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Thakur V, Akerele OA, Randell E. Lean and Six Sigma as continuous quality improvement frameworks in the clinical diagnostic laboratory. Crit Rev Clin Lab Sci 2023; 60:63-81. [PMID: 35978530 DOI: 10.1080/10408363.2022.2106544] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Processes to enhance customer-related services in healthcare organizations are complex and it can be difficult to achieve efficient patient-focused services. Laboratories make an integral part of the healthcare service industry where healthcare providers deal with critical patient results. Errors in these processes may cost a human life, create a negative impact on an organization's reputation, cause revenue loss, and open doors for expensive lawsuits. To overcome these complexities, healthcare organizations must implement an approach that helps healthcare service providers to reduce waste, variation, and work imbalance in the service processes. Lean and Six Sigma are used as continuous process improvement frameworks in laboratory medicine. Six Sigma uses an approach that involves problem-solving, continuous improvement and quantitative statistical process control. Six Sigma is a technique based on the DMAIC process (Define, Measure, Analyze, Improve, and Control) to improve quality performance. Application of DMAIC in a healthcare organization provides guidance on how to handle quality that is directed toward patient satisfaction in a healthcare service industry. The Lean process is a technique for process management in which waste reduction is the primary purpose; this is accomplished by implementing waste mitigation practices and methodologies for quality improvement. Overall, this article outlines the frameworks for continuous quality and process improvement in healthcare organizations, with a focus on the impacts of Lean and Six Sigma on the performance and quality service delivery system in clinical laboratories. It also examines the role of utilization management and challenges that impact the implementation of Lean and Six Sigma in clinical laboratories.
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Affiliation(s)
- Vinita Thakur
- Department of Laboratory Medicine, Health Sciences Center, Eastern Health Authority, St. John's, Canada.,Faculty of Medicine, Memorial University of Newfoundland, St. John's, Canada
| | - Olatunji Anthony Akerele
- Department of Laboratory Medicine, Health Sciences Center, Eastern Health Authority, St. John's, Canada
| | - Edward Randell
- Department of Laboratory Medicine, Health Sciences Center, Eastern Health Authority, St. John's, Canada.,Faculty of Medicine, Memorial University of Newfoundland, St. John's, Canada
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2
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Letelier P, Guzmán N, Medina G, Calcumil L, Huencho P, Mora J, Quiñones F, Jara J, Reyno C, Farías JG, Herrera BL, Brebi P, Riquelme I, San MA. Workflow optimization in a clinical laboratory using Lean management principles in the pre-analytical phase. J Med Biochem 2021; 40:26-32. [PMID: 33584137 PMCID: PMC7857853 DOI: 10.5937/jomb0-26055] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 05/10/2020] [Indexed: 12/28/2022] Open
Abstract
Background The application of the Lean methodology in clinical laboratories can improve workflow and user satisfaction through the efficient delivery of analytical results. The purpose of this study was to optimise delivery times of the test results at a clinical laboratory, using Lean management principles in the pre-analytical phase. Methods A prospective study with a quasi-experimental design was implemented. Staff functions were restructured and sample flows were modified. Delivery times of clinical results (glucose and haematocrit; 6648 data) from the Medicine and Adult Emergency services for years 2017 and 2018 were compared. Results A reduction (p < 0.05) in turnaround times in the delivery of glucose test results at the adult emergency service was observed (84 to 73 min, 13%, pre and post). In addition, there was a non-significant reduction in the turnaround times for glucose (Medicine) and haematocrit in both services. In the analytical and post-analytical phase (not intervened), an increase in turnaround times was observed in some cases. Conclusions Other studies have indicated that the application of the Lean methodology in clinical laboratories improves workflow, increasing effectiveness and efficiency. This study showed an improvement in the delivery time of test results (glucose - Emergency), giving rise to a culture of cooperation and continuous improvement. It would, however, be essential to address the management model integrating the analytical and post-analytical phases.
