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Laboratory Design

Michael Baisch Principal Systems Engineer Department of Laboratory Medicine and Pathology Mayo Clinic Rochester, Minnesota

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Disclosures

Relevant Financial Relationship(s):

Nothing to Disclose

Off Label Usage:

Nothing to Disclose

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Agenda

• Define your laboratory strategy

• Establish your baseline

• Design the component pieces

• Assemble the pieces and create flow

• Putting the whole story together

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Define your laboratory strategy

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Defining the priorities

• Supporting the practice

• Growth expectations

• Test menu updates (new test and test obsolescence)

• Methodology & Technology changes

• Safety & Ergonomics concerns

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Defining the timeline for the priorities

• Near term

• Items that need to be completed in the next year

• Mid term

• Items that need to be addressed in the next 2 to 3 years

• Long term

• Items that need to be addressed in the next 4 to 6 years, and possibly beyond

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Supporting the Practice

• What are the health systems current concerns with laboratory performance?

• Turn Around Time – results available at the correct time

• Quality of results – have we had any revised results

• Availability for Questions – help with interpretation of results

• What are the health systems plans for the future?

• What parts of the practice will be growing?

• What parts of the practice will be shrinking?

• What are the impacts to the lab?

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Growth Expectations

• From a financial perspective, has the health system leadership shared any plans or concerns related to revenue or cost goals?

• Are we currently performing at the level they are looking for?

• If they have plans

• Are they revenue growth related?

• Are they cost reductions related?

• Are they both? (i.e. margin growth)

• Are we or should we be growing our outreach program?

• Where do I have extra capacity?

• Who can help me fill that capacity?

• How do I reach out?

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Test menu changes

• Review of test utilization

• What are my low volume assays?

• Does it make sense to continue to offer this assay?

• Do we already have a similar/better assay offering?

• Does our outreach program have some untapped demand?

• What are my high volume assays?

• Are there any known changes coming based on practice or outreach?

• Is there a replacement assay coming to market soon?

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Test menu changes (continued)

• Review of test utilization

• What are the assays I refer out?

• What is the volume I’m sending out?

• Do I already have the equipment and knowledge to run that assay?

• Does the financial analysis indicate bringing the assay in house or leaving it as a referral?

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Methodology & Technology

• Existing equipment and instruments

• Do we have a list of replacement equipment that has already been purchased?

• Do we have a list of equipment in the laboratory that is past its useful

life?

• How far past?

• How much is the maintenance costing us?

• Is it supported by the manufacturer?

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Methodology & Technology

• Future equipment and instruments

• With the current test menu, what changes are in the pipeline?

• Methodology changes

• Significant technology changes (automation)

• More POC, less in lab

• Future test menu

• To support the proposed future assay offering to support the practice and outreach, what equipment or instruments will be needed?

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Safety & Ergonomics

• Has the laboratory been reviewed by workplace safety and ergonomics recently?

• Exposure hazards

• Lifting hazards

• Chemical & Biological storage/disposal

• Fume or biological hoods

• Various other safety codes

• Ergonomic injury history

• Potential of ergonomics related injuries

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Safety & Ergonomics (continued)

• If your health system has a department with experts in these areas, please reach out and schedule an evaluation

• If you don’t have access to experts internally, are there local resources available

• Some universities will have departments that specialize in this

• Local consultants

• Create an internal expert by reviewing current standards or attending a few seminars

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Laboratory Strategy Summary

• Formally document all of the findings of your investigation

• Share with the laboratory leadership (administrators and laboratory directors) to get their feedback and approval.

• If achieving the laboratory strategy requires a partial or full laboratory redesign, then indicate which sections of the strategy are driving it.

• Have laboratory leadership share with health system leadership. This will create additional awareness about the challenges the lab is facing and what the sources of some of those challenges are.

• Gain their approval to proceed with planning.

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Establish your baseline

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Capturing the data

• What are the current staffing levels?

• Job role detail headcount and FTE

• Schedules

• Turn over rates

• Overtime rates

• Current space allocation

• Wet lab space and location

• Dry lab space and location

• Administrative space and location

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Capturing the data

• Hours of operation

• May need to break this out by laboratory section

• May need to break this out by day of week

• Complete list of major equipment and instruments

• Specimen and/or assay arrival patterns

• Level of detail (Average monthly, Average daily, Average by hour)

• Mix information (same collection event test mix)

• Current Turn Around Time performance

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Design the component pieces

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Starting the design process

• Select an area of the laboratory that appears to be fairly stabile for the near and mid term

• Select a small group of staff that represents those who most often work in that area while also representing the different shifts

• The group should also include someone with little to know familiarity with this area. This person will be there to challenge the status quo.

• Identify all the equipment, instruments, benches, hoods, etc. in that area.

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Arts & Crafts Time

• Preparing for the design session

• Print a blank grid sheet. The grid will represent a scale (each grid is represents one square foot as an example)

• If there are physical boundaries (structural, safety, or methodology).

