Doubling Lab Testing Volume Within the Same Footprint

Doubling Lab Testing Volume Within the Same Footprint

The challenge

In 2012, Carolinas Health System’s (CHS) core lab experienced a a dramatic 50% increase in testing volume due to overall system growth as well as success via their Laboratory Outreach program. Occuring over five years, the growth, while welcome, created numerous challenges:

  • The volume of routine tests from physician offices reached a level where the acute care needs of the campus were being adversely affected.
  • Growth also resulted in testing being spread across five locations, presenting challenges to quality and efficiency.
  • Lab functions at the acute hospitals were rapidly outgrowing their facilities.


The process

Boulder Associates’ Michael Oswald, then a lean master at CHS, was part of an initiative to design a core lab using principles of lean design which were to become the national benchmark for laboratory design and operations. A core team—comprised of architects, project managers, Lean/IE team, SVP of Laboratory, VP of laboratory services and the CMO—was assembled to assess the options for consolidation and develop process improvements that would be designed into a new facility, and could be implemented at existing labs.

The team conducted a lean and industrial engineering assessment of the current state of lab operations at CHS. They then visited lab facilities at the nation’s best labs to set benchmarks as well as record learnings and practices to inform their vision for the project. Guiding principles for the project were developed, which became the framework for the design work.

The first design event included the leadership team, PhD’s from each section of the lab and one front-line person for each area. The team created an affinity diagram to define adjacencies.

Nine distinct 3P rapid prototyping events were conducted to define how the lab would operate in a lean operating system. These events involved 75% of front-line team members, who spent a week working with full-size cardboard models of spaces, simulating work processes and flows to determine the ideal layout of spaces, equipment, and paths of travel to maximize operational efficiency.

The results of the 3P events not only informed operations, but also the physical design of the new facility. The leadership team implemented the new processes into the existing locations to start improving and conducting “Plan–Do–Check–Act” (PDCA), allowing return on the investment in the initiative for CHS to start immediately.

In addition, the team developed a new system for materials management that took into account on-site inventory, product lead times, visual management fundamentals, and a robust process for handling QC-required items. They worked with suppliers and implemented new internal processes including: defining roles within the organization, providing training, and developing leadership principles, which improved the overall lab process immensely.


The outcome

The new core lab was 9% under budget, opened on time, and CHS was able to fully return their investment in the project by the third year of operation. This was in no small part due to the operational efficiencies uncovered throughout the entire lean approach of the team.

The success lay in the planned capacity of the new lab. Within the same 28,400 s.f., the lab was projected to be able to handle 8.8 million billable tests in 2021, more than double the 4.3 million tests for 2015. This meant that the facility would be able to handle a potential 355 billable tests per square-foot in 2021, up from the 150 per of the 2015 volume. These benchmarks are significantly higher than that of current equivalent labs, which ranged from 78-94 tests per square-foot.




The new lab was 9% under budget, opened on time, and CHS was able to fully return their investment in the project by the third year of operation.