Chapter 10: Lean Manufacturing and Informatics in Transfusion Medicine
Files
Description
In this Chapter, Dr. Lichtiger talks about two significant changes instituted while he was Chair of Laboratory Medicine. He first talks about his participating in the selection of the Informatics System that enables Transfusion Medicine to handle all information about a unit of blood from the moment it is contributed by a donor, through all of the production and testing, to its final delivery to a patient. This system facilitated automation of the services, accelerating the handling of all blood products. Wireless connections also mean that some laboratory services can be made available on patient floors. Next he talks about how in 2004/’05 he spearheaded the move to redesign Transfusion Medicine around the principles of Lean Manufacturing, a series of principles for efficiency and quality derived from the Toyota auto manufacturers in Japan. He describes how every process in the lab was analyzed and most revamped. (For example, analysis revealed that technicians working among various stations walked over a 1 mile/day. Lab redesigns reduced that to 400 feet, saving time.) Each change was analyzed statistically to confirm that it would be a valid change. The result has been hundreds of thousands of dollars of savings. Dr. Lichtiger next talks about adopting strategies to reduce variation from the Sic Sigma program, very important in a laboratory that performs over one million tests per year. He talks about the situation that led him to undertake these redesign project and the $250,000 of support he received from the administration to complete it.
Identifier
LichtigerB_02_20120612_C10
Publication Date
6-12-2012
City
Houston, Texas
Interview Session
Benjamin Lichtiger, MD , Oral History Interview, June 12, 2012
Topics Covered
The University of Texas MD Anderson Cancer Center - Building the Institution The Administrator The Clinician Overview Building/Transforming the Institution Definitions, Explanations, Translations Institutional Processes Devices, Drugs, Procedures Professional Practice The Professional at Work
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.
Disciplines
History of Science, Technology, and Medicine | Oncology | Oral History
Transcript
Tacey Ann Rosolowski, PhD :
I wanted to shift gears a little bit and talk about some initiatives that you undertook when you were department chair. I’m not sure about this, when it actually took place. I read that you played a role in selecting and implementing the Informatics System in the department in the blood bank and also in Laboratory Medicine, and I wanted to know when that happened. And also, what is the Informatics System?
Benjamin Lichtiger, MD :
Well, it’s the information system in the blood bank so already from being exposed—initially the department developed an in-house information system, so we gained a lot of experience about what our needs were, and so I played a very important role in evaluating and selecting both a system for the laboratory and for the blood bank, and we traveled all over. We talked to users and—
Tacey Ann Rosolowski, PhD :
What were your needs? What were the needs that you had here?
Benjamin Lichtiger, MD :
Well, the needs were—for example, we wanted a system that could handle from the moment we contact the donor until we transfuse the unit of blood, going through processing, the production, testing, component preparation, cross-matching, everything to be all unified in a system and that would comply with the FDA requirements so that we minimize errors. Human beings do make errors for different reasons, so we had brought in a very good system at that point. Many countries had it, and we were very happy, and in the laboratory too. It allowed us to implement some automation and to really move the data from the laboratory to the floor to the patient’s area. That was instantaneous, and so we accelerated the whole process from collection to reporting, and in order to even make things further more efficient, I became involved with other people in the department in implementing a lean manufacturing initiative.
Tacey Ann Rosolowski, PhD :
I wanted to ask you about that.
Benjamin Lichtiger, MD :
In order to really apply the industrial approach to assembly line production, we really looked at our operations and we identified what in the lean manufacturing is called garbage, muda. The Japanese call it muda. People don’t want to use the word garbage. It’s unnecessary steps or unnecessary movements. For example, in one laboratory we put in a camera just to see how the technology personnel moved from station to station. We calculated they did about 1.6 miles a day walking, and we restructured in such a way—because we worked with experts. It was a team effort. I always brought the medical perspective, and we reduced it to almost 400 feet a day. We shortened the times. We had to revamp the things that we do. For example, in one area we bring in twelve patients every fifteen minutes to draw the blood in the outpatients. That was a couple of years ago. Now we bring in more, but twelve every fifteen minutes. After the sample is collected, it goes to another station where it’s sorted and then goes to another station where it’s spun in a centrifuge. But now the centrifuge has room only for eight samples, so four patients are waiting already.
Tacey Ann Rosolowski, PhD :
And that adds up.
Benjamin Lichtiger, MD :
It adds up. At the end of the day it’s like four hours. We need to buy new equipment and reduce the waste. The waste, that’s the waste. Change equipment, change the way we are doing things so we could absorb more volume, so instead of doing twelve every fifteen minutes now we can do twenty to twenty-five and open more stations and identify bottlenecks. And all of that turned out that we saved personnel. We saved the equipment. We could open the Mays Laboratory without buying a new single piece of equipment and without personnel. Now we have to expand, of course, but at that time we were able to really—and we really had the return investment in the first two years of $800,000. It was really very, very important, $750,000-$800,000.
Tacey Ann Rosolowski, PhD :
When was that lean manufacturing initiative—?
