Effect of lean method implementation in the histopathology section of an anatomic pathology laboratory

Abstract

Background: In the United States, the lack of processes standardization in histopathology laboratories leads to less than optimal quality, errors, inefficiency, and increased costs. The effectiveness of large scale quality improvement initiatives rarely has been evaluated.

Aim: To measure the effect of implementation of a Lean quality improvement process on the efficiency and quality of a histopathology laboratory section.

Methods: We performed a non-concurrent interventional cohort study from January 1, 2003 to December 31, 2006 and implemented the Lean process on January 1, 2004. We also compared the productivity of the Lean histopathology section to a sister histopathology section that did not implement Lean processes. We measured pre- and post-Lean specimen turn-around time and productivity ratios (work units/full time equivalents). For 200 Lean interventions, we used a 5-part Likert scale to assess the impact on error, success, and complexity.

Results: In the Lean laboratory, the mean monthly productivity ratio increased from 3,439 and 4,074 work units/full time equivalents (P < 0.001) as the mean daily histopathology section specimen turn-around time decreased from 9.7 to 9.0 hours (P = 0.01). The Lean histopathology section had a higher productivity ratio compared to a sister histopathology section (1,598 work units/full time equivalents, P < 0.001) that did not implement Lean processes. The mean impact, success, and complexity of interventions were 2.4, 2.7, and 2.5, respectively. The mean number of specific error causes affected by individual interventions was 2.6.

Conclusion: We conclude that Lean process implementation improved histopathology section efficiency and quality.