title: Value stream mapping of the Pap test processing procedure: a lean approach to improve quality and efficiency.
abstract: We developed a value stream map (VSM) of the Papanicolaou test procedure to identify opportunities to reduce waste and errors, created a new VSM, and implemented a new process emphasizing Lean tools. Preimplementation data revealed the following: (1) processing time (PT) for 1,140 samples averaged 54 hours; (2) 27 accessioning errors were detected on review of 357 random requisitions (7.6%); (3) 5 of the 20,060 tests had labeling errors that had gone undetected in the processing stage. Four were detected later during specimen processing but 1 reached the reporting stage. Postimplementation data were as follows: (1) PT for 1,355 samples averaged 31 hours; (2) 17 accessioning errors were detected on review of 385 random requisitions (4.4%); and (3) no labeling errors were undetected. Our results demonstrate that implementation of Lean methods, such as first-in first-out processes and minimizing batch size by staff actively participating in the improvement process, allows for higher quality, greater patient safety, and improved efficiency.
authors.affiliation: Department of Pathology, Case Western Reserve University, 11100 Euclid Ave, Room 212B, Cleveland, OH 44106, USA. Claire.michael@case.edu
authors.forename: Claire W
authors.initials: CW
authors.lastname: Michael
authors.forename: Kalyani
authors.initials: K
authors.lastname: Naik
authors.forename: Michael
authors.initials: M
authors.lastname: McVicker
mesh_terms: D017598:Efficiency, Organizational; D005260:Female; D006801:Humans; D007755:Laboratories, Hospital / Q000458:organization & administration / Q000592:standards; D065006:Papanicolaou Test; D010338:Pathology, Clinical / Q000379:methods / Q000592:standards; D017064:Process Assessment, Health Care / Q000458:organization & administration*; D011785:Quality Assurance, Health Care; D058996:Quality Improvement / Q000458:organization & administration*; D013048:Specimen Handling / Q000592:standards*; D013647:Task Performance and Analysis; D014626:Vaginal Smears / Q000379:methods / Q000592:standards*