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Affiliation(s)
- Pablo Letelier
- Universidad Católica de Temuco, Facultad de Ciencias de la Salud, Departamento de Procesos Diagnósticos y Evaluación, Precision Health Research Laboratory, Temuco, Chile
| | - Neftalí Guzmán
- Universidad Católica de Temuco, Facultad de Ciencias de la Salud, Departamento de Procesos Diagnósticos y Evaluación, Precision Health Research Laboratory, Temuco, Chile
| | - Gustavo Medina
- Universidad Católica de Temuco, Facultad de Ciencias de la Salud, Departamento de Procesos Diagnósticos y Evaluación, Precision Health Research Laboratory, Temuco, Chile
| | - Luis Calcumil
- Universidad Católica de Temuco, Facultad de Ciencias de la Salud, Departamento de Procesos Diagnósticos y Evaluación, Precision Health Research Laboratory, Temuco, Chile
| | - Pamela Huencho
- Universidad Católica de Temuco, Facultad de Ciencias de la Salud, Departamento de Procesos Diagnósticos y Evaluación, Precision Health Research Laboratory, Temuco, Chile
| | - Jonathan Mora
- Universidad Católica de Temuco, Facultad de Ciencias de la Salud, Departamento de Procesos Diagnósticos y Evaluación, Precision Health Research Laboratory, Temuco, Chile
| | - Francisco Quiñones
- Hospital Dr. Hernán Henríquez Aravena, Clinical Laboratory, Temuco, Chile
| | - Jorge Jara
- Hospital Dr. Hernán Henríquez Aravena, Clinical Laboratory, Temuco, Chile
| | - Cristóbal Reyno
- Universidad de La Frontera, Scientific and Technological Bio-resource Nucleus, Genomic Unit
| | - Jorge G Farías
- Universidad de La Frontera, Faculty of Engineering and Science, Department of Chemical Engineering, Temuco, Chile
| | - Belén Lisandra Herrera
- Universidad de La Frontera, Faculty of Engineering and Science, Department of Chemical Engineering, Temuco, Chile
| | - Priscilla Brebi
- Universidad de La Frontera, Scientific and Technological Bioresource Nucleus (BIOREN), Center for Excellence in Translational Medicine (CEMT), Laboratory of Integrative Biology (LIBi), Temuco, Chile
| | - Ismael Riquelme
- Universidad Autónoma de Chile, Facultad de Ciencias de la Salud, Instituto de Ciencias Biomédicas, Chile
| | - Martín Andrés San
- Hospital Dr. Hernán Henríquez Aravena, Clinical Laboratory, Temuco, Chile
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Rotter T, Plishka C, Lawal A, Harrison L, Sari N, Goodridge D, Flynn R, Chan J, Fiander M, Poksinska B, Willoughby K, Kinsman L. What Is Lean Management in Health Care? Development of an Operational Definition for a Cochrane Systematic Review. Eval Health Prof 2019; 42:366-390. [PMID: 29635950 PMCID: PMC6659584 DOI: 10.1177/0163278718756992] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Industrial improvement approaches such as Lean management are increasingly being adopted in health care. Synthesis is necessary to ensure these approaches are evidence based and requires operationalization of concepts to ensure all relevant studies are included. This article outlines the process utilized to develop an operational definition of Lean in health care. The literature search, screening, data extraction, and data synthesis processes followed the recommendations outlined by the Cochrane Collaboration. Development of the operational definition utilized the methods prescribed by Kinsman et al. and Wieland et al. This involved extracting characteristics of Lean, synthesizing similar components to establish an operational definition, applying this definition, and updating the definition to address shortcomings. We identified two defining characteristics of Lean health-care management: (1) Lean philosophy, consisting of Lean principles and continuous improvement, and (2) Lean activities, which include Lean assessment activities and Lean improvement activities. The resulting operational definition requires that an organization or subunit of an organization had integrated Lean philosophy into the organization's mandate, guidelines, or policies and utilized at least one Lean assessment activity or Lean improvement activity. This operational definition of Lean management in health care will act as an objective screening criterion for our systematic review. To our knowledge, this is the first evidence-based operational definition of Lean management in health care.
