The effect of a Lean quality improvement implementation program on surgical pathology specimen accessioning and gross preparation error frequency.
Few reports have documented the effectiveness of Lean quality improvement in changing anatomic pathology patient safety. We used Lean methods of education; hoshin kanri goal setting and culture change; kaizen events; observation of work activities, hand-offs, and pathways; A3-problem solving, metric development, and measurement; and frontline work redesign in the accessioning and gross examination areas of an anatomic pathology laboratory. We compared the pre- and post-Lean implementation proportion of near-miss events and changes made in specific work processes. In the implementation phase, we documented 29 individual A3-root cause analyses. The pre- and postimplementation proportions of process- and operator-dependent near-miss events were 5.5 and 1.8 (P < .002) and 0.6 and 0.6, respectively. We conclude that through culture change and implementation of specific work process changes, Lean implementation may improve pathology patient safety.
Dept of Laboratory Medicine and Pathology, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ 85259, USA. smith.maxwell@mayo.edu
Maxwell L
ML
Smith
Trent
T
Wilkerson
Dana M
DM
Grzybicki
Stephen S
SS
Raab
D003951:Diagnostic Errors; D006801:Humans; D007755:Laboratories, Hospital / Q000592:standards*; D008499:Medical Records / Q000592:standards; D010340:Pathology, Surgical / Q000592:standards*; D015397:Program Evaluation; D058996:Quality Improvement; D013048:Specimen Handling / Q000592:standards*; D017749:Total Quality Management