Putting Lean principles to work in the anatomic pathology lab

Jan. 1, 2012

“The automobile industry is credited with introducing Lean Process Management to U. S. manufacturing years ago, after which many companies applied Lean Principles to their manufacturing processes. Over the past decades, it has become more commonly recognized that these manufacturing concepts can be applied to other industries beyond the assembly line, including healthcare. Within the past few years, several articles have been published by laboratorians explaining how their labs have utilized these principles to streamline their work flow and reduce waste and probabilities for error, all of which favorably contribute to the bottom line and a more satisfactory customer experience. The intent of this article is to comment on how laboratorians might augment the process, perhaps with support from their vendors.

Basic definition

A basic definition of the Lean Process was coined by Taiichi Ohno, the father of Toyota Production System, the model for the Lean Process:

“Look at the timeline from the moment the customer gives us an order to the point when we collect the cash and reduce that timeline by removing the non-value-added steps.”

Putting Lean Principles into practice is a continuing process requiring commitment from the grassroots of the organization to senior management. Some facilities hire consultants or individuals who have been trained in Lean Principles to guide them through the process, realizing a payback within a relatively short time frame. These individuals generally come equipped with the knowledge and tools to manage the process from the onset and champion the process through the years. We all can imagine the value of adopting the Lean Principles methodology, but one might fairly ask, “Short of hiring a consultant, where do we begin with limited resources?”

Where do I begin?

Many laboratorians who have a high-level understanding of the benefits of implementing Lean Principles are nevertheless challenged by the lack of tools, time, and funding. While I am a proponent of a properly funded and formal approach to Lean, I am also a realist: Most of us will not gain approval to hire consultants. As a result, we are left to develop a process on our own in a way that will not significantly increase our budget or headcount.

Perhaps a place to begin is to invoke the 80/20 rule. It suggests that, of our total laboratory activity, changing only 20 percent of what we do will be influential in obtaining 80 percent of our desired outcomes. The key to this is to identify the correct 20 percent of the activity you need to focus on to eliminate waste and enhance the value to your lab and your clients.

Five steps to a leaner process

  1. Identify the activities that create value.
  2. Prioritize and focus on those activities that will have the most impact in adding value to your lab.
  3. Eliminate activities that do not add value.
  4. Automate the value-added process in a way that provides your lab and your clients a more favorable experience.
  5. Continue to improve the process. (Start all over again.)

A critical early step in the Lean Process is developing a Process Map. Mapping a process helps you to understand how your lab currently works and to identify and set priorities as to how it could work better. Documenting this process and sharing in this activity with others in the lab will help you to:

  • obtain a more accurate reflection of what is actually occurring (as opposed to what you may think is occurring);
  • share the information with others in the lab, and gain their buy-in to address duplicate effort and inefficient or unnecessary activity;
  • establish a baseline from which goals can be set and improvement monitored over time.

See if your vendors can help

Some vendors you deal with MAY be able to help you navigate your way to a Leaner, more value-added Process. Check with them. As an example, NovoPath offers an integrated software module for labs to practice Lean Process Improvement principles in day-to-day operations. By tracking activities and determining metrics that are essential for patient safety, quality control, staffing, and overall lab efficiency, labs can pinpoint areas of improvement. Moreover, labs can monitor the impact of the work flow enhancements they implement to reach their operational goals. With NovoPath’s “Lean Process Improvement Module,” you will be able to start a Process improvement project without negatively impacting staff productivity.

Final thoughts

    • Your vendors may be able to help…give them a chance.

Reach out to all individuals in all functional areas of the lab (management, order entry, accessioning, grossing, histology, resulting, report delivery, and specimen archiving) to establish a TEAM approach to process improvement.

  • Build a very thorough communications network involving all parties.
  • Don’t force your AP LIS to accommodate a poor work flow. Rather, make sure your AP LIS is flexible enough to help improve and change your work flow.


Rick Callahan, Vice President of Sales and Marketing at New Jersey-based NovoPath, Inc., has 15 years’ experience in medical IT solutions, particularly regarding pathology and radiology.