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Affiliation(s)
- Thomas Rotter
- Healthcare Quality Programs, School of Nursing, Queen's University,
Kingston, Canada
| | - Christopher Plishka
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon,
Canada
| | - Adegboyega Lawal
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon,
Canada
| | - Liz Harrison
- School of Rehabilitation Science, College of Medicine, University of
Saskatchewan, Saskatoon, Canada
| | - Nazmi Sari
- Department of Economics, University of Saskatchewan, Saskatoon, Canada
| | - Donna Goodridge
- College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Rachel Flynn
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - James Chan
- School of Health Sciences, University of Northern British Columbia,
Canada
| | - Michelle Fiander
- Assistant Research Professor, College of Pharmacy, Department of
Pharmacotherapy, University of Utah
| | - Bonnie Poksinska
- Department of Management and Engineering, Linköping University, Sweden
| | - Keith Willoughby
- Edwards School of Business, University of Saskatchewan, Saskatoon,
Canada
| | - Leigh Kinsman
- University of Tasmania and Tasmanian Health Service (North), Launceston,
Tasmania, Australia
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4
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Implementation of modern tools in autopsy practice-the way towards contemporary postmortal diagnostics. Virchows Arch 2018; 474:149-158. [PMID: 30426205 DOI: 10.1007/s00428-018-2482-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 10/11/2018] [Accepted: 11/01/2018] [Indexed: 10/27/2022]
Abstract
Medical, legal, and socioeconomic issues have contributed to the decline of autopsy rates. Pathology-related factors, however, with changing clinical duties on the one hand and decreasing interest and lack of substantial technical developments in this field on the other, may have contributed to this condition as well. We present our experience of a restructuring project that culminated in the introduction of a modernized postmortal diagnostic (PMD) unit: Workflows of PMD procedures and space organization were restructured according to LEAN management principles method. Classical autopsy suites were transformed into postmortal operating rooms. A PMD pathologist staff was designated to perform postmortal operative diagnostics (i.e., using laparotomy and thoracotomy approaches) with the intention of gradually replacing classical autopsy procedures. Postmortal minimal invasive diagnostics (PMID) using laparoscopy and thoracoscopy were successfully implemented with the expertise of clinical colleagues. Reorganization of workflow reduced turn-around times for PMD reports from a median of 33 days to 15 days. Short-term analysis revealed that this combined effort leads to a slight increase in the number of adult postmortal examinations 1 year after the introduction of this project. A change of culture in postmortal diagnostics may contribute to a better reputation of postmortal examinations from the perspective of clinicians, the general public, and affected relatives of the deceased. It may also serve to demonstrate that the pathology community is keen not only to preserve but also to further develop this valuable tool for medical quality control and education.
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Cromwell S, Chiasson DA, Cassidy D, Somers GR. Improving Autopsy Report Turnaround Times by Implementing Lean Management Principles. Pediatr Dev Pathol 2018; 21:41-47. [PMID: 28478740 DOI: 10.1177/1093526617707581] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The autopsy is an integral part of the service of a large academic pathology department. Timely reporting is central to providing good service and is beneficial for many stakeholders, including the families, the clinical team, the hospital, and the wider community. The current study aimed to improve hospital-consented autopsy reporting times (turnaround time, TAT) by using lean principles modified for a healthcare setting, with an aim of signing out 90% of autopsies in 90 days. An audit of current and historical TATs was performed, and a working group incorporating administrative, technical, and professional staff constructed a value stream map documenting the steps involved in constructing an autopsy report. Two areas of delay were noted: examination of the microscopy and time taken to sign-out the report after the weekly autopsy conference. Several measures were implemented to address these delays, including visual tracking using a whiteboard and individualized tracking sheets, weekly whiteboard huddles, and timelier scheduling of clinicopathologic conference rounds. All measures resulted in an improvement of TATs. In the 30 months prior to the institution of lean, 37% of autopsies (53/144) were signed out in 90 days, with a wide variation in reporting times. In the 30 months following the institution of lean, this improved to 74% (136/185) ( P < .0001, Fisher exact test), with a marked reduction in variability. Further, the time from autopsy to presentation at weekly clinicopathological rounds was also reduced (median: 73 days prior to lean; 63 days post-lean). The application of lean principles to autopsy sign-out workflow can significantly improve TATs and reduce variability, without changing staffing levels or significantly altering scheduling structure.
