Dec 20 2012

Anatomic Pathology’s lean learning path

For a patient anxiously awaiting lab results—the good news, or the bad—time is of the essence. Learning that their tissue specimen was lost would be horrible.

“We aim to put patients first. That’s why we focus on breakdowns in process,” says Jeffrey Myers, M.D., A. James French Professor, and director of the Divisions of Anatomic Pathology and MLabs. AP provides diagnostic and consultative services in the areas of surgical pathology, cytopathology, neuropathology, dermatopathology, and renal and autopsy pathology for U-M and outside health care organizations.

The last time the Division of Anatomic Pathology lost a specimen was 1 year, 25 days ago, and counting. It’s an amazing feat considering that AP processes about 85,000 pathology specimens a year—and that every single one of those specimens goes through 17 separate steps.

Dr. Jeffrey L. Myers, director, Anatomic Pathology and MLabs, and John Perrin, quality assurance coordinator, Department of Pathology, stand in front of the “No Time to Lose” clock outside the Anatomic Pathology and Histology labs in the main hospital. The clock is Myers’ brainchild, and Perrin has the key. Every day, the AP team works to prevent errors—and no one wants to restart the clock.

If you do the math, AP’s current risk of losing a specimen is 2.94 per million opportunities. Their performance surpasses the Six Sigma level, the quality standard of “near perfection.”

They credit their success to a lean journey that began when Myers took the helm in 2006. Myers came to U-M from Mayo Clinic, where he also led lean endeavors.

By 2007, Myers began introducing lean training, lean teams and onsite gemba walks throughout AP that have paid off big by reducing lost specimen errors for weeks, months, years at a time—and by reducing lead times for selected services by 50 percent.

AP’s average turnaround time went from 7 days in 2005 to about 3 days currently.

These improvements occurred while AP’s workload rose 25 percent—from approximately 68,000 specimens in FY2007 to about 85,000 in FY2012.

As a result of lean thinking, AP has:

  • Implemented an operating room (OR) runner to bring specimens to the lab, freeing up OR nurses to spend more time with the patient. For permanent specimens alone, average time of delivery fell from 1 hour, 19 minutes to 7 minutes—an 88 percent decrease.
  • Eliminated the opportunity for specimens to go missing by creating an action plan to limit distractions for lab staff, reorganizing the lab bench to work towards single piece flow, and standardizing workflow.
  • Developed a lost-specimen policy and orienting new residents, pathology assistants, histotechnologists, fellows and faculty.
  • Created an environment in which technicians are encouraged to “stop the line” and ask for help when they are having difficulty with a piece of tissue. Read the rest of this entry »