title: Lean six sigma methodologies improve clinical laboratory efficiency and reduce turnaround times.
abstract: BACKGROUND
  Organizing work flow is a major task of laboratory management. Recently, clinical laboratories have started to adopt methodologies such as Lean Six Sigma and some successful implementations have been reported. This study used Lean Six Sigma to simplify the laboratory work process and decrease the turnaround time by eliminating non-value-adding steps.
  
  
  METHODS
  The five-stage Six Sigma system known as define, measure, analyze, improve, and control (DMAIC) is used to identify and solve problems. The laboratory turnaround time for individual tests, total delay time in the sample reception area, and percentage of steps involving risks of medical errors and biological hazards in the overall process are measured.
  
  
  RESULTS
  The pre-analytical process in the reception area was improved by eliminating 3 h and 22.5 min of non-value-adding work. Turnaround time also improved for stat samples from 68 to 59 min after applying Lean. Steps prone to medical errors and posing potential biological hazards to receptionists were reduced from 30% to 3%.
  
  
  CONCLUSIONS
  Successful implementation of Lean Six Sigma significantly improved all of the selected performance metrics. This quality-improvement methodology has the potential to significantly improve clinical laboratories.
authors.affiliation: Department of Medical Biochemistry, Medical Faculty, Çukurova University, Adana, Turkey.
authors.forename: Tamer C
authors.initials: TC
authors.lastname: Inal
authors.affiliation: Department of Medical Biochemistry, Medical Faculty, Çukurova University, Adana, Turkey.
authors.forename: Ozlem
authors.identifier: http://orcid.org/0000-0001-9325-5296
authors.initials: O
authors.lastname: Goruroglu Ozturk
authors.affiliation: Department of Medical Microbiology, Medical Faculty, Çukurova University, Adana, Turkey.
authors.forename: Filiz
authors.initials: F
authors.lastname: Kibar
authors.affiliation: Hospital Central Laboratory, Medical Faculty, Çukurova University, Adana, Turkey.
authors.forename: Salih
authors.initials: S
authors.lastname: Cetiner
authors.affiliation: Medical Biochemistry Laboratory, Adana Numune Teaching Hospital, Adana, Turkey.
authors.forename: Selcuk
authors.initials: S
authors.lastname: Matyar
authors.affiliation: Hospital Central Laboratory, Medical Faculty, Çukurova University, Adana, Turkey.
authors.forename: Gulcin
authors.initials: G
authors.lastname: Daglioglu
authors.affiliation: Department of Medical Microbiology, Medical Faculty, Çukurova University, Adana, Turkey.
authors.forename: Akgun
authors.initials: A
authors.lastname: Yaman
mesh_terms: D064790:Clinical Laboratory Services / Q000458:organization & administration / Q000592:standards / Q000706:statistics & numerical data; D003951:Diagnostic Errors / Q000517:prevention & control; D006801:Humans; D058996:Quality Improvement; D013997:Time Factors; D017749:Total Quality Management; D057188:Workflow
keywords: medical error; pre-analytical; process flow; quality improvement; quality management; workflow