December 2009: Volume 35, Number 12
H1N1 Spreads Across the United States
Tips on Handling the Spike in Demand for Testing
As of early November all indications were that the 2009 H1N1 influenza outbreak was still gaining steam and labs were continuing to do yeoman’s work in handling a huge spike in testing demand.
To explore how labs might find some relief from the testing onslaught in a climate of tight economic circumstances and limited staff resources, CLN spoke recently with efficiency expert Ron Wince, president and CEO of Guidon Performance Solutions, a Phoenix-based management consulting firm specializing in business performance improvement. Wince’s clients include major health systems and diagnostic manufacturers.
Q: The H1N1 outbreak started last spring, slowed somewhat during the summer, and came back with full force this fall. What feedback are you hearing from labs about how they are dealing with it?
A: The feedback probably mirrors what happened in the spring. Labs are feeling taxed and perceive that they don’t have enough staff. At times they’re running 20 to 25 percent overtime to keep up, and when you’re paying someone time-and-a-half, the cost is significant.
Q: What are some steps labs can take to ease the pressure, since most aren’t able to add new staff to deal with the outbreak?
A: In our work with labs, we’ve found that about 80 percent of technologists’ time is consumed doing things that don’t add value to the outcome of the sample. They’re spending time filling out paperwork, tracking things down, walking around. So we’ve found three areas where labs working creatively over a couple of days may be able to eliminate 20 to 30 percent of that waste.
Q: What specifically are the three areas of opportunity?
A: One way is to look at how samples flow through the lab. They tend to get moved a lot without anything really happening to them. So we suggest co-locating equipment in a layout that enables things to happen more sequentially, thereby minimizing the amount of walking around staff have to do. With the equipment closer together, the technologists can work more on processing samples and getting results out.
Another area is inventory management and storage. Things technologists need from a consumables perspective often are poorly placed, so we encourage labs to think about technologists as if they were surgeons. When a surgeon is performing surgery, he stands in one place and has people bring things to him so he can do the surgery. We want that same mentality around lab staff. Reconfiguring the bench so technologists have what they need right around them can take out as much as 10 to 20 percent of cycle time on a per-sample basis.
The third area is that technologists spend a lot of time doing paperwork or working in the LIS. We had one client where they had to go through 32 screens for each sample. If you multiply that by hundreds of samples that’s a lot of time each day. So we recommend changing the way lab staff do paperwork or interface with the computer.
Q: Changing the LIS sounds complicated and not something that could be done in a timeframe that would help labs deal with the H1N1 crunch. How could this be done quickly?
A: If you make IT staff part of the team addressing this issue, they’re usually pretty creative at figuring out how to do work-arounds quickly. It may involve temporarily using a replacement template or sheet until the LIS can be updated. The goal is to have an immediate impact and not let the LIS be a roadblock to finding efficiencies.
Q: If labs are struggling to keep up with testing demand, how will they be able to step back and look at these areas?
A: The vast majority of hospitals have some kind of internal improvement team; it’s just that they haven’t been focused on labs. But let’s say the hospital either doesn’t have a team or it can’t be freed up to solve this problem. This is just like any other investment that you make. There’s no good time to fix a process, but if you don’t, the problem will persist. But if you can do it quickly and within a week have the whole process changed so it’s working better, you’re making a positive investment. So we suggest organizing a small team of technologists, lab management, and IT staff and look at it as if they were on vacation for a few days. You’re freeing them to address the work flow and within a few days they can have a solution that will make a measurable impact.