New Analytics & Automation in Limited Spaces: Principles ... · optimizing delivery of service is the goal PROCESS INFORMATION BEST . Key Objectives Best Practice Lab Design Balancing

Confidential

JOHN HILDEBRANDT Strategic Workflow Consultant

New Analytics & Automation in Limited Spaces:

Principles for Best Practice Lab Design

Success depends on adoption

by the whole team

PEOPLE

Best Practice Lab Design

Critical Design Considerations

He who touches least wins......Maybe

Creating & moving information is the job,

optimizing delivery of service is the goal

PROCESS

INFORMATION

BEST

Key Objectives


Balancing

CAPACITY,

CAPABILITY, AND

FLOW

Managing

THE PEOPLE SIDE

OF THE CHANGE

Delivering

THE RIGHT

INFORMATION IN

THE RIGHT TIME

Improving

DELIVERY OF

SERVICE

KEY

OBJECTIVES

Key Objectives


Balancing

CAPACITY,

CAPABILITY, AND

FLOW

Managing

THE PEOPLE SIDE

OF THE CHANGE

Delivering

THE RIGHT

INFORMATION IN

THE RIGHT TIME

Improving

DELIVERY OF

SERVICE

KEY

OBJECTIVES

Dagen Högertrafik

The day in 1967 that Sweden changed from driving on the left-hand side of the road to the right.

Are We Ready for Change?

The Impact of Change on ROI

How Much of Your Success is Dependent on Operator’s Adoption?

Low High

High

Achievement

of Expected

Outcome

Complexity of Change for Your Staff

Changing to

Cheaper

Barcode Labels

Changing

Processes Around

New

Instrumentation

Based on *Prosci Model

Adapted from Prosci’s ROI of Change Management

The ADKAR Model

Organizational Change is the Sum of Individual Change

Awareness Desire Knowledge Ability Reinforcement Change

Adapted from Prosci- ADKAR OCM

Frustration Awareness Knowledge Ability Reinforcement

Confusion Awareness Desire Ability Reinforcement

Anxiety Awareness Desire Knowledge Reinforcement

Desire Knowledge Ability Reinforcement False Starts

Awareness Desire Knowledge Ability Regression

Key Objectives


Balancing

CAPACITY,

CAPABILITY, AND

FLOW

Managing

THE PEOPLE SIDE

OF THE CHANGE

Delivering

THE RIGHT

INFORMATION IN

THE RIGHT TIME

Improving

DELIVERY OF

SERVICE

KEY

OBJECTIVES

he who

touches least

wins!

The Art of Optimizing Workflow

Reduce TAT and Errors

TAT

Errors

Multiple Touches, Multiple Steps

Managing Capacity, Capability, & Flow

Analytics, Automation, & Floor Plan

1 2 3 4

Analytics &

Consolidation Lean Flow Automation &

Functionality

Floor Plan &

Configuration

Horsepower &

Capacity:

Can the Consolidated

Analyzers Deliver the

Needed TAT with Your

Volume & Test Mix,

Maintenance Schedule,

& Growth Profile?

Directional Flow:

Highest Volume, Most

Automated Analytics

to Lowest Volume

Manual Testing

Capability vs. ROI:

Can the System

Automate All of the

Tasks You Require

With the TAT to

Support Your Service

Delivery Demands?

Trade Offs:

Can You Tolerate the

Trade Offs Among

Configuration, Space

Limitations, &

Functionality?



1

Lean Flow

Directional Flow:

Highest Volume, Most

Automated Analytics

to Lowest Volume

Manual Testing

Managing Capacity, Capability, & Flow Lean Flow in the non-Automated Lab

IN/O

UT

In

/Out B

ench

Hig

h V

olu

me

Technical

Low

Volu

me

Sample Analysis

Non-Technical

Central Processing

RECV

SORT

SPIN

SHIP

STORE RETRIEVE

REG

COE

QA

PHLEB

Managing Capacity, Capability, & Flow Lean Flow in the non-Automated Lab

IN/O

UT

In

/Out B

ench

Hig

h V

olu

me

Technical

Low

Volu

me

Sample Analysis

Non-Technical

Central Processing

RECV

SORT

SPIN

SHIP

STORE RETRIEVE

REG

COE

QA

PHLEB

Opportunity Optimize Staff Allocation, ID & Minimize Wait States, Drive

Visual Controls & Leverage LOS to Eliminate Batch Process



2

Analytics &

Consolidation

Horsepower &

Capacity:

Can the Consolidated

Analyzers Deliver the

Needed TAT with Your

Volume & Test Mix,

Maintenance Schedule,

& Growth Profile?


