new building

1/5

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Main automated solutions installed before1/5

� Background

� BacTAlert Classic

� SirScan micro+

� Mini API

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Main automated solutions installed

� BacTAlert 3D BC & MB

� VITEK 2 XL

� 2 UF 1000 i

� SirScan micro+

� PREVI Isola

� PREVI Color Gram

1/5

10

Customers expectations to follow a Lean Lab Assessment

� Building a new Lab (Microbiology lab = 177 m2)

� Integration of PREVI Isola in this new platform

� Purchasing of various automated solutions� 2 UF1000i

� 1 PREVI Color Gram

� 1 PREVI Isola

� 1 VITEK 2XL

� 1 BTA for Mycobacteria

� 1 ScanBact

1/5

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Five main objectives

� Integrate new automated solutions (UF 1000i, PREVI … as mentioned previously)

� New organization of the of the workflow process forMicrobiology� Architecture with Day0 & Day1

� Smooth workflow without rework & bottlenecks (no turn back processes)

� Dedicated room for management of MB (P3)

� Running all the samples by having only 2 biologist working inthis new lab

� Consolidate activities of many labs in Bordeaux area (22 labs)with an increased of 185% in terms of samples

1/5

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Staff required to manage daily Microbiology activities

Before Lean Assessment(March 2008)

� Working hours:

� Week: 7.30am – 8.00 pm

�4.7 FTE

� Saturday: 8am – 1pm

�1 FTE

� Sunday: 8.30am – 12am

�1 FTE

After Lean Assessment

(November 2010)

� Working hours:

� Week: 7am – 8.00 pm

�5.64 FTE

� Saturday: 7.30am – 4pm

�1 FTE

� Sunday: 7.30am – 12am

�1 FTE

Manage an Increasing Activity of 185%

with only 20% more FTE

2/5

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Specimen Breakdown

� Increase your activity by 185%:� More urine samples (+250%)

� More pus samples (+84%)

� More stools samples (+400%)

March 2008 November 2010

2/5

66,79%

4,33%3,61% 2,89% 2,53%

4,69%

5,42%

Urine Pus Stools

Genital Blood cukture MB culture

Parasitology

53,85%

8,38%

8,00%

5,36%

3,68%3,60% 2,86% 2,64%

Urine PusBlood culture GenitalStrepto B MycobacteriaFOC Stool

485 samples/week 1385 samples/week

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15/11/10 - 16/11/10 (207 measurements)

0,00%

5,00%

10,00%

15,00%

20,00%

25,00%

30,00%

35,00%

Type of activity

% a

cti

vit

y

Série1 30,43% 27,05% 19,81% 11,59% 11,11%

Technical Other activity Administrative Motion Movement

Split of Activities by type

18/03/08 - 20/03/08 (407 measurements)

0,00%

10,00%

20,00%

30,00%

40,00%

50,00%

Type of activity

% a

cti

vit

y

Synthèse 43,79% 20,84% 14,52% 11,01% 9,84%

Technical AdministrativeOther activity Motion Movement

Productivity analysis

Split of Activities by type

� Less technical tasks due to automation,

� Increasing « other activities tasks »: trainings …

� Stable Administrative workload thanks to the scan of documents (even with a +185% samples increase),

� Equivalent amount of motions having triple the surface of the lab.

2/5

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Productivity improvements

� Increase your productivity by 116% for urine samples

� Full automation of the process: UF 1000i, PREVI Isola, VITEK2)

2/5

March 2008

� 52 samples a day

� Positive rate = 28%

� Batch size = 9

� Batch a day = 6

� Takt Time* = 13.23 min

� FTE = 0.53

November 2010

� 185 samples a day

� Positive rate = 30%

� Batch size = 37

� Batch a day = 5

� Takt Time* = 4.23 min

� FTE = 0.76

* Takt Time = pace of production needed to meet customer demand.

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Productivity improvements

� Increase your productivity by 138%

� March 2008:

� Targeted productivity: 4.62 patient/working hour

� Real productivity: 2.77 patient/working hour

� November 2010:

� Targeted productivity: 6.86 patient/working hour

� Real productivity: 6.60 patient/working hour

� still some productivity gains to look after = 4% (real to targeted)

2/5

Estimated productivity savings with previous organization = 67%

… the lab reached 138% !!!

Successful Implementation =Staff involment + new technologies

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Before - lead time issues due to

unsuitable workload/capacity

Capacity (technicians )

Workload (D0 + D1)

Reduce costs by improvingcapacity / workload

After - implementation of recommendations:

� Smoother workload

� Quicker time to result

� Better productivity

2/5

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March 2008

Reading 24/48H & ID/ATB

Streaking for other specimen

Streaking for urine

FTE

MB & Parasitology

Mycobacteria processed 2 d/week

Other tasksOther tasks

Adequacy Existing Workload Capacity Typical Day in Week

Adequacy Existing Workload Capacity Typical Day in WeekDiffered access to

specimen

Differed access to specimen

Reduce costs by improving capacity/workload

� Staff can leverage the period of time with less activities to prepare the work for next steps.

