“In doing the traditional Six Sigma variation reduction, we were getting incremental improvements,” says Christopher Harris, Lean Master Blackbelt at Quest Diagnostics. “A lot of the Six Sigma toolset is understanding where variation is causing problems, and it uses a number of statistical tools to help detect that. At Quest Diagnostics, one example of this translated to analyzing the variation in the way patients come into our Patient Service Centers, trying to even out the flow, and set up appointment scheduling. However, we wanted more than just incremental improvements.”

Seeking greater flexibility and responsiveness to customers, Quest Diagnostics implemented lean methods, taking a holistic view of all of its processes to identify and eliminate waste.

“Rather than just driving out variation, the lean toolset looks at the entire process to see where the biggest waste components are, so you can go after those first,” says Harris. “We’re in a very competitive market, so we’re always thinking about how we can drive out these wastes, which translates into driving out unnecessary cost.”

To narrow the scope of the lean project, Quest Diagnostics employed a tool called SIPOC, an acronym derived from the tool’s examination of a company’s suppliers, inputs, processes, outputs, and customers.

“We looked at how our product is delivered, how specimens come into our site, how we actually process all this work,” says Harris. “SIPOC helped us to see that focusing on parts of our lab operation would give us the most impact for the least effort.”

When trying to understand where to focus its efforts, Quest Diagnostics undertook an extensive look at customer and business data, while keeping in mind the definition of value added: a service provided to a customer at the right time, at an appropriate price, as defined in each case by the customer. Analysis of key data revealed that the actual testing and delivery of results were the activities that added the most value for customers. That is what Quest Diagnostics is paid to do. Transportation (internal as well as external) and numerous sorting of specimens added little value. However, analysis of the cost of individual business activities yielded an important discovery.

“Picking up, transporting and sorting of the specimens was the most resource intensive process we looked at, but it is where we add the least value for customers,” says Harris. “This meant that we were spending the largest portion of our resources on the part that added the least value. We realized that the front-end process was ripe for going after some benefit.”

Improving the Front End

Harris’s description of the complexity of Quest Diagnostics’ operations illustrates the potential for gain through optimization of front-end processes.

“Each night, 30,000 requisitions pass through the pilot lab, meaning that 30,000 people have had blood drawn or some other test,” says Harris. “On those 30,000 requisitions, we’ll perform 140,000 to 160,000 tests, most of which have to be resulted back to the doctors by eight o’clock the next morning.”

To improve its front-end operations, Quest Diagnostics focused on five characteristics of a “best-in-class” lab: smoothing of arrival of specimens; layout of laboratory testing areas based on ordering patterns, shared specimen type, and open floorplan; consolidation of preanalytic and postanalytic steps such as sorting and aliquoting (portioning specimens for testing); introduction of new technology; and just-in-time delivery of supplies to testing areas.

“Our incoming profile was not optimal, and it still isn’t today, but we’re driving to get it closer,” says Harris. “Specimens were coming in during a narrow window, mostly between 9 p.m. and 4 a.m. Bringing in more specimens earlier and leveling out the flow gave us access to a lot of extra testing capacity on the lab floor that we were never able to use before, and we reduced overtime and enhanced operator efficiency.”

Tasks were reallocated by workers’ skill level, so that higher-skilled medical technologists focused on testing and delivering results, and lab aides, with less training, handled data entry, sorting, and storage. A materials strategy was created to handle ordering and retrieval of supplies.

New sorting and aliquoting technology “drove an extraordinary amount of productivity for our corporation,” says Harris. “We’re selectively automating. The data showed us the best place to do it.”

Just-in-time delivery of supplies, via a Kanban system, enabled the elimination of an entire warehouse from a Quest Diagnostics facility. The new system stores supplies in a “supermarket” on the lab floor. Where required, each department, or cell, is equipped with double-sided refrigerators that receive deliveries of supplies without interrupting lab operations.

