A Rapid Improvemment Event Using Lean Concepts Can Substantially Improve Histology Laboratory Efficiency
Jennifer A Collins, Natasha Grandhi, Rekha Prasad, William S Twaddell, Paul N Staats. University of Maryland Medical Center, Baltimore, MD
Background: Pathologist workflow relies on the ability of a histology lab to produce quality slides in a timely manner. Common obstacles labs need to overcome include understaffing, machine down times, repeat processing, physical distance and facility space, and interruptions. The Lean process was initially designed for manufacturing to decrease non-value added effort and improve efficiency. More recently, the medical field and the pathology community in particular has taken an interest in these techniques. Our medium-sized pathology lab (∼15,000 surgical specimens per year) recently undertook a “rapid improvement event” (RIE) focused on improving the efficiency of producing routine slides in the histology lab.
Design: The RIE was a week-long rapid, focused effort to improve productivity. The team included pathologists, residents, histology staff, and “fresh eyes” from other areas of pathology, working in a collaborative manner to recognize problems, identify their root causes, and rapidly implement experiments aimed at improvement. The RIE involved extensive adjustments to the physical space and layout, with immediate on-site help from facilities and bioengineering staff. A six sigma approach to eliminating waste and removing extraneous items from the work space was implemented. Several measures of lab-wide productivity were collected before and after the RIE, with a focus on time of availability of finished slides.
Results: The RIE resulted in significant improvements in productivity, while also improving histology staff morale. There was a marked decrease in histology turn-around-time, from 64% of biopsy slides prepared by 11:30 AM to 100% by 10:00 AM; and from 76% of routine slides prepared by 5 pm to 100% by 5:00pm. The physical space utilized to produce histological slides for routine (hematoxylin and eosin staining), special stains and immunohistochemical stains decreased by 34% from 2208 ft2 to 1466 ft2.
Conclusions: A RIE using Lean concepts resulted in rapid and sustained improvement of slide preparation time due to optimization of work-flow, while improving staff morale and maintaining slide quality. The reduced time spent on non-essential activities by cutters and embedders appeared to be the most important element in increasing efficiency. A collaborative approach, with pathologists, managers, and histotechnologists is critical. The basic principles of “Lean thinking” are commonly utilized for commercial applications, but have clear implications for identifying waste and improving work efficiency within the context of a university hospital histology laboratory.
Category: Quality Assurance
Tuesday, March 5, 2013 9:30 AM
Poster Session III # 255, Tuesday Morning