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Affiliation(s)
- Susan Cromwell
- 1 Division of Pathology, Department of Paediatric Laboratory Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
| | - David A Chiasson
- 1 Division of Pathology, Department of Paediatric Laboratory Medicine, Hospital for Sick Children, Toronto, Ontario, Canada.,2 Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Debra Cassidy
- 1 Division of Pathology, Department of Paediatric Laboratory Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Gino R Somers
- 1 Division of Pathology, Department of Paediatric Laboratory Medicine, Hospital for Sick Children, Toronto, Ontario, Canada.,2 Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
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Hewer E, Hammer C, Fricke-Vetsch D, Baumann C, Perren A, Schmitt AM. Implementation of a 'lean' cytopathology service: towards routine same-day reporting. J Clin Pathol 2017; 71:395-401. [PMID: 28974539 DOI: 10.1136/jclinpath-2017-204504] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Revised: 07/28/2017] [Accepted: 08/23/2017] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To systematically assess the effects of a Lean management intervention in an academic cytopathology service. METHODS We monitored outcomes including specimen turnaround times during stepwise implementation of a lean cytopathology workflow for gynaecological and non-gynaecological cytology. RESULTS The intervention resulted in a major reduction of turnaround times for both gynaecological (3rd quartile 4.1 vs 2.3 working days) and non-gynaecological cytology (3rd quartile 1.9 vs. 1.2 working days). Introduction of fully electronic reporting had additional effect over continuous staining of slides alone. The rate of non-gynaecological specimens reported the same day increased from 4.5% to 56.5% of specimens received before noon. CONCLUSIONS Lean management principles provide a useful framework for organization of a cytopathology workflow. Stepwise implementation beginning with a simplified gynaecological cytology workflow allowed involved staff to monitor the effects of individual changes and allowed for a smooth transition.
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Affiliation(s)
- Ekkehard Hewer
- Institute of Pathology, University of Bern, Bern, Switzerland
| | - Caroline Hammer
- Institute of Pathology, University of Bern, Bern, Switzerland
| | | | - Cinzia Baumann
- Institute of Pathology, University of Bern, Bern, Switzerland
| | - Aurel Perren
- Institute of Pathology, University of Bern, Bern, Switzerland
| | - Anja M Schmitt
- Institute of Pathology, University of Bern, Bern, Switzerland
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Roy S, LaFramboise WA, Nikiforov YE, Nikiforova MN, Routbort MJ, Pfeifer J, Nagarajan R, Carter AB, Pantanowitz L. Next-Generation Sequencing Informatics: Challenges and Strategies for Implementation in a Clinical Environment. Arch Pathol Lab Med 2016; 140:958-75. [PMID: 26901284 DOI: 10.5858/arpa.2015-0507-ra] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT -Next-generation sequencing (NGS) is revolutionizing the discipline of laboratory medicine, with a deep and direct impact on patient care. Although it empowers clinical laboratories with unprecedented genomic sequencing capability, NGS has brought along obvious and obtrusive informatics challenges. Bioinformatics and clinical informatics are separate disciplines with typically a small degree of overlap, but they have been brought together by the enthusiastic adoption of NGS in clinical laboratories. The result has been a collaborative environment for the development of novel informatics solutions. Sustaining NGS-based testing in a regulated clinical environment requires institutional support to build and maintain a practical, robust, scalable, secure, and cost-effective informatics infrastructure. OBJECTIVE -To discuss the novel NGS informatics