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Effect of Lean method implementation in the histopathology section of an anatomical pathology laboratory
  1. S S Raab1,2,
  2. D M Grzybicki3,
  3. J L Condel1,2,
  4. W R Stewart1,
  5. B D Turcsanyi1,
  6. L K Mahood1,
  7. M J Becich3
  1. 1Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
  2. 2Center for Quality Improvement and Innovation, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
  3. 3Department of Biomedical Informatics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
  1. Stephen S Raab, Department of Pathology, University of Colorado Denver, 12605 East 16th Avenue, Anschutz Inpatient Pavilion, Room 3022, Aurora, CO 80045, USA; stephen.raab{at}


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

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

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

Results: In the Lean laboratory, the mean monthly productivity ratio increased from 3439 to 4074 work units/full time equivalents (p<0.001) as the mean daily histopathology section specimen turnaround time decreased from 9.7 to 9.0 h (p = 0.01). The Lean histopathology section had a higher productivity ratio compared with a sister histopathology section (1598 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: It is concluded that Lean process implementation improved efficiency and quality in the histopathology section.

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  • Funding: This study was supported by a grant from the Jewish Healthcare Foundation, Pittsburgh, Pennsylvania, USA, and grant HS13321-01 from the Agency for Healthcare Research and Quality, Rockville, Maryland, USA. The funding agencies had no role in the study design, data collection, data analysis, interpretation of data, writing of the manuscript, and the decision to submit the manuscript.

  • Competing interests: None.