Benjamin Lichtiger, MD :
We started in 2004 or 2005 and now we have a whole department in our—a whole area in our division that is dedicated to—we have engineers now. They’re constantly looking at what we can—because we went from lean manufacturing to Six Sigma now to reduce the variation.
Tacey Ann Rosolowski, PhD :
What does that mean? Six—?
Benjamin Lichtiger, MD :
Six Sigma is the—that came from Motorola and GE that— Six Sigma is one non-conformity every ten million events, and we have about 3,000 non-conformity every en million events, so in order to reduce the variation in our processes you really have to implement mechanisms to make sure that there’s no reason for the variation. You have to remove the areas that really induce the creation of variations.
Tacey Ann Rosolowski, PhD :
Was this all controversial? Did people resist?
Benjamin Lichtiger, MD :
Yes.
Tacey Ann Rosolowski, PhD :
Why?
Benjamin Lichtiger, MD :
Well, the ones that resisted were the frontline personnel. “I did it for the last twenty years, and I always did a good job.” Yes, you did. We don’t disagree with that, and we thank you, but the system now requires that people be cross-trained. When you get sick, what do we do? Cross-train, then everybody has to know. Everybody has to step in for different procedures. One cannot have a fiefdom, and so we also changed the lay of the laboratory and removed the walls so everybody can—one team—so we could cut down on the number of supervisors, because one supervisor had vision management and moved people from one station to the other. The volume of this—I think that we’re doing ten million tests a year. You have to look at it from a point of view of an assembly line, a large assembly line where you really have to move, be able to move personnel from one area to the other. They all need to know what everybody else is doing. Yes, people left. Some people left. They couldn’t take it, and they went to work at other places, and lo and behold, the other places started with lean too, so I don’t know. I’m sorry they left, different people. I worked with them very closely.
Tacey Ann Rosolowski, PhD :
I was surprised when you told me that you undertook this initiative in 2004. I was thinking it might have taken place earlier because there was that time in the institution when there was a lot of examination of other processes.
Benjamin Lichtiger, MD :
No, but we undertook it at that time because frankly we went through some shakedown, and once it settled down we started to look at how do we—and there were publications. We were not the first one that’s showing that really there are a lot of savings and efficiencies going to lean manufacturing. And we also implemented lean manufacturing here too, removed many things. Why are we doing that? Nobody really knew. What’s the value? No value. Out. It’s not something dictatorial. It was everybody participated. We formed teams, bringing in people from different levels to really look because one needed the history too. Why are we doing it? Because many times new people come to work with us and I tell them, “Don’t think that we are stupid or idiots for doing something. Behind every procedure there is a story and a history on why we do it, so before you start criticizing, wait. Find out why. There might be a logic behind that, or it may seem stupid, but it is not.” But everybody that comes in is—I understand. No problem.
Tacey Ann Rosolowski, PhD :
Were there other departments that were taking up similar—?
Benjamin Lichtiger, MD :
Oh, yeah. Billing took it on, and the clinics started to take it on. They saw the advantage because we presented—because the institution invested money.
Tacey Ann Rosolowski, PhD :
Were you the first to do it? Benjamin Lichtiger, MD The first department in the institution, yeah, and then Billing started to do it and Patient Scheduling, different areas, and they got their own engineers. But everybody started to see, and the institution was pushing because they saw that there is an advantage. Tacey Ann Rosolowski, PhD Did you and others come up with the idea and then go to the administration?
Benjamin Lichtiger, MD :
No, no. We saw it from publications, from other places, and we called in consultants and said, “What can we do to improve our operation?”
Tacey Ann Rosolowski, PhD :
Well—I mean—did you go to the administration with a request for funds?
Benjamin Lichtiger, MD :
Yes, yeah, it finally became—I and other people—it became a team because our people from administration became part of our team. It was many people. It has many parents, this success.
Tacey Ann Rosolowski, PhD :
How much money was poured into that transformation?
Benjamin Lichtiger, MD :
I think they put in at that time close to $250,000-$300,000.
Tacey Ann Rosolowski, PhD :
It sounds really—like an exciting—
Benjamin Lichtiger, MD :
Yeah, it was very exciting. It was fascinating to see the changes, and then the graphs. And we hired an engineer, and he was able to locate and keep an eye on that. He was telling us if we were successful or not, because one starts to apply statistical evaluation. One looks at the cold numbers. Does it make sense or not? Are we doing the right thing or not? Where does it fall on the curve? One starts to look at the trends, doesn’t look at individual events. You have a nonconformity. Why? No, we’re looking at trends. If you have underemployed people and other people and other people, there is something wrong there. You have to zoom down on that and re-analyze it. Why is it happening? And many times the problem was in the procedure, and many times we built our own minefields. Let me answer this page. (audio pauses )
Recommended Citation
Lichtiger, Benjamin MD, PhD and Rosolowski, Tacey A. PhD, "Chapter 10: Lean Manufacturing and Informatics in Transfusion Medicine" (2012). Interview Chapters. 1465.
https://openworks.mdanderson.org/mchv_interviewchapters/1465
Conditions Governing Access
Open
