Process Transparency For Laboratory Performance
By Antti Leino, Senior Industrial Engineer at LTS
A laboratory without transparency is akin to going somewhere you've never been before, without a map or any idea how to get there. Antti Leino, Senior Industrial Engineer at LTS looks at the significance of performance transparency in laboratories — and how to achieve it.
How well do you understand the performance of your laboratory? Here are three questions are at the heart of laboratory performance, that can provide critical direction and guide you to success. They provide transparency.
Do you know what the maximum capacity of your laboratory is?
Do you know the specific areas where capacity is at risk of excess utilisation, thus impacting your laboratory's delivery and turnaround time?
In order to improve, do you know what goes on in your laboratory?
And yet, initiatives are often embarked on without an adequate understanding of these questions. Public pathology services are increasingly under pressure to meet growth expectations and changes in demand. In addition, high quality of service is expected, and patient safety has to be prioritised.
The need for performance improvement that delivers results could not be more emphasised.
In some cases, improvement initiatives are often seen as a cost to the organisation. Clinicians have argued that a focus on operational performance improvement without increasing organisational costs is typically not feasible, risks patient safety and deteriorates patient quality through prolonging turnaround time (TAT). Performance improvement is equated with corner cutting, quality reduction and result in savings that can be difficult to quantify in terms of real value.
Based on an assessment of 22 trusts within the NHS, it was identified that savings of £5bn per annum may be achieved through improvements to operational productivity by 2020. £2bn of this could be delivered by improving workflow and containing workforce costs, combined with a stronger management understanding of the use of non-productive time. Additionally, the savings can be driven by the effective management of staff rosters, specifically with regards to the appropriate alignment of staffing levels and skill mix.
The ideal balance of high quality, TAT performance and affordability are what any laboratory strives towards, but the perception exists that one of these factors cannot be improved without negatively affecting the others. There is an informative PinpointBPS article on this topic that illustrates how quality, time and cost need not be a zero-sum game. Managers and clinicians may see the initiative of improving TAT through speed and efficiency as a decrease of quality and therefore will not pursue it — a critical requirement. Managers must make significant decisions with the increasing demand on the pathology operations in relation to current capacity, in order to maintain or improve TAT and quality, without increasing costs. Increases in sample volumes naturally affect utilisation of equipment and staff dealing with activities related to sample and test processing. Understanding the impact at a given time on a specific group of resources enables us to know how we can deal with the change.
In order to drive improvement initiatives, it is imperative for laboratory managers to understand all aspects of their operations rather than justifying change through data extracted from financial systems.
In an organisation as complex as a laboratory, it can be difficult to comprehend daily operations within any department and adhere to the responsibility of delivering KPI reports in a timely manner. Accurately identifying the relationship of peaks and troughs of volumes to be processed against staff rotas, or understanding the impact of staff absence on their peers and result quality are examples of how operations impact their service. But being pressed for time and required to perform means
However, managers do not always have the adequate time along their primary responsibilities to comprehend the minute details of their operations, which impact their service. Without a detailed understanding of operations, it is not possible to understand the true capacity of equipment or staff with regards to throughput-related and non-throughput-related activities. Decisions made without accurate data can lead to discrepancies with senior management and staff, which may have a negative impact on the quality of the service due to the lack of transparency.
Transparency helps you understand the impact of your decisions and initiatives
The lack of transparency of processes may affect decisions to be made in all areas of the laboratory. This also impacts any decisions based on the specific understanding of operations from a lab process, lab equipment and a staff perspective.
Achieving transparency can be done by following these guidelines.
Firstly, you need to establish an understanding of your processes. This can already provide you with a lot of information on why your current performance is the way it is. There are three objectives that every laboratory manager should have in place in order to ensure this:
- Achieve end-to-end process understanding from receipt to result
- Ensure cross-disciplinary understanding of processes
- Gain understanding of resources at specific times to enable optimal alignment of demand and capacity.
Next, it is important to understand your equipment. For instance, do you know if there is a potential for growth with the current operations without affecting TAT? Is there any underutilised equipment within the organisation to be used more efficiently before procurement of additional analysers?
Lastly, you need to understand your workforce, especially how busy they are and what they are busy with. Often, small changes here can have a drastic impact on performance. Consider the following:
- Enable staff to realise their added value to the process and understand relationships to all departments from reception
- Highlight the importance of the quality of work the staff conduct and what effect this has on the downstream activities
- Is there enough or a lack of staff numbers within specific areas of the laboratory to efficiently process volumes?
- Is there an appropriate skill mix of staff processing the current volumes within the laboratory?
Your laboratory also has different levels of understanding, affecting how improvements will be approached.
MLA, BMS, Senior Management. Having worked in laboratories across the world we have identified that there may be different perspectives of understanding for different employee types within the lab – the knowledge of each of which is critical to a full understanding. Knowing your operations in depth is critical for any decisions that will impact the service. Such knowledge is required to safely make decisions resulting in improvements from either a cost or a performance improvement perspective while ensuring the quality of the service is either sustained or increased.
The below figure illustrates the current and ideal standing of knowledge of in-depth understanding of detailed operations.
The figure does not indicate a transition of knowledge between different stakeholders. The main focus is to highlight that in order to make sound decisions based on detailed operational knowledge and accurate data, transparency of processes will benefit all levels of staff. For example, when was the last time senior management spent a day in the pre-analytical area during peak sample arrivals to truly understand the constraints of the area? What level of detailed information can they access to understand what happens in the laboratory at different times? Transparency of processes enable the constrained staff to highlight risks in excess utilisation, as well as enable managers to focus on underutilised areas for more effective deployment.
Lack of transparency is like going somewhere new. Without a map.
Given that generating reports and reviewing processes is perceived to take up a significant portion of senior staff time, the argument that senior managers can benefit from gaining more transparency into current operations will have an impact on the success of performance improvement initiatives.
This emphasises the need for process maps in the laboratory. More importantly, it shows how a process map is, in fact, a performance management tool, to guide performance in the lab and for managers to understand where they are going. It should show transparency of all activities within the laboratory. Additionally, transparency supports the effective planning of rotas and the use of the appropriate skill mix within the laboratory, which previously was identified as a risk in taking up a significant portion of senior management time or incur additional costs.
How do you achieve transparency by adopting innovative principles and tools?
With the constant growth of demand and increased reporting requirements of accreditation, senior managers are faced with an information overload combined with a limited number of working hours per day in order to improve their operations. However, operations can be made transparent in order to accurately quantify, control and improve in a fast and effective manner through process mapping tools.
The mind-set of thinking that all inefficiencies from the laboratory will be addressed by increasing resources (more cost) or that only by working harder (more stress) is counter intuitive. Performance improvements can be achieved through the accuracy of data and transparency within the organisation.
In order to achieve transparency a clear communication method needs to be established. PinpointBPS accurately documents all processes within laboratory operations and produces into standardised visual process maps, which enables bi-lateral discussions between senior managers and staff to accurately identify improvements.