In this presentation, Joseph Campos of Children’s National Medical Center discusses healthcare and laboratory testing using Lean, and the 5 Lean principles that apply to the laboratory. He shares three case studies from his lab: microbiology lab workload and staffing data, microbiology incoming work cell and automated culture plate inoculation. Joe also discusses the difference between and traditional approach to microbiology testing versus a Lean approach.

1. Making a Positive Impact on Patient Care: A
Case Study of Children’s National Medical
Center Clinical Laboratory
Presented by: Joseph M. Campos, PhD, D(ABMM), F(AAM)
Children’s National Medical Center, Washington, DC

2. Your Presenter Today
Joseph M. Campos, Ph.D.,
D(ABMM), F(AAM)
Children’s National Medical
Center, Washington, DC
• Obtained AB (1968), MA (1970), and PhD (1976) in Bacteriology from the
University of California, Berkeley.
• Served as Director of the Microbiology Laboratory at both Children’s Hospital of
Philadelphia (1978-1985) and at Children’s National Medical Center (1985-
present). He is also Director of the Molecular Diagnostics Laboratory and Director
of Laboratory Informatics at Children’s National Medical Center.
• Tenured Professor of Pediatrics, Pathology, and
Microbiology/Immunology/Tropical Medicine at George Washington University
Medical Center and is board-certified by the American Board of Medical
Microbiology.
• Currently is serving his fourth year in the elected position of Secretary of the
American Society for Microbiology.
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3. What We’ll Cover Today
• Healthcare and Laboratory Testing Using
Lean
• 5 Lean Principles that Apply to the Laboratory
• Case Studies
– Microbiology Laboratory Workload and Staffing
Data
– Microbiology Incoming “Work Cell”
– Automated Culture Plate Inoculation
• Microbiology Testing – Traditional vs. Lean
Approach
• Summary
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4. Healthcare and Lean
• Lean principles can be applied to Start
activities that have a defined series
of steps during preparation of
products Step 1
• Healthcare and laboratory testing in
particular are ideal targets for Lean
• Presently the waste in the Yes
Decision Step Y1
healthcare system of the U.S. alone
is monumental amounting to $850
No
billion per year
• A Lean overhaul of the hospital Step N1 Step Y2
laboratory can eliminate wasteful
activity and inactivity, reduce costs,
improve patient outcomes, and Step 3
provide for safer healthcare
encounters
Finish
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5. Laboratory Testing and Lean
• The main objective of a Lean
laboratory reorganization is to
deliver the highest quality test
results, at the lowest cost,
within the shortest time frame,
while improving
physician/patient satisfaction
• The deliverables of a
successful Lean laboratory
reorganization are:
– Improved operational performance
– Standardized processes
– Fewer errors during testing
– Better employee morale
– Increased patient/employee safety
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6. Five Lean Principles that Apply to the Laboratory
1. Value: Strive to increase the
value of testing from the
physician/patient perspective
2. Value Stream: Define the steps
of testing processes and
eliminate wasteful activities and
inactivities
3. Flow: Make each testing
process flow as consistently as
possible
4. Pull: Maintain a “just-in-time”
inventory of supplies
5. Continuous Improvement:
Seek perfection by constantly
reviewing the steps of the
testing processes
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7. Implementation of Lean at CNMC
• Microbiology Laboratory workload
and staffing data were pre-
submitted to Guidon Performance
Solutions
• A 3.5 day laboratory assessment
was conducted on-site by Guidon
• The focus was on the blood culture
and urine culture value streams
• Recommendations were made
regarding maximal use of available
staff, opportunities for automation,
and more efficient utilization of
laboratory space
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8. Microbiology Testing – The Traditional Approach
Day Zero 0000 – 1600 1600 – 2400
New specimens are examined New specimens are examined
microscopically and inoculated to microscopically and inoculated to
culture media culture media
Day One 0800 – 1600 0800 – 1600
Culture media are examined for growth Culture media are reincubated to allow
and identification/antimicrobial more time for organisms to grow
susceptibility tests are set up
Day Two 0800 – 1600 0800 – 1600
Identification/antimicrobial Culture media are examined for growth
susceptibility test results are reviewed and identification/antimicrobial
and released to the physician susceptibility tests are set up
Day Three 0800 – 1600
Identification/antimicrobial susceptibility
test results are reviewed and released
to the physician
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9. Microbiology Testing – The Lean Approach
Day Zero 0000 – 2400
New specimens are examined
microscopically and inoculated to
culture media
16 Hours 0000 – 2400
Culture media are examined for growth
Later and identification/antimicrobial
susceptibility tests are set up
18-24 Hours 0000 – 2400
Identification/antimicrobial
Later susceptibility test results are reviewed
and released to the physician
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10. Traditional Versus Lean Microbiology Testing
• In the traditional testing scenario,
work is performed when the
laboratory staff is ready –
organisms wait for the staff to be
available on the next day shift
• In the Lean testing scenario, work
is performed when the organisms
are ready – staff is always
available to begin work on
positive cultures
• In the traditional testing scenario,
final results of positive cultures
are available in 40-64 hours
• In the Lean testing scenario, final
results of positive cultures are
available in 34-40 hours
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11. Other Lean Microbiology Improvements
• Creation of “work cells” to
minimize unnecessary
movement and motion
• More frequent deliveries of
culture media and reagents to
lessen inventory storage
requirements and deterioration of
labile materials
• Automation of mindless repetitive
steps to eliminate human error
and free up staff for brain-
intensive activities
• Use of information technology to
standardize culture workups –
reducing inefficiency and
mistakes
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12. Microbiology Incoming “Work Cell”
(A) (B)
• Photo A
– Specimen processing hood, continuously monitored
blood culture instruments, and Gram staining sink in
the left foreground
• Photo B
– Automated culture media inoculator and incubators
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13. Automated Culture Plate Inoculation
Manual Automated Manual Automated
• The goal of a microbiology culture is to furnish well-isolated
colonies for additional testing
• The photos above illustrate how much better the automated
culture medium inoculator does than a human
• In this example, identification and antimicrobial
susceptibility results would be available at least 18 hours
sooner from the media inoculated with the automated
instrument
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14. Summary
• While still in progress, the
Lean-based reorganization of
our Microbiology Laboratory
has already eliminated a great
deal of wasted time and effort
• The changes to our laboratory
are being achieved without
increasing our space nor the
number of our staff
• Most importantly, the clinical
utility of our test results are
being improved because they Mission
are less prone to human error Accomplished!
and are available on a more
timely basis
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15. Questions?
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16. Thank You
Guidon Performance Solutions
866-986-4414 or 480-986-4414
contact@guidonps.com
www.GuidonPS.com
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© 2008 Guidon Performance Solutions, LLC. All rights reserved. Guidon Performance Solutions is a licensee of LeanSigma®, a service mark of TBM Consulting Group.