challenges facing pathology laboratories today and offer solutions and future developments to address these obstacles. DATA SOURCES -The published literature pertaining to NGS informatics was reviewed. The coauthors, experts in the fields of molecular pathology, precision medicine, and pathology informatics, also contributed their experiences. CONCLUSIONS -The boundary between bioinformatics and clinical informatics has significantly blurred with the introduction of NGS into clinical molecular laboratories. Next-generation sequencing technology and the data derived from these tests, if managed well in the clinical laboratory, will redefine the practice of medicine. In order to sustain this progress, adoption of smart computing technology will be essential. Computational pathologists will be expected to play a major role in rendering diagnostic and theranostic services by leveraging "Big Data" and modern computing tools.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Liron Pantanowitz
- From the Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (Drs Roy, LaFramboise, Nikiforov, Nikiforova, and Pantanowitz); the Department of Pathology, MD Anderson Cancer Center, Houston, Texas (Dr Routbort); the Department of Pathology and Immunology, Washington University School of Medicine, St Louis, Missouri (Drs Pfeifer and Nagarajan); PierianDx, St Louis, Missouri (Dr Nagarajan); and the Department of Pathology and Laboratory Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia (Dr Carter)
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8
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Behling KC, Marrone D, Hunter K, Bierl C. Decreased Clinical Laboratory Turnaround Time After Implementation of a Collection Manager System. Arch Pathol Lab Med 2015; 139:1084-6. [DOI: 10.5858/arpa.2014-0529-le] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Kathryn C. Behling
- Department of Biomedical Sciences, Cooper Medical School of Rowan University, Camden, New Jersey
- Department of Pathology, Cooper University Hospital, Camden, New Jersey
| | - Dale Marrone
- Department of Pathology, Cooper University Hospital, Camden, New Jersey
| | - Krystal Hunter
- Biostatistics Group, Cooper University Hospital, Camden, New Jersey
| | - Charlene Bierl
- Department of Pathology, Cooper University Hospital, Camden, New Jersey
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Blick KE. Providing critical laboratory results on time, every time to help reduce emergency department length of stay: how our laboratory achieved a Six Sigma level of performance. Am J Clin Pathol 2013; 140:193-202. [PMID: 23897254 DOI: 10.1309/ajcpnutipqtrrg0d] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVES To develop a fully automated core laboratory, handling samples on a "first in, first out" real-time basis with Lean/Six Sigma management tools. METHODS Our primary goal was to provide services to critical care areas, eliminating turnaround time outlier percentage (TAT-OP) as a factor in patient length of stay (LOS). A secondary goal was to achieve a better laboratory return on investment. RESULTS In 2011, we reached our primary goal when we calculated the TAT-OP distribution and found we had achieved a Six Sigma level of performance, ensuring that our laboratory service can be essentially eliminated as a factor in emergency department patient LOS. We also measured return on investment, showing a productivity improvement of 35%, keeping pace with our increased testing volume. CONCLUSIONS As a result of our Lean process improvements and Six Sigma initiatives, in part through (1) strategic deployment of point-of-care testing and (2) core laboratory total automation with robotics, middleware, and expert system technology, physicians and nurses at the Oklahoma University Medical Center can more effectively deliver lifesaving health care using evidence-based protocols that depend heavily on "on time, every time" laboratory services.