Analytic Consolidation, TAT, & Horsepower

Analytic Consolidation

Touches, Cost, & Space- More Analyzers Means More of Each

Vendor Standardization- Same as Above w/ Single Contact Point

Analytic Horsepower

On Board Turn Around Time

Test Mix & Capacity at Receipt

12 Min at the 90th Percentile






Analytic Horsepower



Capacity When it is Needed

Peak Hours

12 Min at the 90th Percentile

2 Line System Capacity






Analytic Horsepower




Peak Hours

1 Line Down


1 Line Down






Analytic Horsepower




Peak Hours

1 Line Down

Maintenance Schedule


1 Line Down






Analytic Horsepower




Peak Hours

1 Line Down

Maintenance Schedule

Growth


1 Line Down

Challenge Detailed Quantitative Analysis and Simulations are Necessary

to Tailor the Analytic Solution to Your Specific Objectives



3

Automation &

Functionality

Capability vs. ROI:

Can the System

Automate All of the

Tasks You Require

With the TAT to

Support Your Service

Delivery Demands?


Automation Functionality

Capabilities: Every Touch Drives TAT, Quality, Productivity & Design Space

In Lab Receipt- Does the Automation & Your IT Infrastructure Support?

Multiple Disciplines- Chem, Heme, Coag, & Reference?

Multiple Sample Types- Serum, Plasma, PPP, Whole Blood, & Body Fluids?

Multiple Tube Sizes- Choose One or Support All?

Screw & Push Cap Recapping- In lab storage vs. Full Send-Out Processing?

Stat Processing- Both Automation & Analytics?

Centrifugation- Chemistry & Coagulation?

Sample Quality- Tube/ Test Match & Hemolysis, Icterus, and Lipemia?

Add-On & Refrigerated Storage- One Choice or Two?

Capacities & TAT: The Same Detailed Quantitative Analysis and Simulations

are Necessary to Tailor the Automation Solution to Your Specific Objectives


Automation Functionality


In Lab Receipt- Does the Automation & Your IT Infrastructure Support?

Multiple Disciplines- Chem, Heme, Coag, & Reference?

Multiple Sample Types- Serum, Plasma, PPP, Whole Blood, & Body Fluids?

Multiple Tube Sizes- Choose One or Support All?

Screw & Push Cap Recapping- In lab storage vs. Full Send-Out Processing?

Stat Processing- Both Automation & Analytics?

Centrifugation- Chemistry & Coagulation?

Sample Quality- Tube/ Test Match & Hemolysis, Icterus, and Lipemia?

Add-On & Refrigerated Storage- One Choice or Two?

Capacities & TAT: The Same Detailed Quantitative Analysis and Simulations

are Necessary to Tailor the Automation Solution to Your Specific Objectives

Opportunity Careful Design that Exploits the Available Capabilities Can

Liberate Existing Workstation Space for Use w/ Automation



4

Floor Plan &

Configuration

Trade Offs:

Can You Tolerate the

Trade Offs Among

Configuration, Space

Limitations, &

Functionality?

26

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Managing Capacity, Capability, & Flow Floor Plan & Configuration Trade Offs

Trade Offs: Automation Systems Specifications

Service Space

Track Lengths

Connection Points

Direction of Flow

43

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cobas 8100

output station

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RSF

Challenge Each of These Categories, Common to All Manufacturers, Can

Present Significant Trade Offs to Space and Flow

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Managing Capacity, Capability, & Flow Floor Plan & Configuration: Example Design Challenge

Expansion Plans Driving Even More Growth

Needs to Fully Standardize Pre-Analytics

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Managing Capacity, Capability, & Flow Floor Plan & Configuration: Example Design Challenge Designed Process Flow



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Managing Capacity, Capability, & Flow Floor Plan & Configuration: Example Design Challenge Actual Process Flow

Challenge Outgrew Design Capacity In 5 yrs.

Added IA Analyzers for ID Testing



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Managing Capacity, Capability, & Flow Floor Plan & Configuration: New Design Example Lab

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kg

84

kg

34

kg

34

kg

41

kg

41

kg

28

kg

27

kg 77

kg

72

kg

24

kg

25

kg

133

kg

118

kg32

kg

31

kg

38

kg

39

kg

17

kg17

kg122

kg

137

kg

19

kg

19

kg

37

kg

37

kg

31

kg

30

kg

128

kg

120

kg

148

kg

16

kg

17

kg

144

kg

21

kg

22

kg



In Lab Receipt- Transitioned to a New LIS w/ Unique ID & All Inpatient to are pre-Accn’d.

