Evaluation of Hospital Laboratory Workflow Design in Ethiopia: Blood Specimen Collection and Chemistry Laboratory Testing

Background: Laboratories have recognized their internal business and operate as a set of business processes or workflows. Modern Laboratories are highly suitable to this workflow driven approach. Evaluation of current workflow and re-design processes are necessary and requirements of customers to increase customer needs and efficiency in daily laboratory operation. In Ethiopia there is no baseline information on hospital laboratory workflows sited on literature. Objective: To evaluate existed workflow in clinical hospital laboratory and proposed new workflow in Addis Ababa, Ethiopia. Method: A cross-sectional study design was used. Quantitative method and direct observation were conducted. Standardized checklist and questionnaire was used to assess the workflow of existed automated chemistry laboratory testing and OPD specimen collection workflow. To assessed these the study drawn a map of the sample`s journey using a tool called value stream mapping; spaghetti diagram and record detail of workflow. A new workflow simulation model is proposed based on adoption of Vacutainer blood collection device and its associated tubes instead of syringe needle. Results: The average time of samples waiting at reception after collection and prior to delivery to respective laboratories were decline as more samples collected within short time interval. The average cycle times of 489 blood sample drawing processes were 3.58 minutes and 76.5% (374) of blood samples were drawn with an average cycle time of 1.0 to 5.0 minutes. A total of 1231.31 minutes were identified as non-value added (waste) time from existed workflow of chemistry laboratory testing process and seven non-valued added process steps were recognized. Clinical chemistry laboratory process cycle efficiency was 56.6%. New simulation workflow is redesign by considering Vacutainer blood collection device and their associated tubes are being used rather than syringe needle. Accordingly simulated specimen collection workflow were reduced to 19 steps from existed workflow of 28 steps, 18 major steps were proposed for new chemistry laboratory testing workflow from 26 steps; and the movement of operator could be reduced significantly into six steps as compared 17 steps of movement where 12 operator`s movements were considered as wastes. Conclusion: Laboratories should identified non-value added process, steps or activities and by eliminating those wastes and implementing a powerful business improvement tools like lean method possible to maximized and redesign process to meet customer needs. Laboratories should assess their workflow periodically to identify wasteful practices and focused only value-added activity to increase the process cycle efficiency and productivity.