FMLA - Workflow Services Case Study Exalab

Hubert Palumbo - Florent Mulatero

Full Microbiology Lab Automation

Global solution based on building a close and unique partnership with each laboratory

Needs for Automation in Microbiology

Needs for Automation in Microbiology

Drivers for Automation

Needs for automated solutions and

For a new Organization with a smoother flow, To decrease Turn Around Time, To better manage quality, traceability, accuracy of results & provide support for accreditation, To improve lab productivity and profitability, Training + design for a new layout (how many m? , FTE?).

Background on Workflow audits

How many audits already performed in Europe ? 60 workflow audits done Among them how many created sales afterwards? 30 instruments sold ( ~2.2 m) + other in progress Increase consolidation of laboratories: More & more expectations from our customers to be supported for designing and improving their lab workflow

Content

Customers expectations for a Lean Lab assessment (1/5) Before After: proof of evidence with key figures (2/5) The Lean Lab in few words (3/5) Key Messages (4/5) Tools (5/5)

Background at Exalab
March 2008 : Presentation of Workflow audit principle at the lab (equipped with SIRScan, API, BTA class, manual cytology) June 2008 : 1st Workflow audit done

1/5

recommendations provided

End 2008 : sales & installation for: PREVI Isola + VITEK 2XL + BTA BC and TB, + PREVI Color Gram + 2 x UF 1000i March 2010 : Installation in a new building with increased activity (200 % more) November 2010 : another workflow audit to confirm improvements, plus KAIZEN approach in the new building
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Main automated solutions installed before

1/5

Background
BacTAlert Classic SirScan micro+ Mini API

Main automated solutions installed

1/5

BacTAlert 3D BC & MB VITEK 2 XL 2 UF 1000 i SirScan micro+ PREVI Isola PREVI Color Gram

Customers expectations to follow a Lean Lab Assessment

1/5

Building a new Lab (Microbiology lab = 177 m2) Integration of PREVI Isola in this new platform Purchasing of various automated solutions
2 UF1000i 1 PREVI Color Gram 1 PREVI Isola 1 VITEK 2XL 1 BTA for Mycobacteria 1 ScanBact
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Five main objectives

1/5

Integrate new automated solutions (UF 1000i, PREVI as mentioned previously) New organization of the of the workflow process for Microbiology
Architecture with Day0 & Day1 Smooth workflow without rework & bottlenecks (no turn back processes)

Dedicated room for management of MB (P3) Running all the samples by having only 2 biologist working in this new lab Consolidate activities of many labs in Bordeaux area (22 labs) with an increased of 185% in terms of samples 11

Staff required to manage daily Microbiology activities

Before Lean Assessment
(March 2008)

2/5

After Lean Assessment

(November 2010)

Working hours:
Week: 7.30am 8.00 pm 4.7 FTE Saturday: 8am 1pm 1 FTE Sunday: 8.30am 12am 1 FTE

Working hours:
Week: 7am 8.00 pm 5.64 FTE Saturday: 7.30am 4pm 1 FTE Sunday: 7.30am 12am 1 FTE

Manage an Increasing Activity of 185% with only 20% more FTE

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Specimen Breakdown
Increase your activity by 185%:
More urine samples (+250%) More pus samples (+84%) More stools samples (+400%)
March 2008
485 samples/week
3,68% 5,36% 2,64% 3,60% 2,86% 4,33% 4,69% 5,42%

2/5

November 2010
3,61% 2,89% 2,53%

1385 samples/week

8,00% 53,85% 8,38% 66,79%

Urine Blood culture Strepto B FOC

Pus Genital Mycobacteria Stool

Urine Genital Parasitology

Pus Blood cukture

Stools MB culture

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Productivity analysis

2/5

Less technical tasks due to automation, Increasing other activities tasks : trainings Stable Administrative workload thanks to the scan of documents
(even with a +185% samples increase),

Equivalent amount of motions having triple the surface of the lab.

Split of Activities by type 18/03/08 - 20/03/08 (407 measurements) 50,00% 40,00% % activity 30,00% 20,00% 10,00% 0,00%
Synthse Technical AdministrativeOther activity 43,79% 20,84% 14,52% Motion 11,01% Movement 9,84%

Split of Activities by type 15/11/10 - 16/11/10 (207 measurements)

35,00% 30,00% 25,00% % activity 20,00% 15,00% 10,00% 5,00% 0,00%
Srie1 Technical 30,43% Other activity Administrative 27,05% 19,81% Motion 11,59% Movement 11,11%

Type of activity

Type of activity

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Productivity improvements
Increase your productivity by 116% for urine samples
Full automation of the process: UF 1000i, PREVI Isola, VITEK2) March 2008 52 samples a day Positive rate = 28% Batch size = 9 Batch a day = 6 Takt Time* = 13.23 min FTE = 0.53 November 2010 185 samples a day Positive rate = 30% Batch size = 37 Batch a day = 5 Takt Time* = 4.23 min FTE = 0.76

2/5

* Takt Time = pace of production needed to meet customer demand.