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Affiliation(s)
- Kenneth E. Blick
- Department of Pathology, University of Oklahoma Health Services Center, Oklahoma City
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Machado Guimarães C, Crespo de Carvalho J. Strategic outsourcing: a lean tool of healthcare supply chain management. ACTA ACUST UNITED AC 2013. [DOI: 10.1108/so-11-2011-0035] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Serracino HS, Franklin WA, Aisner DL. Molecular Pathology of Non-Small Cell Lung Cancer. Surg Pathol Clin 2012; 5:903-18. [PMID: 26838508 DOI: 10.1016/j.path.2012.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This review offers an overview of the molecular pathology of lung cancer, with a focus on analyses that are most commonly part of the current clinical testing paradigm. Molecular testing of lung cancer has proved integral to the success of new targeted therapies, and their use is now commonplace in treatment selection. Traditional pathologic evaluation, however, plays a major role in these advances and serves an equally critical role to aid in determining optimal therapy.
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Affiliation(s)
- Hilary S Serracino
- Department of Pathology, University of Colorado Denver, 12631 E. 17th Avenue, Mail Stop B216, Aurora, CO 80045, USA
| | - Wilbur A Franklin
- Department of Pathology, University of Colorado Denver, 12631 E. 17th Avenue, Mail Stop B216, Aurora, CO 80045, USA
| | - Dara L Aisner
- Department of Pathology, University of Colorado Denver, 12631 E. 17th Avenue, Mail Stop B216, Aurora, CO 80045, USA.
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Wong R, Levi AW, Harigopal M, Schofield K, Chhieng DC. The Positive Impact of Simultaneous Implementation of the BD FocalPoint GS Imaging System and Lean Principles on the Operation of Gynecologic Cytology. Arch Pathol Lab Med 2012; 136:183-9. [DOI: 10.5858/arpa.2011-0139-oa] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context.—Our cytology laboratory, like many others, is under pressure to improve quality and provide test results faster while decreasing costs. We sought to address these issues by introducing new technology and lean principles.
Objective.—To determine the combined impact of the FocalPoint Guided Screener (GS) Imaging System (BD Diagnostics–TriPath, Burlington, North Carolina) and lean manufacturing principles on the turnaround time (TAT) and productivity of the gynecologic cytology operation.
Design.—We established a baseline measure of the TAT for Papanicolaou tests. We then compared that to the performance after implementing the FocalPoint GS Imaging System and lean principles. The latter included value-stream mapping, workflow modification, and a first in–first out policy.
Results.—The mean (SD) TAT for Papanicolaou tests before and after the implementation of FocalPoint GS Imaging System and lean principles was 4.38 (1.28) days and 3.20 (1.32) days, respectively. This represented a 27% improvement in the average TAT, which was statistically significant (P < .001). In addition, the productivity of staff improved 17%, as evidenced by the increase in slides screened from 8.85/h to 10.38/h. The false-negative fraction decreased from 1.4% to 0.9%, representing a 36% improvement.
Conclusions.—In our laboratory, the implementation of FocalPoint GS Imaging System in conjunction with lean principles resulted in a significant decrease in the average TAT for Papanicolaou tests and a substantial increase in the productivity of cytotechnologists while maintaining the diagnostic quality of gynecologic cytology.
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Abstract
Concepts for Lean Laboratory OrganizationIn the last decades, hospital laboratories are beset on all sides by demands to lower the costs of laboratory procedures and at the same time to provide (i) more rapid and usable services, (ii) a broader spectrum of parameters, and (iii) process a higher frequency of specimens. These demands are voiced by patients, physicians, hospital administrators, and governmental agencies. Thus, laboratory management is required to decrease costs, increase efficiency, and promote customer satisfaction under the consideration of quality to be of primary importance. Beside the main task of a laboratory (i.e. the analysing of patient specimens, interpretation of results, expert advice for clinicians), quality management, education of technicians and medical staff, research and development, and development of economic strategies are important duties and responsibilities. A lean laboratory organisation is an important condition to cope these duties. Lean laboratory concepts have to include the preanalytical, analytical and postanalytical period. Strategic planning decisions have to be based primarily on information derived from the external environment and have to be long-term. Lean laboratory concepts always have a holistic view, including medical demands and economic aspects. An example will be shown of how lean laboratory concepts influence the organisation, efficacy and performance of a hospital laboratory.
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