Core Lab Support Services Centralization for Atrium Health

Core Lab Support Services Centralization for Atrium Health

Atrium Health is one of the nation’s leading healthcare organizations, with more than 40 hospitals and 900 care locations ranging from doctors’ offices to behavioral health centers to nursing homes. Boulder Associates’ Director of Operational Improvement was Lean Master at Carolinas Health Systems (CHS). In that position, he was responsible for taking on lean process improvement system-wide, with a mandate to seek out and eliminate waste, reduce costs, and increase efficiency throughout the system.

The Challenge

The success of CHS overall and the Laboratory Outreach program (increased clinic revenue) had resulted in significant volume growth, which had created numerous operational challenges. CMC laboratory served as an acute care lab and as the core chemistry and hematology lab for CHS Metro hospitals. Other central lab functions where spread over five locations including–histology, microbiology, molecular, immunology, cytology and chemistry and hematology. The lab service line experienced 50% growth over the past five years. The volume of routine tests from physician offices has reached a level where the acute care needs of the CMC campus were being adversely affected. Growth has also resulted in testing being spread across five locations, presenting challenges to quality and efficiency. Lab functions at CMC and CMC-Mercy were rapidly outgrowing their facilities.

Testing locations

  • 12 acute care hospitals
  • 6 free-standing ED Labs

Reference Laboratory Testing

  • 2,978 providers located in 938 medical practices

Phlebotomy Services

  • 19 patient services centers (locations for outpatient blood draws)
  • 16 physician practices
  • 21 skilled nursing facilities
  • Reference Laboratory Testing
  • 2,978 providers located in 938 medical practices

Laboratory Departments

  • Hematology
  • Chemistry/Toxicology
  • Microbiology
  • Histology/Cytology
  • Blood Bank
  • Cytogenetics
  • Molecular Diagnostics
  • HLA Transplant
  • Coagulation

The Process

  1. A number of possible solutions were evaluated:
  2. Locate consolidated core lab at CMC
  3. Transition CMC into an acute care lab; develop a new facility to consolidate specialized testing and routine outreach testing
  4. Outsource all specialized testing and routine outreach testing
  5. Maintain specialized testing; outsource routine outreach testing
  6. Do nothing

Solution 2 was selected. The plan was to build and operationalize a new core laboratory of approximately 28,400 square feet at Airport Center Building H, and create a leading model of quality, safety, and efficiency in the core lab.

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 visited 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 function 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

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 lab was paid back in five years, which was half of the projected ten-year timeframe. The lab processes more tests per square foot than any other lab in the U.S.:

All lab departments improved their delivery. 98% of all Chemistry and Hematology tests are resulted by 7 a.m. the next day, and 86% of all specimens are delivered to their testing area within 163 feet of the entrance.

Another area of success was FISH TAT. The team was able to reduce the number of days from 10 to below 6, despite an increase in overall test volume.