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Process Improvement Methods in Histology Laboratories

Laboratories continue to feel pressure from growing volumes, resource constraints and shorter turnaround times, while also needing to maintain or improve quality. The goal of the laboratory is to improve patient care by delivering the highest quality slides to the pathologist in the shortest amount of time. By understanding and adopting Process Improvement principles, laboratories can now achieve more efficient workflows by eliminating steps, reducing waste, and producing higher quality slides more quickly than ever before.


LEAN was developed 1948-1975 by Taiichi Ohno at Toyota with the help of others and named the Toyota Production System. Taiichi Ohno was heavily influenced by earlier work by Edward Deming and Henry Ford. Well known Lean Initiatives in the Medical Community are the “Danaher Business System” and the “Henry Ford Health System” in Michigan

The Main focus of LEAN is to create more ”value” with less work (value as being perceived by the customer) by:

  •         Eliminating all non value added process steps (waste or muda)
  •         Harmonizing appropriately skilled people with with a robust process and adequate equipment
  •         Striving for continuous improvement as a mindset to achieve a cultural shift.

LEAN is a very practical approach and can be applied either to a 20,000ft processes level (e.g. a whole Value Stream) or to fix only a part of the entire process


LEAN improvement projects are called “kaizen events”. These are executed in one week events during which the current state of a process is observed and all non value added process steps are identified. Then the team brainstorms root causes on these “wastes” as well as improvement ideas which will be implemented the same week if possible. An action plan is drafted and a process owner identified to implement and sustain the process improvements.

Six Sigma

Six Sigma was invented 1986 by Bill Smith from Motorola and based on E. Demings Plan/Do/Check/Act Cycle. Honeywell and GE (Jack Welsh) are household names amongst other companies known for their success with Six Sigma.

Six Sigma is a very analytical approach and can be applied to high level strategic projects e.g. process improvement over multiple facilities or creating supply chain synergies.

The Main focus of Six Sigma is to:

  •         Improve the quality of process outputs
  •         Reduce Errors/Defects and variation within the process.

Any organization that implements Six Sigma will create an internal hierarchy of Six Sigma experts called “Yellow Belts”, “Green Belts”, “Black Belts” or “Master Belts”.

Similar to Martial arts, the Belt level and colour implicates the number of successfully completed projects.

All Six Sigma Projects follow the 5 phase process:

  •         Define
  •         Measure
  •         Analyze
  •         Improve
  •         Control.

The project has to pass tollgate stages after each of these phases which will traditionally last 1 month each.

One of the key drivers of each Six Sigma project is the return on investment of the project and therefore all results will be quantified and monetarized.

Lean Six Sigma

LEAN Six Sigma is not a trademark but was developed by the consultancy “Accenture”.

Combining the speed of Kaizen events and the data focus of Six Sigma, it uses the best of both initiatives and is the dominant process improvement methodology used in Health Care.

To successfully implement one of these methodologies, the laboratory will need an executive champion who is able to remove roadblocks along the way as well as a trained person within the laboratory to lead improvement initiatives and facilitate change management necessary to get the buy in of all employees.

Neither of these methodologies operate with a “magic wand” but will help to find problems and their root causes, brainstorm and implement improvements “one change at a time”.

Either way the efforts are well worth it as proven by multiple laboratories all around the globe.