title: Applying the Principles of Lean Production to Gastrointestinal Biopsy Handling: From the Factory Floor to the Anatomic Pathology Laboratory.
abstract: OBJECTIVE
  To implement Lean principles to accommodate expanding volumes of gastrointestinal biopsies and to improve laboratory processes overall.
  
  
  METHODS
  Our continuous improvement (kaizen) project analyzed the current state for gastrointestinal biopsy handling using value-stream mapping for specimens obtained at a 487-bed tertiary care pediatric hospital in Dallas, Texas. We identified non-value-added time within the workflow process, from receipt of the specimen in the histology laboratory to the delivery of slides and paperwork to the pathologist. To eliminate non-value-added steps, we implemented the changes depicted in a revised-state value-stream map.
  
  
  RESULTS
  Current-state value-stream mapping identified a total specimen processing time of 507 minutes, of which 358 minutes were non-value-added. This translated to a process cycle efficiency of 29%. Implementation of a revised-state value stream resulted in a total process time reduction to 238 minutes, of which 89 minutes were non-value-added, and an improved process cycle efficiency of 63%.
  
  
  CONCLUSIONS
  Lean production principles of continuous improvement and waste elimination can be successfully implemented within the clinical laboratory.
authors.affiliation: Department of Pathology, Children's Medical Center, Dallas, Texas University of Texas Southwestern Medical Center, Dallas, Texas Parkland Health and Hospital System, Dallas, Texas.
authors.forename: Jessica Z
authors.initials: JZ
authors.lastname: Sugianto
authors.affiliation: Department of Pathology, Children's Medical Center, Dallas, Texas.
authors.forename: Brian
authors.initials: B
authors.lastname: Stewart
authors.affiliation: Department of Pathology, Children's Medical Center, Dallas, Texas University of Texas Southwestern Medical Center, Dallas, Texas Parkland Health and Hospital System, Dallas, Texas.
authors.forename: Josephine M
authors.initials: JM
authors.lastname: Ambruzs
authors.affiliation: Department of Pathology, Children's Medical Center, Dallas, Texas University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Amanda
authors.initials: A
authors.lastname: Arista
authors.affiliation: Department of Pathology, Children's Medical Center, Dallas, Texas University of Texas Southwestern Medical Center, Dallas, Texas Parkland Health and Hospital System, Dallas, Texas.
authors.forename: Jason Y
authors.initials: JY
authors.lastname: Park
authors.affiliation: Department of Pathology, Children's Medical Center, Dallas, Texas University of Texas Southwestern Medical Center, Dallas, Texas Parkland Health and Hospital System, Dallas, Texas.
authors.forename: Sandy
authors.initials: S
authors.lastname: Cope-Yokoyama
authors.affiliation: Department of Pathology, Children's Medical Center, Dallas, Texas University of Texas Southwestern Medical Center, Dallas, Texas Parkland Health and Hospital System, Dallas, Texas Hung.Luu@childrens.com.
authors.forename: Hung S
authors.initials: HS
authors.lastname: Luu
mesh_terms: D001706:Biopsy / Q000379:methods*; D002648:Child; D017598:Efficiency, Organizational; D005767:Gastrointestinal Diseases / Q000175:diagnosis*; D006776:Hospitals, Pediatric; D006801:Humans; D010338:Pathology, Clinical; D057188:Workflow
keywords: Lean principles; anatomic pathology workflow; gastrointestinal biopsy handling; histology laboratory; laboratory processes; process improvement