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For one laboratory, a workflow transformation

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Anne Paxton

June 2018—“Form follows function” is a famous design principle, coined by an architect. But in the health care system and elsewhere, perfect matches between form and function are scarce.

To address the reality of things not working optimally, or just to remain viable, laboratories routinely tweak, upgrade, reboot, and replace. But a sweeping remake, spanning three years and using Lean facility design principles, is beyond the ordinary. That is what the Michigan Medicine Department of Pathology has done.

One of the collaborative spaces within the faculty suite for informal meetings and discussions as well as faculty review of clinical cases.

One of the collaborative spaces within the faculty suite for informal meetings and discussions as well as faculty review of clinical cases. [Photo: Dustin Johnston]

“This is one of the biggest and most extensively designed projects that has ever happened here. Our Lean facility design processes will be very informative for our colleagues as we move forward with other building construction plans as the health system expands,” says Charles Parkos, MD, PhD, chair of pathology at the University of Michigan Medical School. The department, which runs 6 million tests a year, is leading the way in what will be a major expansion of the Michigan Medicine health system.

Known as the Pathology Relocation and Renovation (PRR) project, the initiative aims to create ideal workflows for specimens, people, and materials within the Department of Pathology.

In phase one of the transition, with the physical moves having begun in May and slated to wrap up in August, the PRR project is bringing together molecular, anatomic pathology/histology, microbiology, and other labs (cytology, hematopathology, consult accessioning, special chemistry, and immunology) in five contiguous buildings of the University of Michigan’s North Campus Research Complex. Pathology is to occupy 146,000 new square feet at the research complex site, four and a half miles from the existing University Hospital laboratories in Ann Arbor.

A collaborative area for faculty.

A collaborative area for faculty. [Photo: Dwight Cendrowski]

With the 47,000 square feet of lab space vacated in University Hospital, phase two of PRR will create a fully automated core lab and renovate and expand other critical laboratory and support spaces, including the blood bank, apheresis service, and stem cell processing.

PRR project manager Christine Baker, who brings an engineering background to her job, developed an interest in Lean facility design while working on other large facility projects. “Over the years, I’ve been working on progressively more intricate facility projects using Lean design,” she says of her work at the University of Michigan. When the opportunity arose, she jumped at the chance to work on the redesign of the Michigan Medicine Department of Pathology.

Dr. Charles Parkos, chair of pathology. “Too many times,” he says, “buildings are not designed by the people doing the work.”

Dr. Charles Parkos, chair of pathology.
“Too many times,” he says, “buildings are not designed by the people doing the work.” [Photo: Dwight Cendrowski]

With Lean facility design, she explains, “you work directly with frontline employees as well as management. You engage specific groups to review their current process flow, discover opportunities to improve upon it, and, through significant simulation exercises, design the space around their ideal process flow. You also design the facility with flexibility to change over time.”

New home of the Michigan Medicine Department of Pathology, part of the University of Michigan’s North Campus Research Complex. [Photo: Dwight Cendrowski]

New home of the Michigan Medicine Department of Pathology, part of the University of Michigan’s North Campus Research Complex. [Photo: Dwight Cendrowski]

“Too many times,” Dr. Parkos points out, “buildings are not designed by the people doing the work. The result might be aesthetically pleasing, but may not be optimal for people in the trenches. Involving the personnel actually doing the work is critical in the design process.”

Since 2013, Michigan Medicine has seen demand for laboratory tests increase nearly eight percent per year, so rising volume is one force driving the PRR project. But, as Jeffrey Myers, MD, now Department of Pathology vice chair for clinical affairs and quality, and director of anatomic pathology during much of the design process, describes it on the department’s website, the project adopts a value-based rather than a volume-based approach to improving the patient experience in the health care ecosystem.

An artistic representation of molecular structures developed by the Department of Pathology to be not only decorative but also a subtle reference to clinical and research science within the department.

An artistic representation of molecular structures developed by the Department of Pathology to be not only decorative but also a subtle reference to clinical and research science within the department. [Photo: Dwight Cendrowski]

Both phases of the project are a response directed at reducing the fragmentation of pathology as it has grown at Michigan Medicine. In some cases, Baker says, “Labs have taken over closets, storage rooms, off-site space—whatever is available at different facilities. We’ve been landlocked and unable to grow and develop the testing we need.”
Among the key management goals of the PRR project is eliminating “silos.”

“When subspecialties within and outside pathology are too isolated,” Dr. Myers says, “small subcultures develop. This often results in division between subspecialties or between the clinical enterprise and the research community.”

To avert these divisions, Baker’s team set out to do an exhaustive Lean value-stream map. Traditional design processes are typically architect driven. Architects, working with good intentions, may not necessarily study processes with sufficient input from users before the design of a floor plan and review by management. “The difference here,” Baker says, “is we engage with users first and foremost, asking, ‘What’s your ideal process flow?’ Not ‘How would you like your space designed?’”

Christine Baker at the specimen delivery entrance to the building. In Lean facility design, she says, space is designed around the ideal process flow.

Christine Baker at the specimen delivery entrance to the building. In Lean facility design, she says, space is designed around the ideal process flow. [Photo: Dwight Cendrowski]

Use of 3D virtual “caves” to visualize different laboratory layouts was a great way to review the design, she notes. “The teams can ‘see’ their space and understand the spatial adjacencies and alignment between functions. However, a limitation of using caves is you can’t simulate a process as a team. It is one step of many in the iterative design process.” Distinctly non-virtual methods are needed as well. “You build full-sized cardboard and plywood mockups of layouts and rearrange them to optimize the processes through the space design.”

In the new layout, Baker says, the faculty will be much less separated by clinical discipline. “Standardized offices are clustered around common collaborative spaces arranged in multiple ‘neighborhoods’ that will be populated with an eye toward diversity.” The principles behind the construction of nonlaboratory space were piloted in a hospital “innovation suite,” Dr. Myers explains, “in which offices served as a temporary haven rather than impenetrable residences.” He adds, “It is a place not to habitually retreat to, but a place where faculty can perform tasks for which solitude is necessary, linked to ‘shared’ rather than ‘owned’ space.”

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