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Title: Reconfiguration and modernisation of a district general hospital clinical biochemistry service
Author: Ricketts, David John
ISNI:       0000 0004 2686 2274
Awarding Body: University of Portsmouth
Current Institution: University of Portsmouth
Date of Award: 2010
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Context: The clinical biochemistry department at the North Middlesex University Hospital successfully won funding under the pathology modernisation initiative to automate the core laboratory in 2000. Following procurement procedures, the contract was awarded to two vendors who offered an 'islands of automation' solution as opposed to the popular fully tracked solution. The automation was installed with minor process change, but process reviews occurring in 2003 with the advent of Lean Six Sigma. Methods: The Executive War College meeting in 2003 introduced new quality management tools Lean, Six Sigma and activity-based costing, to the pathology environment. These methods were incorporated into the clinical biochemistry department and the impact of these was studied over a five year period to assess if any additional benefit could be offered when compared to the implementation of automation on its own. The later being introduced using traditional process management methodology. The process review expanded to include the specimen reception area, as delays at this point had a major impact on the performance of the automated laboratory. Results: Introduction of process management tools improved turn around time for key indicators by as much as 50%, compared to automation alone, whilst removing the variation in time to result due to the pull system of samples setting a defined time for samples to arrive for analysis. The total laboratory space for clinical biochemistry was reduced by 32% allowing for the formation of a molecular laboratory and increasing the sample reception area by 133%. The avoided build cost to extend the department for these works was £265,500 .. The value added activity post process change was scored at 17.21 % which was an international best for laboratories who had been assessed using this tool. Using benchmarking data, £1,350,000 of avoided costs, in the year 2007-8, were calculated as a result of the changes made to the service. A staff survey of the changes supported the change process with positive feedback. Automation of request forms using electronic ordering show a dramatic improvement on quality compared to the hand written forms, which had a Sigma level of between 2 and 3, improving to 4.1 Sigma when the electronic requesting went live. ii Conclusion: All process tools strongly recommend taking a baseline reading of the data before making any change, this recommendation was verified as a must in this study. The advent of automation proved very popular with the staff as it removed repetitive functions and made some manual processes obsolete, thus improving morale. The impact of automation however did not improve significantly the turnaround times, but enabled sample archiving and retrieval to be less prone to error. The study found that by aligning the work processes in specimen reception to those processes in the clinical biochemistry department, this created the major benefit. Therefore a strong recommendation is that process managing of specimen reception areas is a must before undertaking any purchase of automated systems. Any delay in the laboratory is minor compared to the potential for delay that poor process can give in the pre-analytical phase. Benchmarking allowed a year on year comparison to be made, but the study highlighted the need to drill into the data and understand the service change when looking at cost per unit. This allowed the return on investment for the new technology to be assessed, in this study the return was realised in eighteen months. Benchmarking highlighted that the quality improvement that new assays provided to patient care impacted marginally on the test volumes but had a 15% impact on the non-pay budget. The use of activity-based costing compliments both Lean and Six Sigma by allowing the true cost of the work to be assessed with both value adding activity and avoided cost, the money not spent as opposed to direct cost cuts, to be calculated. The activitybased costing allowed staff to focus their jobs onto those tasks which were appropriate to their grade and identify and reduce those tasks which were not, improving job satisfaction and morale. Avoiding cost through good process change has a positive impact on both the patient and the budget, which cannot be achieved by cost improvement programmes based on a percentage change in the money allocated to the department.
Supervisor: Not available Sponsor: Not available
Qualification Name: Qualification Level: Doctoral
EThOS ID:  DOI: Not available