Over the past decade, innovations in IT and automation have significantly changed hospital operations. This holds true for hospital laboratories as well, where many routine processes can be automated, allowing for the delivery of high-quality results, improved efficiency and reduced costs for laboratories and hospitals.
The need for innovative and efficient lab practices is pressing, particularly now as healthcare organizations and governments worldwide are working to combat the COVID-19 pandemic. There is an urgent need for rapid and scalable testing to help address the current pandemic as well as public health crises in the future.
But improving microbiology lab efficiency by successfully implementing new IT and automation solutions can be a challenge, straining current workflows as well as the hospital's bottom line. Selecting a partner that can provide expertise and support throughout the process — from the time of purchase through implementation and beyond — is key.
The case for lab automation
A lack of qualified personnel is one of the biggest issues facing microbiology labs today.1 "The number of new graduates do not match the number of open positions, and this, coupled with an aging workforce that is close to retirement, has resulted in a staff shortage crisis,"1 said Dr. Katja Lehmann, global manager, solution discovery and workflow optimization at Becton, Dickinson and Company (BD), a global medical technology company.
"In addition, laboratories are facing reductions in Medicare reimbursement — the most significant in decades,"2 Dr. Lehmann said. At the same time, labs are dealing with an increase in the demand for testing as the general population ages.
This is where automation can make an impact.
"Automation solutions can help laboratories improve efficiency and accommodate increased demand for testing without increasing staffing,"3,4 said Bryan Crawford, U.S. finance director for BD Integrated Diagnostic Solutions.
"You may get a faster time-to-result through automation," he said. (An automated solution) can streamline the testing process, reduce processing errors, and improve staff efficiency so more tests can be processed compared to non-automated labs. As a result, automation combined with workflow optimization may improve the turn-around time for the information microbiologists need for analysis.3,4
And getting that faster result enables the lab to communicate test results to clinicians sooner.
Why lean is necessary for optimal implementation of automation solutions
Lab automation technology, such as BD Kiestra™ Solutions, can help microbiology labs enhance productivity while maximizing financial efficiencies.3,4 BD's lab automation offering provides an array of solutions that can automate a number of processes for microbiology labs, including inoculation, incubation, plate imaging and result reporting. "But incorporating automated solutions into a lab brings with it other considerations, including a potential redesign of the lab space, a revision of lab processes to accommodate automation and a reevaluation of staff schedules and skill sets," said Dr. Lehmann.
"[Hospitals] want the laboratory of the future that's optimized, that's working seamlessly," she said.
There are three aspects that are necessary to achieve an optimized laboratory: people, process and automation.
Adopting a lean mindset and principles can help hospitals make the shifts necessary to successfully deploy lab automation solutions. This involves creating a culture of continuous improvement that is leadership-driven and engages all employees.
"It really takes dedication to successfully implement a continuous improvement culture," Dr. Lehmann said. "But that is what is really needed. Because, without that cultural shift, you might have pockets of success that you create, but you might not have a successful organization overall."
"Labs looking to adopt lean principles must also have a robust process in place to measure success," Dr. Lehmann said.
BD's team of healthcare consultants work with hospital labs to implement BD Kiestra Solutions. The consultants first assess key performance metrics prior to implementation of the automation system to establish a baseline. Then, after the go-live, these metrics can be used to routinely track the improvement in laboratory operations and make adjustments to staffing or specimen processing protocols as needed.
The consultants begin building a relationship with the hospital labs before the sale of Kiestra Solutions is completed. This allows consultant teams led by Dr. Lehmann to better understand the lab's needs and the challenges. "They work with the labs until the new automation solutions are integrated into the workflow and newly implemented processes have become routine," she said.
The consultants also offer resources to manage the changes necessary for successfully deploying the automated solutions. BD's change management kit guides lab leadership as they coach their teams through the transition. Dr. Lehmann also emphasized the value of peer-to-peer conversation and guidance. The BD team trains a group of key users in the lab who can then help their peers troubleshoot when needed.
"Successful change can only happen when every aspect of the change equation is in place," she said. "There has to be a compelling reason behind the change and a strong vision of what the change will look like. Our customers have both of those. The other two parts of the equation are a solid plan and a sustainable approach. And this is where BD comes in." As a result, labs that adopt the BD Kiestra Solution obtain significant improvements in efficiency — fewer staff are needed to process more specimens compared to efficiency levels prior to installation of the system.3,4
The financial perspective
Spending budgetary dollars investing in automated solutions is an important decision and hospital leaders need to make sure their organization sees a return on its investment.
Along with traditional return on investment (ROI) measurements, the one measurement that comes up most frequently for hospitals that purchase lab automation solutions is the payback period, which is the period of time it takes for the cost of purchasing and implementing a solution to line up with the generated savings. "The BD team works with customers to give them a timeline for the payback period," Mr. Crawford said.
"It's important for hospitals to look at all the costs and benefits of automation solutions, including reduction in staffing levels once the solution is in place as well as the solutions enabling smoother and more efficient lab consolidation within a health system without the need to hire new employees," Mr. Crawford said.
But it's also important for hospitals to look at soft costs. Clinical laboratories frequently have a shortage of technical workers due to retirements and a lack of new technologists entering the field.1 Automation solutions can help laboratories manage staffing constraints by freeing up skilled technologists to focus on more complex tasks.
Additionally, automation solutions can help hospitals ensure their microbiology staff have a good work-life balance. Automation solutions can enable lab staff to focus on the most important information needed to analyze results as they become available, relieving them of the long hours they may otherwise have to put in batch reviewing testing results.4
Partnering with hospitals on purchasing options
The decision to incorporate automation solutions into a lab should not be made lightly. It is important that hospitals look for a partner that can work with them and within their budgetary constraints.
BD offers its customers a wide array of purchase options for BD Kiestra Solutions, from traditional capital purchase options to innovative models, such as a pay-per-plate model that was created due to a direct negotiation with a customer, said Mr. Crawford. The pay-per-plate model allows customers to pay based on the number of plates processed.
"In addition, BD offers risk sharing and managed service purchase options. For customers who opt for risk sharing, BD includes risk share language that includes performance-based metrics in the purchase deal," Mr. Crawford said.
The managed service option may include BD partnering with customers to provide associates who assist with operating the system. This option can also help labs navigate employee turnover, as the BD associates will be able to help train new recruits on the machines.
"[My finance team] and I work directly with the customer's finance team, or with their finance director or CFO, to understand what their needs and challenges are," Mr. Crawford said.
There are two parts of the equation for the successful purchase and implementation of lab automation solutions — finding the right solution for your needs and a company that will walk with you all the way.
References
1 Edna Garcia, MPH, Iman Kundu, MPH, Melissa Kelly, PhD, Ryan Soles, MS, The American Society for Clinical Pathology's 2018 Vacancy Survey of Medical Laboratories in the United States, American Journal of Clinical Pathology, Volume 152, Issue 2, August 2019, Pages 155–168.
2 Burns J. CMS issues PAMA final rule that aims to cut Medicare's clinical laboratory test price schedule sharply beginning in 2018. Dark Daily July 18, 2016.
3 Desjardins M, Sant N, Miron-Celis M, Gosal J, Jémus MF, JémusGonzalez E. Impact of reduced incubation times on culture and susceptibility testing of urine cultures incubated in the BD Kiestra ReadA Compact incubators. Diagn Microbiol Infect Dis. 2020;96(1):114899.
4 Thomson RB Jr, McElvania E. Total Laboratory Automation: What Is Gained, What Is Lost, and Who Can Afford It? Clin Lab Med.2019;39(3):371-389. doi:10.1016/j.cll.2019.05.002