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Productivity improvements Increase your productivity by 138%

2/5

Successful Implementation = Staff involment + March 2008: new Targeted productivity: 4.62 patient/working hour technologies Real productivity: 2.77 patient/working hour November 2010: Targeted productivity: 6.86 patient/working hour Real productivity: 6.60 patient/working hour still some productivity gains to look after = 4% (real to targeted)

Estimated productivity savings with previous organization = 67% the lab reached 138% !!!
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Reduce costs by improving capacity / workload

Before - lead time issues due to unsuitable workload/capacity

2/5

After - implementation of recommendations: Smoother workload Quicker time to result Better productivity

Capacity (technicians ) Workload (D0 + D1) 17

Reduce costs by improving capacity/workload

FTE

2/5

March 2008
Mycobacteria processed 2 d/week
Differed access to specimen

November 2010
Adequacy Existing Workload Capacity Typical Day in Week Other tasks

Reading 24/48H & ID/ATB Streaking for other specimen

Streaking for urine MB & Parasitology

% Planned Workload % Planned Workload D0 Planned J0 Planifie % Workload % Charge Planifie%% ChargeWorkload D0 % Capacit % Planned Workload % Workload

Staff can leverage the period of time with less activities to prepare the work for next steps. Peak of activity at 8.00 & 11.00am
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Reduce costs by improving capacity/workload

2/5

Better organization of the weekly workload to be managed:

Adequation on Saturday is going to be optimized (technologist still on training)
Weekly Basis Adequation Workload Capacity
% Specimen Arrivals
20% Hours Installed 15% 10% 5% 0%
MON % Manpower Installed % Specimen Arrivals 17% 15% TUES 20% 17% WED 20% 19% THURI 20% 19% FRID 16% 19% SAT 4% 11% SUN 2% 0%

25%

25% 20% 15% 10% 5% 0% Specimen Arrival

Jours de la semaine % Hours installed % Specimen Arrival

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Turn Around Time Improvements

Improve your TAT by 21% for urine samples

2/5

March 2008: Average TAT of 39.27h/urine sample (28% of positive samples) November 2010: Average TAT of 31.12h/urine sample (>30% of positive samples)
March 2008
Turn Around Time Urines before Average = 39,27h / Positive rate = 28%
35 30 25 Frquences 20 15 10 5 0
-3 ,

November 2010

-5

51 60 ,1 69 ,2 78 ,3 87 ,4 96 ,5 10 5, 6 11 4, 7 12 3, 8 13 2, 9 14 2 15 1, 1 16 0, 2

6 5, 5

14 ,6 23 ,7 32 ,8 41 ,9

Classes

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Turn Around Time Improvements

Improve your TAT by 5% for genital samples
March 2008: Average TAT of 68.2h/genital sample (7% of positive samples) November 2010:

2/5

Average TAT of 65.48h/ genital sample (>30% of positive samples)

March 2008
Turn Around Time Genital before Average = 68.2h / Positive rate = 7%
20 18 16 14 12 10 8 6 4 2 0 -2 Frquences

November 2010

84 ,1 11 7, 9 15 1, 7 18 5, 5 21 9, 3 25 3, 1 28 6, 9
Classes

16 ,5

-1 7, 3

50 ,3

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Productivity Improvements for 2011

2/5

What about 2011 ?

Targeted workload: 1745 samples/week (1345 samples processed today) 2011: Targeted productivity: 6.96 patient/working hour (6.86 in Nov.10) Real productivity: to be measured Targeted FTE = 7.17 Real/Planned FTE: 7

Need to develop continuous improvement process to optimize the workload/capcity adequation in 2011
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To Be Continued

2/5

Kaizen approach by order of difficulty

Cytology day 0: from sample reception to UF 1000i Urine streaking day 0: from the UF 1000i to the incubator Safety Cabinet (swab): from sample reception to PREVI Isola ID/AST bench 24/48h reading: from the incubators to reading benches Pre-analytical

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The lean lab in few words

3/5

Avoid complex process (bacteriology analysis) to be complicated:

Simplify the flows, Visual management of the rules, Standardized procedures, Be polyvalent , Be focused on bacteriology expertise: Prioritize the analysis with high added value, Innovation based on technology. Look after any waste (tasks without added value)

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Key Messages

4/5

Increase activity by 185% Reduce cost by improving Capacity / Workload Improve productivity by 138% Improve the Turn Around Time by 21% for urines Prepare for 2011 challenges with a planned increase activity by 30%

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Customer testimonial
Exalab Laboratory (France)
5/5

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Tools

5/5

Christian Borjessons interview

New Website about FMLA Workflow Services

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Lean Lab Assessment: Case Study

Joseph Campos, Ph.D., Director, Microbiology Laboratory, Molecular Diagnostics Laboratory & 5/5 Laboratory Informatics, Childrens National Medical Center, Washington, D.C.

Analysis of Staffing and Specimen Volume

Positive Culture Turnaround Time

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A unique bioMrieux program in 5 steps for a global solution

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Summary

Workflow set accordingly with recommandations made during the lean lab assessment (March 2008) Arrival time of specimen at the lab have been reworked (less specimen to be managed at the end of the day) Perfect balance between day0 and day1 workload Coninuous workflow from sample reception to microbiologist validation Turn Around Time has been significantly shorten for urine samples thanks to the day0 / day1 automated process Still some room for improvements: 10% of samples from day0 are processed on day1
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Conclusion

With the FMLA Workflow Services bioMrieux can ensure our customers to get the most out for streamlining their lab workflow. FMLA Workflow Services will help to:
Reduce Costs Leverage Quality Enhance Productivity Improve Turn-around time Reduce Strain

bioMerieux can commit on improvements the lab will reach by following the recommandations.

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