Abstract
Providing molecular HLA services with increased volumes and no additional staff, while maintaining or improving the quality of output.
A contracted LEAN consultant created an in-house team to study the molecular HLA lab workflow, consisting of evaluating sample volumes, error rates, and staffing levels. The team then implemented the following: Phase one was to cross train staff to perform all lab functions as cross training was viewed to offer flexibility in all aspects of the workload and process. Phase two was to determine the most efficient workflow. Standard Work, Single-Piece-Flow, along with standard batches versus Right-Size-Batches were studied to evaluate the efficacy of each. Phase three studied the error rates and re-work rates for all processes to determine root cause of errors, to include evaluating staff errors and the need for automation and/or upgrading technology. Phase four consisted of the design of a visual, posted Production Board, to include process timing, task assignments, and daily metrics including sample volumes and individual and collective staff output.
Even as the volumes continue to increase, the implementation of the changes resulting from the points above have shown a substantial impact, including: Error rate reductions. For example, the decrease in the pre-analytical error rate from 7.9% to 3.2%. Turn-Around-Time (TAT) reductions. For example, the TAT for Chimerism testing has decreased by half, even as the volume has increased by almost 300%. Increased cross training. Allows for greater flow of ideas on efficiency and cooperation in response to higher volumes. Increased team work and staff morale. Better communication via the production board has increased job satisfaction. Improvements in automation and technology. Data gathered helped obtain new equipment and software. Improvements in services offered. Data on the bone marrow program showed that SBT would not offer the resources needed to meet our TAT goals. The decision was made to validate and implement NGS as our method of high resolution typing.
As the lab continues to grow and adjust, efficiency, staff morale, and client satisfaction continue to improve as a result of the LEAN implementations. Now, areas of concern are considerably easier to define and problem-solve.
