Lab redesign project brings massive cost cuts, improves care quality

949-bed facility reports annual savings of $350,000 in lab department

St. Luke’s Episcopal Hospital in Houston has redesigned its lab to boost efficiency and service, projecting a savings of up to $500,000 while freeing caregivers to spend more time tending to patients and less time tracking down test results.

"We’re here to support the caregivers on the floor," says Linda Wesley, MA, MT, (ASCP), administrative director of pathology. "It makes their job easier to be patient-focused if we can give them what they need as efficiently as possible."

Two years into its initiative, the lab has improved service while slashing its annual budget by $350,000, a figure expected to reach $500,000 this year. The redesign has boosted staff productivity 14% per full-time-equivalent (FTE) from 1995 to 1997. All this improvement was made while the lab reduced its FTEs 32%, from 190 in 1993 to 129 this year.

The redesign team is garnering praise from staff as well as administrators at the 949-bed tertiary care hospital. Last year, the department won the hospital’s President’s Award for Team Excellence.

The lab launched its redesign on the heels of a similar undertaking in nursing. In 1995, the lab created its own self-directed work team called the Lab Enhancement Team. The team initially was composed of staff, but now includes managers.

There is an unchanging core of eight people on the team, but others come and go as projects change. The team and its task forces are made up of staff affected by the problem being tackled. They meet every other week for a one-hour brown-bag lunch.

Past task forces included customer service, non-value-added testing, work flow/staff scheduling, and morale.

Following are some of the major redesign initiatives St. Luke’s has undertaken in its lab:

A customer service position has been created.

Previously, clinicians would call the main lab number, and then they were transferred to the requested department. Now, one person trained in customer service skills can answer most questions by pulling up the appropriate information on the computer. This person answers questions about collections, add-on tests, and test results. The person also handles clerical tasks such as purchasing and ordering, filing, and word processing. The new position is one of the most successful changes in the department, Wesley claims. Techs have fewer phone interruptions, and those calling the lab experience fewer annoying call transfers (and mistransfers).

Staff were cross-trained.

Hematology, chemistry, and microbiology techs are cross-trained to perform each other’s jobs to balance the workload. Also, most lab techs are cross-trained in the duties of central processing to relieve that bottleneck during peak periods. The techs will check specimen labels, enter information into the computer, and send specimens on to be tested.

Cross-training boosts morale, unity

"Our techs might be waiting for samples to perform tests because central processing was overloaded with specimens," Wesley explains. "Now they work where they’re needed."

To jog the memories of the cross-trained staff, reference cards addressing common questions are placed throughout work areas.

Cross-training has not only resulted in greater efficiencies; it has also promoted staff unity.

"This has really broken down the walls," Wesley says. "It’s enhanced the morale and created a sense of camaraderie."

Processes have been streamlined.

The team reviewed numerous processes, questioning the necessity, or value, of each step. By eliminating steps and tests, the lab slashed materials costs and boosted staff productivity. For example, the review helped the microbiology unit cut its annual budget by $51,500, primarily in materials costs. The unit saved an estimated $12,000 to $15,000 simply by forgoing customized panels of antibiotics and using standard panels with the approval of the infectious disease service.

Throughout the lab, additional process changes have included:

— Autoverification, or reviewing tests by exception. Instead of reviewing every test performed on automated instruments, the staff now review only results that test outside the designated normal range. The equipment flags tests that are outside the range, and the rest of the test results are automatically reported. Wesley expects the new policy will result in a labor savings equal to half an FTE.

— Raising awareness about priority lab requests. The lab wanted to reduce the number of unwarranted STAT designations. Such mislabeling hampered the staff’s ability to prioritize tests. The staff met with nurse managers to explain how improper designations hurt all patients by slowing turnaround. The educational session has resulted in decreased use of the STAT designation, enabling the lab to meet its turnaround commitment approximately 90% of the time, up from approximately 80%.

Morale boosters.

Maintaining morale is a battle during any change, but it’s particularly difficult when staffing is being reduced. To combat the morale problem, the team initiated the following changes:

— Casual dress day. This began as monthly, went to weekly, and is so successful it now is under consideration for hospitalwide implementation. The success was hard-won, though.

Plan relies on enforcement, button slogans

This proposal required management to trust the staff’s ability to police themselves. To prove they could be trusted, the team submitted a detailed plan for enforcement, explaining that any staff member who arrives wearing dress deemed inappropriate would be given scrubs to wear. Also, to assure managers the dress would not affect work performance, the staff on casual day would wear buttons with a picture of a dress shirt and tie with an X through it, the words "Casual Day," and the slogan, "My dress may be casual, but my attitude is not." (For more on team building, see related story, p. 75.)

— Perfect attendance award. Employees who have no unexcused absences in a year receive a party honoring them. Management resisted this idea at first, arguing that employees are supposed to show up for work. But they eventually conceded to the team’s request.

"The staff were grateful employees showed up because when they don’t, whether they’re supposed to or not, it means double the work," explains Duke Rohe, a health care consultant with Holland & Davis in Houston, who worked with St. Luke’s. "They wanted to thank those employees who were dedicated."

— Monogrammed lab coats. Management had wrestled with the issue of disappearing lab coats. When the coats would be sent to the cleaners, often several never made it back. Others would get misplaced at work. Staff would arrive for a shift and be unable to find a coat. The team took on the issue and decided to turn ownership of the coats over to the staff. Each employee would be given his or her own monogrammed coat and would have responsibility for it.

"Little things like this have a huge impact on morale," Wesley explains. "If you come to work and can’t find your lab coat you get frustrated."

The teams are continuing to review processes and practices in their ongoing quest for efficiency.

"It’s never-ending," Wesley says. "Change just becomes a part of your life."

[Editor’s note: For more information about redesigning a hospital lab, contact Linda Wesley at St. Luke’s Episcopal Hospital, 6720 Bertner, Houston, TX 77030; telephone: (713) 794-6340, or Duke Rohe, Holland & Davis, 3355 West Alabama, Suite 1050, Houston, TX 77098; telephone: (713) 877-8130.]