title: Dissemination of Lean methods to improve Pap testing quality and patient safety.
abstract: OBJECTIVE
  To determine if the implementation of Lean methods resulted in improved Pap test quality and diagnostic accuracy in 5 clinician practices.
  
  
  METHODS
  We performed a 1-year case-control study that included 5,384 control (preintervention) and 5,442 case (postintervention) women who had a Pap test procured by 1 of 5 clinicians. Using Lean methods, the clinicians increased their focus of Pap test procurement by creating a "one-by-one" workflow and recorded process completion using a Lean checklist. We compared the case and control Pap test quality and accuracy measures using the proportion of Pap tests lacking a transformation zone component, proportion of unsatisfactory Pap tests, frequency of newly detected cervical intraepithelial neoplasia following a previous benign Pap test, and proportion of Pap tests with a diagnosis of atypical squamous cells of unknown significance.
  
  
  RESULTS
  After the intervention, there was a statistically significant decrease in the mean proportion of Pap tests lacking a transformation zone component, p =.011. Two of 5 clinicians showed a statistically significant decrease in their unsatisfactory Pap test frequency, although the overall Pap test unsatisfactory frequency for the case group was not statistically significant lower, p =.087. The case group showed a 114% increase in newly detected cervical intraepithelial neoplasia following a previous benign Pap test, p =.004. There was no statistically significant difference for the proportion of Pap tests with a diagnosis of atypical squamous cells of unknown significance, p =.908.
  
  
  CONCLUSIONS
  Disseminating Lean methods across a group of clinicians resulted in improved Pap test quality and diagnostic accuracy.
authors: Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. raabss@upmc.edu
authors: Stephen S
authors: SS
authors: Raab
authors: Carey
authors: C
authors: Andrew-Jaja
authors: Dana M
authors: DM
authors: Grzybicki
authors: Colleen M
authors: CM
authors: Vrbin
authors: Carole M
authors: CM
authors: Chesin
authors: John M
authors: JM
authors: Fisch
authors: David J
authors: DJ
authors: Dabbs
authors: Deborah L
authors: DL
authors: Sommer
authors: Sandra M
authors: SM
authors: Blaser
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000175:diagnosis*; D002983:Clinical Competence; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D017749:Total Quality Management; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*; D014626:Vaginal Smears