Laura M. Bolt, PhD
Sherry Polhill, MBA, is associate vice president for hospital labs, respiratory care, and pulmonary function services at the University of Alabama Birmingham (UAB), UAB Medicine. Polhill has worked in high levels of hospital administration for more than 30 years. From 2003 to 2017, Polhill was the administrative director for hospital labs and respiratory care for UAB Medicine Health System, and from 1988 to 2003, Sherry was the division director of operations administrator for Children’s Hospital of Alabama.
Q: What was the initial motivation behind lab automation at UAB? How did the automation process happen?
A: UAB is a large academic medical center, so we wanted to make UAB a more progressive institution that offered increased lab efficiency and data quality. We realized automating a lab would be a long process. The idea for the lab was first mentioned in 2007, and serious discussion started in the years following. It took several years to implement the bar code system for lab samples, which was a necessary precursor to automation. The process took time, but we were very pleased with the results.
Q: Your automated lab at UAB has now been running for three years. How has the performance of the automated equipment compared to your expectations?
A: We knew that automation would ramp up the hospital lab’s processing capability, but it has exceeded expectations. Samples rapidly process with automation and without the human factor. Using bar codes largely minimizes human error, with the barcodes directing how samples are processed and then directed toward the instrumentation. The lab allows us to provide safe care for many more patients than we could have prior to automation.
Q: With automation, how does the lab’s processing schedule work? How much human input is necessary?
A: The lab now runs 24/7. The equipment was installed with a minimum of duplication devices in the areas of automation, so when analyzers are taken down for maintenance, samples continue to run seamlessly. However, automation still requires labor. For example, employees working during the morning shift perform the equipment maintenance, and lab technicians take samples out of the pneumatic tubes and load specimens in the pre-analytical trays. Medical technologists monitor the automated processes at the central command station and troubleshoot issues during the testing process. The automation system programs reference testing and other nonautomated testing to go to the outlet station for manual pickup when needed.
Q: How has the UAB hospital lab’s use of personnel changed since the automated lab started running?
A: We were able to repurpose eight staff members from automation to other business lines. Three other businesses were created in which labor from automation was added. The molecular diagnostics lab received labor. We added a mass spectrometry confirmation lab for drugs with application to pain management, with the intention to bring in new revenue. This new lab is not operable quite yet but will be in the near future. Laboratory medicine added a customer service department, with lab technicians and a medical lab technician lead available within the call center for 12 hours daily each weekday. This customer service department has received incredible reviews from physicians and clinicians within the health system. Everyone in the health system now receives care more efficiently as a result.
Q: What was the total cost of automating your lab? How will UAB recoup the costs associated with installing automation?
A: The total cost of automation was $9.8–$10 million. The actual automation line and equipment cost approximately $7 million, while the renovations needed to provide the supporting infrastructure (e.g., new heating system, reinforced floors, new water system) cost another $2.8–$3 million. The biggest financial savings so far has been on the wages for the lab employees. Labor costs usually estimate around 65 percent of total operating costs. By creating other business opportunities, we were able to save on labor with the talented labor pool we had available. The total cost of automating the lab will take a long time to recoup, but you cannot put a price tag on the other benefits that automation provides. Automation causes increased efficiency and data quality, which in turn means a higher quality of care for many more patients. You cannot place a financial value when giving higher quality and safer results. In essence, we were able to create a high-reliability organization (or an HRO) after implementing the automation project.
Q: Do you have plans to increase automation levels for this clinical laboratory or to apply automation to any other processes at UAB?
A: We have already upgraded the sample loader. We noticed the sample loader was running at capacity after two years of automation. Looking ahead to the future, we wanted to upgrade the loader to be able to receive an additional 40–45 percent capacity for future work. We also want to implement automation in the microbiology department. The proposed system will plate microorganism samples more efficiently and will increase safety for personnel. Right now, all medical technologists have to identify microorganisms by placing plates containing infectious agents in close proximity to their faces. With automation, technologists will be able to process plates with an additional barrier between themselves and the infectious agents. This will minimize hands-on lab work with pathogens and make the work environment safer. The growth time for the microorganisms with automation is also more rapid than the traditional methods of batching the current work volume, meaning that work will also be more efficient.
Q: Have there been any unanticipated benefits to installing automation at UAB?
A: One benefit I did not think about prior to automation was the close relationships we would establish among the different key stakeholders from the automation project. All of us worked on and shared strategic values over a long period of time to make automation happen. Our experiences together led to rewarding continuing relationships throughout various hospital departments. Another benefit from automation was the HRO we created. Through automation, the customer service department, and giving clinicians rapid, accurate, and value-added information, we successfully created and sustained an HRO.
Q: What advice would you give to other facilities that are considering implementing an automated hospital lab?
A: My advice would be to consult with someone who has been through the automation process before you begin. Do not try to do things on your own; consult someone experienced. You need to benefit from the strategic thinking, guidance, and insights gained by those who have already navigated automation effectively. Ask your vendor for a list of at least five customers who implemented automation, including those sites where the process went well and those where it went poorly. You can learn from the users from both experiences. Also, be realistic about your expectations for how long the automation process will take. Automation does not happen overnight but will be worth it in terms of adding quality.