The company’s biggest lab has so far striked a right balance between quality and quantity and is a result of smart, systematic and efficient work flows. But will it be able to sustain its efficiencies in the long run?
How do we evaluate the success of a particular diagnostic lab?
By the number of test samples processed at the lab? Or, by the turnover that the lab generates? Or by quality indicators (preanalytical, analytical, and post-analytical), accreditation? Reduced operation cost? Customer satisfaction or any other parameter?
Most experts say that majority of successful laboratories have two common traits; they are effective and efficient. Successful laboratories accomplish their tasks faster than others, by way of systematic management of sample processing, quality efficiencies, optimal utilisation of resources and ofcourse add immense value to the diagnostics business. Moreover, they strike a right balance between quality and quantity and this indeed, is a result of smart work, continued commitment, and good leadership. Thyrocare Laboratories’ diagnostic lab situated in Turbhe, Navi Mumbai is an apt example of the right amalgamation of smart work, high quality efficiencies and systematic workflows that ensures reduced turn-around-time, customer satisfaction, non-conformities and complaints as well as this laboratory contributes maximum to the overall business of the company. It is one of the biggest laboratory that the company has apart from its nine regional and rural market labs. And since Thyrocare works on a high volume business model focussing on centralised collection centre, this lab plays a crucial role in their business function. It is also said to be the first reference laboratory in India which barcoded samples at point of collection in 25,000 points.
As per Dr A Velumani, Ceo and Founder, Thyrocare Laboratories, the success of this lab and his business truly rests on the core values that his organisation and his team comprises. These values aimed at providing highest customer satisfaction, play a significant role in defining all clinical and non-clinical functions within the organisation and the lab.
The automation advantage
Being one of the first automated lab in the country, this laboratory has a 93 metre-long track (Aptio by Siemens Healthineers) for sample processing that processes around 65,000 samples in a day with 90 per cent of procedures and 99 per cent of automatable being automated. It includes pre-analytical, analytical, post analytical components which supports an IT-driven front end for franchisee operations, quality control, inventory controls, analyser controls and also total testing cycle or turn-around-time (TAT) controls. Moreover, even the vial opening, vial closing, dispatching to right department, to right technology, to right analyser and then validating the results till all results are released and archived – in a right location in right cold room, all is automated.
Thyrocare was one among the first labs to make a bi-directional interfacing, where the server and analyser are communicating both ways seamlessly. That ensures that the franchisee sitting in Madurai or Ludhiana can give instructions to the analysers for their patients needs and once the testing is done and results are released, printouts can be remotely taken. They have a huge IT department that remotely supports this system in order to monitor and enhance the process.
Thereupon, what are the key features of this system that enables around 65,000 blood samples processed in a day? How does the system ensure accuracy and robustness?
According to Dr Velumani, these 65,000 samples correspond to 3,50,000 investigations that are done using 15 different technologies and 100 plus auto-analysers that are needed by 3000 plus franchisees from various part of the countries, which is tested in 8 different locations. “A lot of IT controls are there which makes a sample to reach to the right location, to the right technology and to the right analyser. An investment of Rs 20 crore has been gone into devising the multi-layered control system which allows a man to think very little. An idiot proof system that is purely dictated only by barcodes – ensures that almost nil, data entry errors, pre-analytical errors, analytical and post analytical, results down loading, billing and credit systems,” he informs.
What about QC/QA?
Quality checks and more
Once you install an automated system in lab, one cannot be complacent. Even an automated system needs quality checks and so Thyrocare has come up with a SOP for the same on a daily basis. The lab processes maximum blood samples only in the night. During the day, the lab undergoes quality checks and maintenance in order to perpetuate efficiency in the process. The quality checks are done every four hours or at least thrice a day.
According to Thyrocare, the company religiously complies with the NABL and CAP norms. Dr Velumani invests around Rs 6 crores per annum in QC which is 1.5 per cent of their total turnover. Therefore to maintain accuracy and quality of output, they have a system in place. “Accuracy aspect is decided not by Total Laboratory Automation but by individual analyser automations, maintenance and calibrations. Enough measures are there to avoid, intra assay, inter assay, intra analyser, inter analyser consistencies, which are supported by internal quality controls and external QC participation,” he says.