Streamlining Laboratory Layouts

Quest Diagnostics also examined laboratory layouts with a tool called value stream mapping, which graphically shows the flow of products through the laboratory system and helps to discover constraints in the flow and communication feedback.

“We documented and timed each major step in the process and obtained a complete view of everything on paper, beginning to end, including how many people were involved in each step and how often a product would just stop and sit somewhere for a while,” says Harris. “We also looked at how customer feedback is communicated back into our processes. We plotted material flow on the bottom of the value stream map and communication flow across the top looking to see if they were aligned.”

Quest Diagnostics also analyzed laboratory layouts using “spaghetti mapping,” which documents workers’ movements with lines drawn on a scaled laboratory floorplan, a diagram that over time comes to resemble spaghetti.

“We found that some people were walking six to seven miles per night just to get their work done,” says Harris. “This was instrumental in telling us where things should be located. People had to take a lot of steps in the high-volume areas, so we put those closest to where the specimens come in.”

To aid in the overall work process analysis the data and maps were analyzed using the lean seven wastes: overproduction, waiting, transportation, over processing, inventories, motion, and defects. From this analysis Quest Diagnostics found key areas of improvement in the sorting, aliquoting, and transportation of specimens.

“In some cases, we found that we were sorting the same specimens eight different times,” says Harris. “For the most part, we realized that we only needed to do the sorting a maximum of three times. Handling greater than 60,000 specimen tubes three times a night instead of eight times really added up in productivity and cost.”

Another lean tool, 5S—which draws its name from its component steps: sort, set in order, shine, standardize, and sustain—was particularly useful in stabilizing storage areas, Harris says.

“An area in one of our laboratories was devoted to the storage of consumable materials such as gloves, tubes, etc. With the first S—sort—pwe asked why these objects were there, when they were used, and how often. Even though they were going through a box of gloves per day, there were about 15 boxes of gloves of each size in this storage area, so we removed all of the extra boxes and left only what was required. We did the same for every other object in that area, allocated spaces for everything, labeled them, and made clear that things would be returned to their established spaces every time.”

Workstations also benefited from 5S.

“With the fourth S—standardize—we methodically established the amount of each material that was supposed to be at each station, which helped us standardized work processes. We posted a ‘radar chart’ that showed workers where they were every day in the 5S process, so they knew whether they were going forward or backward.”

After determining automation and instrumentation needs with a process model, Quest Diagnostics used another tool called systematic layout planning to establish the instruments’ optimal spatial arrangement. Then, using a “value add/non value add” analysis, Quest Diagnostics set about driving out non-value-added activity and crystallizing the new knowledge in streamlined work environments. In these U-shaped cells, samples proceed in a stepwise fashion from station to station, finally exiting the cell at the same point they entered. Heavy, antiquated furniture was replaced with low-walled, flexible, moveable lab furniture that maximizes visibility throughout the lab.

“We are constantly changing our lab floor, and with several changes a year on the lab floor, we wanted to make furniture changes easy to do,” says Harris.

Lean Gains

Quest Diagnostics’ lean project yielded myriad benefits, among them increased throughput, reduced testing time, lower costs, and improved morale.

“We had a 30 percent reduction in inventory,” says Harris. “We also had a tremendous reduction in defects. This increase in quality lowered our cost per test, which made us a more productive and flexible company. The organized work spaces and more predictable and balanced workflow raised the morale of the people on the floor. People are excited knowing that they can contribute to the redesign and actual configuration of their workspaces.”

Lean has also moved Quest Diagnostics significantly closer to its goal of “virtual perfection.”

“Virtual perfection—what we strive for—is to do everything completely right all the time,” says Harris. “Quest Diagnostics understands that this is a journey not a destination, but that’s what we continually strive for.”

By Deborah Kreuze

We welcome your Questions and Comments

Copyright 2008 Tradeline Inc.
All Rights Reserved
ISSN: 1096-4894