Implementing Laboratory Automation

A well-chosen team and careful planning make for a successful project

By Sue Yost 

Implementing a lab automation solution may be the biggest task any lab manager will face. This article provides a blueprint that can be used in any size lab preparing for an automation conversion. Such a blueprint will enable lab managers to:

• Align the project plan to meet the business, strategic, and clinical goals of the automation initiative.
• Measure current productivity and identify opportunities to improve it.
• Engineer the best solution to meet defined goals.
• Manage people and processes to the plan.
• Stay on track by managing to specific milestones.

One of the biggest challenges facing any hospital is space. New services, new technologies, and new capacities put every square foot at a premium. Such a demand for space creates a special challenge for hospital services such as radiology and the clinical laboratory, which rely on equipment that is bulky and often immovable. In many cases, project leaders must figure out a way to renovate and upgrade within an existing footprint, while continuing to provide 24/7 patient services. (For more information, see the companion article, “Key Steps in Implementing Automation.”)

This was the challenge facing Veronique De Vroey, MS, lab manager at the Antwerp University Hospital (UZA), Antwerp, Belgium, who was charged with replacing the hospital’s existing laboratory automation system with a new system—and incorporating even more analyzers. Not only did she have to accomplish this task within the same square footage as the previous automation system, she also had to ensure that the lab remained online during the entire conversion process.

Once the decision was made to upgrade, says de Vroey, the list of items to be addressed blossomed. Among the key tasks were:

• Identifying and engaging stakeholders. The conversion team needed to reach out to every physician and department that utilizes the services of the hospital laboratory, including representative external customers, so that written commitments and buy-in could be obtained from each group.
• Budgets. The team needed to prepare a master budget as well as budgets for specific items such as training, staffing, dismantling the old track and uncoupling analyzers, installation of the new track, facility remodeling (floor, ceiling, lighting, airflow, water, and electrical supply), utility hook-up, information technology (IT) services, and other components.
• Scope. The team needed to prepare a clear articulation of the objectives and scope of the project and, just as important, to define what activities would be considered outside the scope of the project.
• Internal and external opportunities and risks. The team created an assessment of such opportunities, including the potential for adopting new tests, and for pursuing new business opportunities with such third parties as other hospitals, individual and group practices, and other laboratories.
• A realistic timeline. The team needed to create a timeline with realistic and achievable milestones and measurable criteria for success.
• Frequent communication. The team identified channels for communicating with stakeholders, both scheduled and as needed for urgent issues.
• Staff engagement. The team worked to ensure that existing staff understood the project, emphasizing how the renovation would make their roles more fulfilling.

Moving forward with these tasks began the moment the renovation and purchase decision was made, says de Vroey. Doing so is the only way to ensure that throughout the planning and transition process, operations will continue on time, on budget, and without disruption.

“Our initial meetings were held well in advance of the implementation and were quite important for enabling us to organize our steering committee and core teams, and to identify and involve all of the other departments that needed to be involved,” says de Vroey. “Then we made sure everyone clearly understood their roles and responsibilities—and our goals.”

GETTING HELP

One early decision that de Vroey made was to utilize the services of a consultant to assist in leading the process, in this case, Siemens.
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Automation and Communication: Keys To Success

When it comes to upgrading the automation capabilities of a clinical laboratory, change can be both hard and complex. Members of the transition team can ease anxieties among lab staff and others in their institution by regularly communicating the status of current change processes and the next steps in line to be addressed.

Create: Daily 10-minute meetings with lab staff to keep them informed.

Hold: Weekly meetings with detailed minutes, agendas, and specific date assignments and deliverables.

Review: As a team, review each milestone achieved, and next steps.

Communicate: Using e-newsletters and other tools, keep the team, stakeholders, and the entire organization involved and informed.
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“We bring all stakeholders through an extensive workflow consultation,” says Iris Jungherr, vice president of automation and diagnostics IT at Siemens Healthcare. “We analyze their current workflow and metrics, document their short- and long-term objectives, and apply best practices derived from extensive data analysis to make the right recommendations. Then we discuss their options and review the plan. When a lab has all the information to make the right decisions, complexity is replaced by clarity.”

“The first step is always to take a hard look at current processes, and utilize tools like spaghetti diagraming and 5C (company, customer, competitor, collaborator, and climate) to help understand current and ideal workflow, where to place an analyzer along the track, and even the lab’s strengths and weaknesses, both internally and within the market,” says Alistair Gammie, PhD, senior director of global healthcare consulting solutions for Siemens Healthcare.

A spaghetti diagram literally records every step of each staff member in performing their daily tasks, and can also be applied to the movement of individual samples through the lab. It is not uncommon for a spaghetti diagram to help labs identify miles of wasted steps each day. Every mile saved is 15–20 minutes of walking.

The next step is to use the data, including projections about future 5- and 10-year demand, to eliminate waste and optimize workflow, drive higher productivity, maximize staff utilization, and refine clinical processes. In turn, such planning documents enable the implementation team to quantify improvements in turnaround time and accuracy of results, and define what they will mean to the lab’s clinician customers.

