Abstract
This is the second article in a three part series describing how Bristol Regional Medical Center Laboratory is addressing the challenge of managed care in today's complex environment, as well as preparing for the future. Part one (LAN 2; Vol. 3) described the program phase required for our new laboratory. In this article we will discuss many of the special features integrated in our laboratory's physical design, which improves operations as well as meeting operational requirements for the next century.
Following the program phase with Quorum, the laboratory planning team worked with HKS, an architectural firm from Dallas, on schematics for the new laboratory. The combined efforts of our staff, HKS, and Quorum resulted in a laboratory design focused on state of the art features with respect to employee accessibility, convenience, and safety while offering improved operational efficiencies and significant growth potential. These efforts produced a 20000K sq. ft ground floor laboratory with easy external access, convenient to the ED., Ambulatory Care, and patient rooms, but with limited public access.
The majority of the hospital specimens are received through the laboratory's two Translogic pneumatic stations, sent from any of the 26 house-wide stations. Each laboratory station is on a different circuit reducing potential down time. Laboratory couriers and home health staff have the convenience of parking within 100 feet of the main laboratory entrance for specimen distribution. A four-foot laminar flow hood for processing cultures and a three foot hood for allocating 24 hour urine's are adjacent to the reference laboratory (quest) processing area. Four centrifugation stations and a “cold bar” for storing processed specimens are additional features in the processing area.
The water system specifications were for two 12 port re-circulating water units with UV lights and 5 and 0.2 micron filters resulting in Type II water. The current output of the unit, to our delight meets Type I criteria. The re-circulating system appears to reduce the overall cost while improving water quality over the system in our old facility. The sink and instrument (floor level) drains are all acid/solvent resistant with most of the sinks having foot pedal controls and/or automatic sensors for hands-free operation. Two of the sinks are exceptionally deep (24″). All of the liquid waste from the laboratory empties into a thousand-gallon dilution tank.
The main laboratory and related testing area walls are painted with an Epoxy based paint allowing for simple cleaning and decontamination. After three and a half years the walls still appear to be freshly painted. The floors were covered with a seam welded Armstrong product that reduces contamination and simplifies cleaning. The 9″ ceiling height and eight-foot main isles amplify the open nature of the laboratory. A large central storeroom and three walk-in refrigerators make supply handling and distribution simple. The storeroom is equipped with shelving that is easily manipulated with one hand. Effective shelf space is doubled over conventional shelving.
The laboratory air handling units are separate from all other hospital units and are terminated on the roof. The units are set for a minimum of six air exchanges per hour that can be doubled if required. The morgue, AFB/MYCOLOGY, and Special Testing Labs all maintain negative pressure. In addition a 12″ and 36″ vent were placed in the ceiling for future expansion with atomic units.
The laboratory is wired for four types of power. Regular (white), emergency (red), dedicated lines for PC's (gray) and emergency dedicated (red/grey) for instruments' PC's. In compliance with building codes, all receptacles with six feet of a sink have ground fault protection. Eight 208 vac circuits are available with six connected to 50 amp UPS systems. Twenty 1300 va and four 1800 va portable UPS units are used for most other 120 vac instruments. These units removed the variable power issues experienced in past years.
One of the greatest strengths of the facility design rests in the Hughes/Fiber communication backbone. The laboratory communication closet, like the other 28 factory wide, is fed with twenty-four fiber optic cables. Only two of the twenty-four fiber strands are currently being used to connect the 120+ device to the Cerner Pathnet system, so expansion will be simple. The laboratory LIS wiring plant will allow expansion to 300 devices in the lab without pulling additional wire. There are 60 additional devices connected to the LIS throughout the facility (system).
The laboratory is also equipped with over 50 ring master intercom units that back-up the 100 hands-free phones located throughout the laboratory. The phone system, like the LIS devices can be expanded by 100 more units without additional lines.
Employee amenities include a large break room (16′ × 25′), with a fully equipped kitchen, outdoor picnic tables convenient to the break room and a locker room with 125 lockers, showers, handicap bathrooms, and other facilities. Classrooms and conference rooms within the laboratory suite provide comfortable space for meetings, education and training. Specially designed comfort mats were installed in the higher traffic areas to reduce fatigue.
Within six months of moving to the new facility and opening the laboratory, major staff-wide reductions were defined. Over the next twelve months the laboratory staffing was reduced from 84 full time staff to 59 full time. Salary expenses dropped by over $600,000 while other expense reductions worth $300,000 were also achieved. Many of these reductions were a result of TENN-CARE, a reorganized Medicare/Medicaid service program in Tennessee. This program added 700,000 new patients to the health system without increased funding. Admission and ordering patterns altered dramatically and overall turnaround times were grim. Ten job titles for technical and support positions were redefined, resulting in 5 newer (and lower) classifications. Management and supervisory positions were refocused and many of the job responsibilities became part of the general staff members job.
The changes were more reflective of general staff reductions rather than a true “re-engineering”. Immediate collaboration with other departments such as Respiratory Therapy, became critical and necessary for our survival as well as continued quality patient care. The laboratory design and work flow allowed for simple relocation of instruments to minimize employee efforts in working multiple work sites. All electrophoretic procedures, I.S. Ratio, Toxicology (except screening), and all RIA procedures (except Shillings) were discontinued and testing sent to reference laboratories. The following twelve months were somewhat of a blur to all of us.
In the fall of 1995 the laboratory management staff, in conjunction with the department of Human Resources, refined an employee survey used by Radiology. All laboratory employees completed the survey which focused on management style, work environment, team work, scheduling, trust, and most importantly communication. The employee survey summary revealed immense distrust with the remaining management staff reflecting poor communication across a range of areas. As a group we did not have the skills to deal with the major environmental changes and the survey results reflected this. Over the next two years we began a true re-engineering process that allowed many of the issues to be identified and addressed. The next article will describe the two year process improved employee job satisfaction, operations and involvement in decision making. These changes combined with the laboratory design, will allow almost any obstacle or challenge to be defined and addressed with great zeal and effectiveness.