Moreover, to maintain quality of the tests done at the lab, Dr Velumani informs that they have an unique barcoding system that ensures error free results. “We understood in 1996 itself after doing first 10,000 samples that 90 per cent of errors are due to — not using a right quality of tube (results in rejections), using glass tubes (results in breakage and loss of specimen) and also un-uniform size that makes transportation costly and cumbersome. So, before rolling out the first franchisee, which has all components, with barcodes grouped for that patient, that are required to do blood collection. Depending on packages asked the colour of tube, barcode, kit guides for an error free sample collection. We were the first reference laboratory in India (may be even today only laboratory) which barcoded the samples at point of collection in 25,000 points in this country,” he says proudly.
Apart from all of these, the lab also has an efficient waste management system that automatedly separates hazardous waste and the others, and also collects material which can be sent for recycling process to the Brihanmumbai Municipal Corporation (BMC). According to the lab staff, this system and process of waste management costs them less than a rupee making this system highly efficient, cost effective and advantageous to the extent that it helps them maintain their the social footprint as well.
Now, having SOPs for quality checks, automated barcoding and a good waste management system for error free results is certainly commendable, but what happens when automation fails?
Automation failure and crisis management
Automation failure can cause a derailment in the entire functioning of the lab services, damage customer service and experience and even impact the balance sheet. Thyrocare also deals with such crisis. Dr Velumani informed that they experience automation failure at least twice in a month. While initially, automation failure caused them a loss of around 25 per cent of revenue, they decided to bring in the old system where each clinical human resource has a specific task to follow. It is organised, efficient and well-executed to make up for the time that automation fails. Around 100 staff members are deployed in this process.
While, thyrocare has managed to create an idiot proof system, a diagnostic business model based on a centralised collection system can have some slip-ups and logistics issues. And since, this lab pulls the maximum weight of all the blood samples processed at Thyrocare, how does Dr Velumani manage to organise logistics in an efficient way?
“This is a puzzle piece for the entire industry. People think air cargo is very costly. Of course it is costly. A consignment of 10 kgs costs Rs 5000. We derive pleasure of volumes in logistics also. We made sure using such standardised vials, kits and components in such a way, that 5000 vials can travel in a cool pack that weighs 10 kgs for a cool Rs 2 per sample. We receive our consignment from 25 different major airports in this way. Rs 10,000 per destination is a Rs 8 crore annual budget which is 2 per cent of our total revenues. We also cover 200 kms around each airport where the specimen comes by road or train to the nearest airport,” Dr Velumani replies.
While Dr Velumani has managed to maintain and efficiently run his automated lab, it is important to note that this entire automated process demands for a huge investment. “The total automation on floor works out to be approximately Rs 100 crores of investments and 99 per cent of them are imported. Thus, it is a huge investment for a laboratory. Also an MNC charges 10 per cent of the hardware cost as maintenance and hence we incur an annual basis of around 7 or 8 crores of maintenance charges. Again as I said, automation does not give revenues. It is not expected to justify its cost. Without that one cannot just run anything more than 25,000 tests a day. It is a necessity to a large extent but it is also a luxury for the brand to have it on its floor. I am happy that I have one-of-its-kind in India, on my floor and will continue to invest more on them,” Dr Velumani expounds on the logic behind the investment in automation.
In future, Thyrocare plans to expand its TB unit at this lab. The company will also be investing in pre-natal analyses as it sees huge market opportunities. While Dr Velumani informed that he does not have plans to invest in another automated lab elsewhere in India at present, he will continue to invest in maintaining and adding value to this Mumbai lab. The only concern could be the overload on this central lab. It currently undertakes more than 50 per cent of the overall blood samples processed by Thyrocare. Will this lab continue to successfully endure the volume of work it undertakes? And will it sustain its efficiencies in the long run?