Both Gammie and Jungherr agree that the planning process should result in an understanding of how new processes and upgraded automation will affect both efficiency and clinical outcomes. In turn, this allows the implementation team and the customer to better understand not only the cost of current inefficiencies, but the potential return on investment and the bottom-line clinical and financial benefits that a successful automation project, including workflow optimization, will bring.

“One of the hardest things to do is to cast a critical eye over a lab’s processes,” says Gammie. “Has the lab measured all aspects of its productivity? Is there a clear idea of what every member of the staff does every day to support the business?”

The easy arguments in favor of laboratory automation typically center on the need to reduce staff, or to address a lack of available qualified staff in the marketplace. But while such benefits may be realistic, if lab leadership does not know which of its staff members is performing specific operations, who may be over- or underperforming, or where the lab’s inefficiencies lie, it is just not possible to quantify the impact of new automation features or upgraded analyzers.

The answers to these questions will help dictate the design and workflow of new or upgraded lab automation. Measurable benchmark achievements that define success include:

• Significantly improved efficiency and performance.
• Much higher volumes with reduced turnaround time.
• Lower overall costs and better staff utilization.
• Greater and more consistent clinical accuracy.

The key, says Gammie, is to measure everything. Understanding and optimizing workflow is the critical first step. Lab leaders need to anticipate and understand demand for the kinds of tests that will be run in the new lab, including the overall volume for both existing and emerging technologies.

GETTING SPECIFIC

Once the planning team has a good understanding of current workflow and future expectations, it will be in a good position to make specific decisions about issues that need to be addressed before finalizing workflow and laying out a new floorplan. Key issues typically include the following:

• Decide which instruments are to be kept, augmented, or replaced.
• Determine whether to keep or replace the lab’s existing middleware and other information technology hardware and software. For instance, lab managers may be told they must achieve a 30-minute turnaround time for clinical chemistry test results, but have no idea how this translates into management decisions affecting patients. Maybe the need isn’t so much to increase the speed that automation can deliver for a particular test, but to employ smart middleware that will reduce unnecessary testing automatically based on results—translating into faster, more reliable performance with less waste and higher productivity.
• Consider whether expansion will be needed again. How might that be accomplished given existing space, or will new space be available if another expansion is needed?
• Review the characteristics of the lab’s IT solutions. Available systems should be able to offer a seamless IT solution with integrated connectivity across all instruments and environments, providing a centralized view of all workflow and productivity, supporting multiple sites (if applicable), and making it possible to scale as necessary to meet future growth needs.
• Finally, determine the cost of change itself. It is more than just the price tag for new analyzers and modules. It is also the interim costs of training, additional staff to cover for those being trained, development of new protocols, and writing new standard operating procedures. Determine how the implementation plan might affect the need for supplies; unplanned shortages during the installation process can cost productivity, money, and potentially reputation.

Once all of these issues were addressed for her project at UZA, says de Vroey, it was critical to develop a step-by-step implementation plan that covered each and every detail.

Automating any lab involves many distinct tasks and objectives, depending on the lab’s specific requirements. UZA required uncoupling the instruments from their existing track; transitioning to manually managing workflow with the now standalone instruments; dismantling the track and replacing it with the new automation system in a tight space; and introducing new instruments and modules.

“We outlined the entire project in a detailed, phase-by-phase, step-by-step implementation plan,” says de Vroey. The blueprint for making the transition included:

• Moving instruments offline.
• Temporarily working with standalone instruments.
• Dismantling the old track.
• Installing the new track.
• Installing the new middleware server.
• Coupling all instruments on the new track.
• Staff training.
• Operational parameters during the installation process.

At UZA, taking such a step-by-step approach was critical to transition management—keeping the lab operational while the new automation was being installed. But there is no one-size-fits-all solution, say the experts. If the automation will include all-new instrumentation in a different footprint, the transition can be relatively easy. But for others, such as UZA, the process can be a bit more challenging.

“Moving instruments in the lab was like playing musical chairs,” says de Vroey. “But we did have the advantage of duplicate equipment, so that for every instrument, we had another we could use for processing samples.”

The transition also requires that attention be paid to infrastructure needs such as power, water, compressed air, drainage, and computer networking—all of which should be addressed in the initial project budget so that such essential resources remain available for both the transitional lab equipment and the new automation system that is being installed. It also is important to pay significant attention to making sure the software connection and installation on the new automation equipment is fully integrated and functioning before switching over to the new system.

“In the end,” says de Vroey, “our project was so successful because we prepared very thoroughly, planned in detail, and had a very good team working together toward a clearly defined goal.”

Sue Yost is senior manager of automation for the North America healthcare consulting solutions business at Siemens Healthcare Diagnostics, Tarrytown, NY. For further information, contact CLP chief editor Steve Halasey via [email protected].