Multiple Disciplines- Consolidate and Expanded Chem, Heme Delivered in Analyzer Racks,

Coag Spun and Delivered, & Reference Testing Aliquotted, Labeled, Screw Capped for Tx.

Multiple Sample Types- Serum, Plasma, PPP, & Whole Blood.

Multiple Tube Sizes- 13x75mm up to 16x100mm Onboard.

Recapping- Push Caps for In lab storage & Screw Caps for Send-Outs.

Stat Processing- Multiple Levels on Automation & Analytics.

Centrifugation- Chemistry & Coagulation.

Sample Quality- Tube/ Test Match & Hemolysis, Icterus, and Lipemia. on Automation.

Add-On & Refrigerated Storage- Add-On Buffer Accommodates Rolling 8 Hour Availability.

Capacities & TAT: Extensive Modeling w/ Multiple, 5 Day LIS Data Sets to

Assess Capacity , Model Growth, & TAT

Key Objectives


Balancing

CAPACITY,

CAPABILITY, AND

FLOW

Managing

THE PEOPLE SIDE

OF THE CHANGE

Delivering

THE RIGHT

INFORMATION IN

THE RIGHT TIME

Improving

DELIVERY OF

SERVICE

KEY

OBJECTIVES

Components of TAT

What Segments of TAT is your Design Controlling?

Receipt Onboard Auto to Result Release w/ Extensive Autoverification

Auto & Analytic TAT Receipt to Load on Auto or Analyzer

Post Analytic TAT Result Available to Release

Pre-Analytic TAT

Receipt to Load on Auto or Analyzer

Receipt to Result Release

LIS TAT

Components of TAT




Pre-Analytic TAT



LIS TAT

Manual Receipt to Result Release w/ Extensive Autoverification

Components of TAT




Pre-Analytic TAT



LIS TAT

Manual Receipt to Result Available

Components of TAT


Receipt Onboard Auto to Result Release w/ Extensive Autoverification



Pre-Analytic TAT



LIS TAT

Manual Receipt to Result Available Manual Receipt to Result Release w/ Extensive Autoverification Every Touch Drives Variation & Increased TAT

Drive to Receipt Onboard Automation & Maximum

Autoverification to Deliver Optimum TAT to Physicians

OPPORTUNITY

Gaining Control of TAT New Automation & Analytics Example- LIS Data Analysis

Background

3 M Chemistry & Immunoassay Tests per Year

Live on cobas 8100 & cobas 8000s ~ 10 months

ED not Equipped w/ Remote Accessioning Devices

All ED Testing Manually Received, Transported & Loaded on c8100

Extensive Autoverification

90th Percentile 0:43

Average 0:34

Median 0:31

N 343

Time to First Result

Gaining Control of TAT New Automation & Analytics Example- Audit Analysis

Audit Analysis

5 Day Parallel Operational Data from Cobas 8100 & Cobas 8000s

TAT Analysis- Tubes Loaded on Input Buffer to Result Available

Clearly Understand the Components of TAT that Your

Design is Controlling....

If it’s Unacceptable, Change the Design

OPPORTUNITY

Key Objectives


Balancing

CAPACITY,

CAPABILITY, AND

FLOW

Managing

THE PEOPLE SIDE

OF THE CHANGE

Delivering

THE RIGHT

INFORMATION IN

THE RIGHT TIME

Improving

DELIVERY OF

SERVICE

KEY

OBJECTIVES

Summary Incorporating Best Practice into Lab Design

Manage the Change w/ the Entire Team

Engage w/ a Partner who’s Standard Practice Incorporates Change Management

in the Assessment Process & Project Plan

Quantitatively Define the Desired Level of Service Delivery

“What Does Good Looks Like”- Use it as the Project’s Guiding Objective

Analyze, Simulate, & Repeat

Engage Your LIS Manger- Become the Expert on your Testing Demands

Engage Senior Leadership- Surprise Growth is not Comfortable

Engage a Partner who’s Nimble and Armed w/ the Most Accurate &

Comprehensive Analysis Tools

Design Associated Manual Processes to Support Automation & Analytics

Automating an Inefficient Process Can Lead to an Inefficient Automated Process

Success depends on adoption

by the whole team

PEOPLE


Critical Design Considerations

He who touches least wins......Maybe

Creating & moving information is the job,

optimizing delivery of service is the goal

PROCESS

INFORMATION

BEST

Doing now what patients need next

Documents

New Analytics & Automation in Limited Spaces: Principles ... · optimizing delivery of service is the goal PROCESS INFORMATION BEST . Key Objectives Best Practice Lab Design Balancing