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The “Secret” of Lean Histology™

Lean – everybody has heard of it and we would all like to have the claimed productivity benefits, but does it work for real-world ­histopathology? Johnathon Deniz, Automation Product Manager at Leica Microsystems, takes Lean out of the text books and into the histology laboratory to show that Lean Histology™ does offer great potential to laboratories, pathologists and patients.

Jonathan Deniz, Automation Product Manager at Leica Microsystems

Mr. Deniz, lean has a long history in manufacturing, but can it be applied to histology?

Lean started in vehicle manufacturing, but the philosophy and the techniques are exactly the same for any process. It’s just that instead of applying it to a shop floor you are applying it to a histology lab.

We have shown that Lean methodology can definitely be applied to histology laboratories so they can achieve all the Lean benefits like less waste, better productivity and reduced turnaround times. One of the best things I’ve seen about Lean is its ability to bring departments together because it is the one tool that has everybody in a department on the same page and they actually see how they affect each other and contribute to the overall throughput or turnover. It’s a really good tool for bringing everybody – from lab technicians through to pathologists – together to see how they can improve.

Value Stream Mapping (VSM) is an important part of Lean. Can you explain how VSM works?

Value Stream Mapping is all about eradicating waste. So it’s about identifying the opportunities to improve. The way to apply it to histology is to look at a specific sample which is a biopsy or a piece of tissue and actually walk that through the process so you get a snapshot of how the laboratory works. For example, you can see if the laboratory over-produces barcode labels or if samples are left waiting for someone to collect them or put them through a machine or if there’s a long delay waiting for a massive batch before they get processed.

So VSM is about capturing all these processes with timestamps and lead times in the form of a map that is called a Value Stream Map. Then you can graph all your data and see where your main road blocks are, and most of those are usually around waiting time; waiting for a machine to finish processing or waiting for a staff member to be available or waiting for a pathologist for a diagnosis.

Can you provide an example of how your team helped laboratories with Value Stream Mapping?

We conducted a VSM workshop at a histology lab at Addenbrooke’s, one of the largest NHS teaching hospitals operating in the UK. We started by meeting the Acting Histopathology Manager, Ian Sturdgess, about a month beforehand, to answer some specific questions like how many staff they have, what their average working day is, whether they work to a roster, how many machines they have, how many slides they generate per day on average – all the general sorts of questions.

On the actual two to three days of the workshop we had an introduction where we explained the concept to the team for about half an hour. Following this, using ‘post-it’ notes the team mapped out the workflow for a typical day and then we said to them: “Now go away and do your thing like a normal day”. The next day was spent literally watching their workflow. There were five of us from Leica Microsystems who joined the three to four teams depending on the processes that we were watching. At the end of each day we got back together to produce a Value Stream Map that we presented to the hospital the very next day.

What did the customers expect from the VSM process?

Ian Sturdgess and his team had some understanding of Lean concepts. For us, it was very important to explain to them that Value Stream Mapping identifies the waste, it doesn’t get rid of the waste itself. In one to two days you can suggest improvements but then it’s up to their team to sustain the momentum and keep the process driving forward.

From the customer side, who participated in VSM and how did they find the process?

Ian Sturdgess was obviously involved. There were two main laboratory Team Leaders, Maggie Luff and Debbie Morgan, and Lisa Happerfield, the Immuno Section Team Leader who was also involved as immuno staining was part of the process we covered. Most of the Team Leaders in the main Histology laboratory were involved in some way so all in all there were ten participants.

The feedback was very positive. All were surprised that when they looked at the overall process lead time – which is basically from start to end taking into account all the waiting times, operator activity and machine processing times – that it was roughly around the time that they had estimated it took. A big plus is that with the VSM they finally have data to present at their service improvement meetings, they can say: “this is a current issue, how can we go forward?”

You didn't get in the way of the laboratory's normal work?

Addenbrooke’s is like a finely tuned racehorse and they don’t have time to slow down, so they actually appreciated having external people coming in to look at their process. A credit to the two leaders – they are naturally busy but they still attended every report-out session and then stayed back to finish around 7:30/8:00 pm every night to keep the daily workload rolling on. They also appreciated that we were going back to our hotels at 5:00 pm to produce the data for the presentations for the next day. So the feedback was definitely positive.

What's the next step for the lab of Addenbrooke's?

One of the biggest things I’m looking forward to is presenting what we have done to the pathologists who are keen to get involved. One point Ian -Sturdgess wanted to portray, which I really agree with, is that you can improve your pathology laboratory as far as possible but if a sample just sits at a pathologist’s desk you haven’t really improved your overall turnaround time for the patient. I’ve also noticed that the people in the laboratory equip each other with a positive mindset, saying “how are you doing this, where can we improve?”, so I’m sure the momentum at this laboratory will definitely continue, and what we’ve started with them is a process of continuous improvement that they are now driving.

Are there many areas in particular where you see the laboratory could further improve?

With LIS (Lab Information System) the laboratory could easily save up to an hour per day in the immuno section because they enter a lot of slides every day. Also, a classic Lean technique is to create work cells and some real improvement could be achieved by organising different sections in this way, so floor plans were proposed to help with some critical areas. To drive this, I have planned for key staff at Addenbrooke’s to attend labs that have already embraced Lean.

How do you see Lean and VSM contributing to histology labs in the future?

In my opinion, it’s something that could yield a lot of improvement in existing laboratories just because it’s a completely different way of thinking. ­Addenbrooke’s are a classic example. They actually halved their batch sizes and split into two teams to do all the operations. Although this doesn’t change the overall workload, far more importantly it allows for patient samples to flow through the process faster.

Most importantly, by using Lean and VSM, we can quantitatively show the areas of improvement and that is really, really impressive. We could, for example, mention a certain technique or a certain piece of equipment, and we could actually show percentage gains and losses. Laboratories, particularly managers, understand quantitative improvement quite well and I think VSM is the first step to going there. Customers are smarter than accepting “if you get this, your laboratory will be better”, I’m starting to find that is not good enough any more. Everyone is looking for more sophisticated solutions. Lean and VSM are part of that solution and while it’s a challenge for laboratories, and it’s a challenge for us, it’s definitely an exciting one.