Draw those onto the grid

• Using the inventory of benches, equipment, and instruments make scale cut outs for everything you currently have in the area

• Place all of the labeled cut outs on the grid paper in the current layout configuration

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Arts & Crafts Time

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Arts & Crafts Time (continued)

• Assemble the team and review with them the objectives of design project

• Share with them any of the future state needs that you gathered from the laboratory strategy that pertain to this area

• Let them know they will have no more than 15 minutes to create a design

• Let them know they will need to create at least 3 different designs. (more are better)

• Let them know you will only interject if there is a hang-up in one particular aspect of the design

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Designers Assemble!

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Let the creativity flow, everyone’s opinion is heard!

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A plate of spaghetti

• Take a picture of each design and print it out

• Overlay a transparency film or a semi-transparent piece of paper and trace out the flow of

• Specimens

• People

• Supplies

• Waste

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Democracy in action

• Post all of the design options in an area easily accessible by the rest of the lab staff

• All staff get a ranking sheet where the must rank the design options from favorite to least favorite. Keep these ranking sheet anonymous, though you may want to know shift information.

• Request all staff include commentary on why they made the choices they did.

• Gather up the ballots and using the rankings to find out which design is preferred.

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Don’t forget the feedback

• Demeter: Not sure how work flow would work for drop off and pick up of specs; in between work space?

• Athena: Move LSA desk behind utilities next to Lead desk by AA to address QNS specs.

• Poseidon: Consider making LSA benches back to back to minimize uncapped pickups

• Should we have one LSA bench adjacent to AA to allow for processing errors and QNS?

• Not sure if it will be a push or pull system for manual so was hard to rate the "Minimize staff getting up to get work“

• Ergonomics was the same for all since all centralized vortexing and all could have at least one slideline or could all be manual.

• I chose Artemis because it has both the AA and Recapper closest to automation. This I find important because we eventually

want to link AA to Distribution automation. This design also allows for an additional AA to be added later once the concept is a

proven one down the road.

• I also like Demeter as it allows for easy access to the manual benches/slideline by the runner if needed.

• I like Hermes as well as it seems to provide adequate spacing and flow. I believe there would need to be some changes including

the removal of "pink" desks between manual benches at the bottom of the diagram.

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Finalize the design and move to the next area

• If there is a tie for the top design, see if you can combine the best attributes of the designs

• Post the final design and the reasoning for choosing it

• Move on to the next area of the laboratory

• Repeat until all areas are designed

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Assemble the pieces and create flow

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The calm before the storm

• Reach out to the architect or building designer

• Schedule some one on one time with them to cover your laboratory strategy with specific emphasis on safety and ergonomic issues

• Share the design pieces you have finalized and have them begin to draw them up. They should be well versed in all building code requirements to make an adjustments to these designs in accordance with those rules. Have them document any changes they make and why they made them.

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Reassemble the team

• Once the architect has drawn all of the lab areas have them attend the meeting where the pieces will be assembled.

• Gather up a small team of laboratory representatives. This group should have background knowledge related to specimen/test arrival patterns. Particularly as it relates to adjacency concerns. (shared specimens)

• Begin by laying out the core laboratory functions and then start layering in the ancillary and esoteric laboratory areas.

• Don’t be afraid to create multiple variants of a complete floor plan. In fact it may be a good idea, as it will avoid hang-ups.

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Finalizing the design

• Once you have a complete laboratory design (or designs) have the architect plot them out so they can be shared with the lab staff at large.

• As before, solicit feedback. Place special emphasis on off shift feedback when dealing the adjacency concerns.

• Do we have development space?

• What about storage?

• Are there other non-testing areas we forgot to include?

• Please share all changes that were made to the component designs that were required as part of meeting building and safety code. It is important staff know why things changed!

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Finalizing the design (continued)

• Future proofing

• As we all know, laboratory technology has been rapidly changing. In some cases, those changes create facility support challenges for us when it comes time to install the new technology.

• Does my design incorporate easy access to the utility corridors to allow for changes and upgrades? (without interrupting testing)

• Does my design allow for easy reconfiguration of a workspace without needing run new utilities?

• What are my special utility needs and how would they be expanded if needed?

• Generate the finalized floor plan.

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Getting the details correct

• Most floor plans end at the two dimensional level, but often times when occupy the space we find ourselves crammed in and the space does work as we intended.

• When vetting your architect, see if they have the ability to generate three dimensional views of the laboratory. Bonus points if they can also create virtual reality tours!

• Have the staff “sit down” and work in there new lab areas.

• How are the specimens, paperwork, and supplies laid out?

• Where are they discarding waste?

• Are they leaving the work area for any reasons?

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Scaled view of north wall

Scaled view of north wall North wall

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Blood Gas, Specimen Tracking

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Collections, Point of Care

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Putting the whole story together

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Updating the strategy

• Once the design is complete, the architect should be able to provide a good faith estimate of the cost to deploy

• Perform a Return On Investment (Proforma) analysis

• Update the strategy section that dealt with the needs for an updated lab design

• Review the updated laboratory strategy with the health system leadership to gain their feedback and approval on your recommendations.

• Set up a recurring touchpoint to keep leadership apprized of the strategy, specifically any changes to it

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QUESTIONS & DISCUSSION

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