CEO SUMMARY: Every clinical lab today must deal with the twin challenges of performing an increased volume of tests while being paid less money. That’s why a handful of innovative lab organizations now use management information systems with analytics that provide detailed, real-time metrics on all aspects of their lab’s business and operations. Instead of reviewing reports weeks after the end of the month, managers in these labs have daily snapshots of their lab’s performance.
ONE REALITY OF TODAY’S HEALTHCARE MARKETPLACE is that clinical laboratories are being asked to perform increased volumes of tests at higher quality while being paid less money.
To meet this challenge, savvy lab managers know they must get better at using metrics to inform the host of operational decisions required to boost the productivity of lab analyzers and lab staff, while reducing overall costs throughout their labs.
But many labs are handicapped in meeting these goals for two reasons. First, the performance metrics they use are typically based on data from weeks or even months earlier. Few labs have performance data from the previous day or week and even fewer labs have real time performance data. Therefore, management of ongoing lab performance is hampered.
Second, external benchmarking is essential once a lab has addressed the basics of its operations and workflow. Benchmarking data from peer labs of similar size helps to identify specific opportunities for process improvement efforts.
This benchmarking data also shows how much additional improvement can be achieved. Another bonus from benchmarking is the ability to network with top performing peers to gain guidance in how to implement best practices.
Timely Access to Metrics
“Timely access to accurate performance metrics is the single biggest requirement for labs wanting to improve performance to best practice levels,” stated Thomas P. Joseph MBA, MT(ASCP), Founder, President, and CEO of Visiun Inc., of Ann Arbor, Michigan. “The irony is that, in the majority of clinical laboratories today, only ‘dated’ performance metrics are available to managers wanting to boost productivity and pursue best practices.
‘Let me explain what I mean by dated,” he said. “Anytime lab managers review data collected only once per month or even once per week, it’s like looking in the rearview mirror at their lab’s performance.
“Further, it is often the middle of the next month when lab managers get these reports,” Joseph explained. “Therefore, they are already at least four weeks behind—and maybe as much as six or more weeks behind—the actual events summarized in the metrics of these reports.
Analyzers Monitored Daily
“Let’s take the example of monitoring the quality performance of lab analyzers,” he said. “Most labs get instrument specific peer comparisons from the QC material vendors, but this information often comes back six weeks after data submission.
“In today’s budget-conscious environment, lab managers and health systems can no longer tolerate allowing a poor performing lab analyzer to continue to run for weeks because this has been shown to lead to unnecessary additional lab testing, other medical procedures, or even incorrect diagnoses,” noted Joseph. “Think of the difference the QA/QC function would have in your lab if managers were given detailed data each day about the performance of individual analyzers, using QC data or patient results.”
Joseph points out that this is just one valuable use for timely review of performance metrics. “Lab managers must look at key performance metrics every day, yet few labs have the information systems in place that can provide daily metrics,” he emphasized.
“Daily metrics must also provide sufficient detail so that managers know exactly when processes are working and when they are not,” he continued. “This information is critical to sustain Lean process improvement and the practice of daily management for those labs organized around this management tool.”
Timely Performance Metrics
This need for more timely performance metrics and operational data is why a growing number of clinical labs have purchased an analytics solution that gives them real-time data feeds. Such systems use management dashboards and other highly-customizable features to deliver detailed information about the lab’s performance in all types of activities, from preanalytical and analytical operations to quality and customer service.
“Once the laboratory implements such a performance management system, each day managers are able to assess the performance of every shift, even every work cell,” observed Joseph. “These systems can determine the required staffing for any laboratory process, by shift and by day of the week.”
“This level of detail about performance makes it possible for managers to identify potential problems on all shifts throughout the week,” he added. “It becomes much easier to spot bottlenecks in the lab. Even the best processes will fail and cause a backup of specimens if there is not sufficient processing capacity (staff or equipment) for the process.