� Peak of activity at 8.00 & 11.00am

November 2010

% Charge Planifiée % Charge J0 Planifiée % Capacité% Planned Workload % Planned Workload D0 % Workload% Planned Workload % Planned Workload D0 % Workload

2/5

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Reduce costs by improving capacity/workload

� Better organization of the weekly workload to be managed:

� Adequation on Saturday is going to be optimized (technologist still on

training)

Weekly Basis

% Specimen Arrivals

2/5

0%

5%

10%

15%

20%

25%

Jours de la semaine

Ho

urs

In

sta

lle

d

0%

5%

10%

15%

20%

25%

Sp

ec

ime

n A

rriv

al

% Hours installed % Specimen Arrival

% Manpower Installed 17% 20% 20% 20% 16% 4% 2%

% Specimen Arrivals 15% 17% 19% 19% 19% 11% 0%

MON TUES WED THURI FRID SAT SUN

Adequation Workload Capacity

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Turn Around Time Urines before

Average = 39,27h / Positive rate = 28%

-5

0

5

10

15

20

25

30

35

-3,6 5,

514

,623

,732

,841

,9 5160

,169

,278

,387

,496

,510

5,6

114,

712

3,8

132,

9

142

151,

116

0,2

Classes

Fré

qu

en

ce

s

March 2008

November 2010

Turn Around Time Improvements

� Improve your TAT by 21% for urine samples

� March 2008:

� Average TAT of 39.27h/urine sample (28% of positive samples)

� November 2010:

� Average TAT of 31.12h/urine sample (>30% of positive samples)

2/5

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Turn Around Time Improvements

� Improve your TAT by 5% for genital samples

� March 2008:

� Average TAT of 68.2h/genital sample (7% of positive samples)

� November 2010:

� Average TAT of 65.48h/ genital sample (>30% of positive samples)

-2

0

2

4

6

8

10

12

14

16

18

20

-17,

3

16,5

50,3

84,1

117,

915

1,7

185,

521

9,3

253,

128

6,9

Classes

Fré

qu

en

ce

s

March 2008

November 2010Turn Around Time Genital before

Average = 68.2h / Positive rate = 7%

2/5

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Productivity Improvements for 2011

� What about 2011 ?

� Targeted workload:

� 1745 samples/week (1345 samples processed today)

� 2011:

� Targeted productivity: 6.96 patient/working hour (6.86 in Nov.10)

� Real productivity: to be measured

� Targeted FTE = 7.17

� Real/Planned FTE: 7

Need to develop continuous improvement process to optimize the workload/capcity adequation in 2011

2/5

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To Be Continued …

� Kaizen approach by order of difficulty

� Cytology day 0: from sample reception to UF 1000i

� Urine streaking day 0: from the UF 1000i to the incubator

� Safety Cabinet (swab): from sample reception to PREVI Isola

� ID/AST bench

� 24/48h reading: from the incubators to reading benches

� Pre-analytical

2/5

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The lean lab in few words …

� Avoid complex process (bacteriology analysis) tobe complicated:

� Simplify the flows,

� Visual management of the rules,

� Standardized procedures,

� Be « polyvalent »,

� Be focused on bacteriology expertise:

� Prioritize the analysis with high added value,

� Innovation based on technology.

� Look after any waste (tasks without added value)

3/5

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Key Messages

� Increase activity by 185%

� Reduce cost by improving Capacity / Workload

� Improve productivity by 138%

� Improve the Turn Around Time by 21% for urines

� Prepare for 2011 challenges with a planned increase activity by 30%

4/5

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Customer testimonialExalab Laboratory (France) 5/5

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Tools5/5

New Website about FMLA

Workflow Services

Christian Borjesson’s interview

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Lean Lab Assessment: Case StudyJoseph Campos, Ph.D., Director, Microbiology Laboratory, Molecular Diagnostics Laboratory &

Laboratory Informatics, Children’s National Medical Center, Washington, D.C.

Analysis of Staffing and Specimen Volume

Positive Culture Turnaround Time

5/5

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A unique bioMérieux program in 5 steps

for a global solution

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Summary

� Workflow set accordingly with recommandations made during the lean lab assessment (March 2008)

� Arrival time of specimen at the lab have been reworked (less specimen to be managed at the end of the day)

� Perfect balance between day0 and day1 workload

� Coninuous workflow from sample reception to microbiologistvalidation

� Turn Around Time has been significantly shorten for urine samples thanks to the day0 / day1 automated process

� Still some room for improvements: 10% of samples from day0 are processed on day1 …

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Conclusion

� With the FMLA Workflow Services bioMérieux can ensure our customers to get the most out for streamlining their lab workflow.

� FMLA Workflow Services will help to:

� Reduce Costs

� Leverage Quality

� Enhance Productivity

� Improve Turn-around time

� Reduce Strain

� bioMerieux can commit on improvements the lab will reach by following the recommandations.