Workflow Optimization in a Clinical Laboratory using Lean management principles in the pre-analytical phase

Applying the Principles of Lean Management to Clinical Laboratory

  • Pablo Letelier Precision Health Research Laboratory, Departamento de Procesos Diagnósticos y Evaluación, Facultad Ciencias de la Salud, Universidad Católica de Temuco
  • Neftalí Guzmán Precision Health Research Laboratory, Departamento de Procesos Diagnósticos y Evaluación, Facultad Ciencias de la Salud, Universidad Católica de Temuco
  • Gustavo Medina Precision Health Research Laboratory, Departamento de Procesos Diagnósticos y Evaluación, Facultad Ciencias de la Salud, Universidad Católica de Temuco.
  • Luis Calcumil Precision Health Research Laboratory, Departamento de Procesos Diagnósticos y Evaluación, Facultad Ciencias de la Salud, Universidad Católica de Temuco
  • Pamela Huencho Precision Health Research Laboratory, Departamento de Procesos Diagnósticos y Evaluación, Facultad Ciencias de la Salud, Universidad Católica de Temuco
  • Jonathan Mora Precision Health Research Laboratory, Departamento de Procesos Diagnósticos y Evaluación, Facultad Ciencias de la Salud, Universidad Católica de Temuco
  • Francisco Quiñones Clinical Laboratory, Hospital Hernán Henríquez Aravena, Temuco, Chile
  • Jorge Jara Clinical Laboratory, Hospital Hernán Henríquez Aravena, Temuco, Chile
  • Cristóbal Reyno Scientific and Technological Bio-resource Nucleus, Universidad de La Frontera
  • Jorge Farías Department of Chemical Engineering, Faculty of Engineering and Science, Universidad de La Frontera, Temuco, Chile
  • Lisandra Herrera Department of Chemical Engineering, Faculty of Engineering and Science, Universidad de La Frontera, Temuco, Chile
  • Priscilla Brebi Laboratory of Integrative Biology (LIBi), Center for Excellence in Translational Medicine (CEMT)- Scientific and Technological Bioresource Nucleus (BIOREN), Universidad de La Frontera, Temuco, Chile
  • Ismael Riquelme Instituto de Ciencias Biomédicas, Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Chile
  • Andrés San Martín Clinical Laboratory, Hospital Hernán Henríquez Aravena, Temuco, Chile
DOI: https://doi.org/10.5937/jomb0-26055
Keywords: Clinical laboratory, Lean methodology, Pre-analytical phase

Abstract


BACKGROUND: The application of the Lean methodology in clinical laboratories can improve workflow and user satisfaction through the efficient delivery of analytical results. The purpose of this study was to optimise delivery times of the test results at a clinical laboratory, using Lean management principles in the pre-analytical phase.

METHODS: A prospective study with a quasi- experimental design was implemented. Staff functions were restructured and sample flows were modified. Delivery times of clinical results (glucose and haematocrit) from the Medicine and Adult Emergency services for years 2017 and 2018 were compared.

RESULTS: A reduction (p < 0.05) in turnaround times in the delivery of glucose test results at the adult emergency service was observed (84 to 73 min, 13%, pre and post). In addition, there was a non-significant reduction in the turnaround times for glucose (Medicine) and haematocrit in both services. In the analytical and post-analytical phase (not intervened), an increase in turnaround times was observed in some cases.

CONCLUSIONS: Other studies have indicated that the application of the Lean methodology in clinical laboratories improves workflow, increasing effectiveness and efficiency. This study showed an improvement in the delivery time of test results (glucose – Emergency), giving rise to a culture of cooperation and continuous improvement. It would, however, be essential to address the management model integrating the analytical and post-analytical phases.

References

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2. Saurav Patra MD BM, Ashok Kumar Das. PRE-ANALYTICAL ERRORS IN THE CLINICAL LABORATORY AND HOW TO MINIMIZE THEM. International Journal of Bioassays. 2013;02(03):551-3.
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8. Flegar-Mestric Z, Perkov S, Radeljak A, Kardum Paro MM, Prkacin I, Devcic-Jeras A. Risk analysis of the preanalytical process based on quality indicators data. Clin Chem Lab Med. 2017;55(3):368-77.
9. Teich ST, Faddoul FF. Lean management-the journey from toyota to healthcare. Rambam Maimonides Med J. 2013;4(2):e0007.
10. Goodridge D, Westhorp G, Rotter T, Dobson R, Bath B. Lean and leadership practices: development of an initial realist program theory. BMC Health Serv Res. 2015;15:362.
11. Melanson SE, Goonan EM, Lobo MM, Baum JM, Paredes JD, Santos KS, et al. Applying Lean/Toyota production system principles to improve phlebotomy patient satisfaction and workflow. Am J Clin Pathol. 2009;132(6):914-9.
12. Cankovic M, Varney RC, Whiteley L, Brown R, D'Angelo R, Chitale D, et al. The Henry Ford production system: LEAN process redesign improves service in the molecular diagnostic laboratory: a paper from the 2008 William Beaumont hospital symposium on molecular pathology. J Mol Diagn. 2009;11(5):390-9.
13. Clark DM, Silvester K, Knowles S. Lean management systems: creating a culture of continuous quality improvement. J Clin Pathol. 2014;66(8):638-43.
14. Rutledge J, Xu M, Simpson J. Application of the Toyota Production System improves core laboratory operations. Am J Clin Pathol. 2010;133(1):24-31.
15. White BA, Baron JM, Dighe AS, