title: Improving Papanicolaou test quality and reducing medical errors by using Toyota production system methods.
abstract: OBJECTIVE
  The objective of the study was to determine whether the Toyota production system process improves Papanicolaou test quality and patient safety.
  
  
  METHODS
  An 8-month nonconcurrent cohort study that included 464 case and 639 control women who had a Papanicolaou test was performed. Office workflow was redesigned using Toyota production system methods by introducing a 1-by-1 continuous flow process. We measured the frequency of Papanicolaou tests without a transformation zone component, follow-up and Bethesda System diagnostic frequency of atypical squamous cells of undetermined significance, and diagnostic error frequency.
  
  
  RESULTS
  After the intervention, the percentage of Papanicolaou tests lacking a transformation zone component decreased from 9.9% to 4.7% (P = .001). The percentage of Papanicolaou tests with a diagnosis of atypical squamous cells of undetermined significance decreased from 7.8% to 3.9% (P = .007). The frequency of error per correlating cytologic-histologic specimen pair decreased from 9.52% to 7.84%.
  
  
  CONCLUSIONS
  The introduction of the Toyota production system process resulted in improved Papanicolaou test quality.
authors.affiliation: Department of Pathology, School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA 15232, USA. raabss@upmc.edu
authors.forename: Stephen S
authors.initials: SS
authors.lastname: Raab
authors.forename: Carey
authors.initials: C
authors.lastname: Andrew-Jaja
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Condel
authors.forename: David J
authors.initials: DJ
authors.lastname: Dabbs
mesh_terms: D016022:Case-Control Studies; D015331:Cohort Studies; D003951:Diagnostic Errors / Q000517:prevention & control* / Q000706:statistics & numerical data; D017598:Efficiency, Organizational; D005260:Female; D006801:Humans; D065006:Papanicolaou Test; D017064:Process Assessment, Health Care; D011785:Quality Assurance, Health Care; D013997:Time Factors; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*; D014626:Vaginal Smears / Q000592:standards*