“Similarly, these performance metrics are the basis of discussions to identify the root causes of systemic problems,” added Joseph. “Guided by accurate, detailed, and timely metrics, the lab team can quickly develop solutions and implement improvements.
“From experience with our client labs, most managers want to assess performance of all segments of the lab’s value stream,” he explained. “Not only does this include the lab’s internal processes, but also activities external to the lab.
“The best performance management programs collect these data principally from the laboratory information system and from the physician or hospital’s electronic health record system,” he stated. “Data from these sources allow us to provide metrics from any part of the work flow and at any point in time, such as from the lab test order in the ED to resulting by the lab.
“We have clients that run 600 or more reports on a set schedule so that they can review their performance on a daily, weekly, and monthly basis,” explained Joseph. “The daily reports go out to different teams in the lab so that they can see their own areas of performance each day. All of this happens automatically, initiated by a one-minute-a-day process.
“This is regular feedback that tells them if they are meeting their targets,” he stated. “If they don’t hit a target in a particular area, they can go to the detail of the report to see which process is not working and who is running that process. That’s powerful information to have every day.”
Surprisingly, Lean laboratories gain as much benefit from daily performance metrics as laboratories managed conventionally. “Once a Lean laboratory has a tool that produces daily performance data,” concluded Joseph, “it becomes easier to not only sustain the initial gains from the original Lean improvement projects, but this timely reporting of data makes it easier to achieve continuous improvement.”
Real-Time Metrics Guide Lab Managers to Achieve Best Practice Performance in Lab Operations
Each chart below shows the range of performance for clinical labs managed by conventional methods, by Lean, and by use of a daily performance metrics tool. The data was gathered and analyzed by Visiun, Inc., of Ann Arbor, Michigan. Note that, for each measure (median turnaround time for a basic metabolic panel [BMP] and troponin time from collection
to result), the Lean labs do better. The labs using Performance Insight to collect and report real-time performance data (Visiun Labs) out- perform the Lean labs and the non-Lean labs. One lesson in these charts for perceptive lab managers is how much potential for operational improvement exists when daily and real-time performance metrics tools are used.
Practical Lessons Learned in how Labs UseDaily Performance Metrics to Improve Operations
ONE FACTOR SEPARATES average performing labs from those with superior performance. That’s the observation of someone who helps numerous laboratory organizations with daily management and process improvement.
“When we assess the performance of labs—including traditional (non-Lean) labs and Lean labs—the top performers in both categories share one attribute,” declared Thomas P. Joseph MBA, MT(ASCP), President and CEO of Visiun Inc., located in Ann Arbor, Michigan. His company develops and sells Performance Insight, a system that provides detailed analytics performance data for clinical laboratories.
“This attribute is a commitment to performance monitoring, informed by detailed data reported in real time,” he said. “These labs are diligent about collecting data on performance and operations and reporting these metrics daily. This information is used to rapidly fix problems. It is also allows the process improvement team to identify opportunities to reduce costs and improve performance on an accelerated timeline.
“When lab leadership is engaged and when the staff operate as a team committed to performance improvement, then processes improve,” continued Joseph. “What reinforces this operational culture is the commitment to a daily review of performance data.
“It is as simple as having everyone review performance reports, talk about the results, and share best practices,” he stated. “Reports with the daily performance metrics reveal what is working and what is not working in each department, at each analyzer, and for each process.
“A few years ago, THE DARK REPORT asked us to contrast the operational performance of early adopters of Lean with conventional labs, using our database of lab performance metrics,” recalled Joseph. “We determined that Lean labs demonstrated dramatically improved performance over labs managed in the conventional manner.” (See TDR, January 21, 2008.)
“Recently we did a study of data from our lab clients practicing daily management and saw even greater performance improvements over Lean-only labs!” he continued. “I attribute this accomplishment to the fact that, although the early lab adopters of Lean had talented teachers, most of these labs had no tools that provided daily metrics. Thus, they depended on their legacy systems for weekly or monthly reporting. This finding confirms the importance and value of daily metrics in achieving top performance.”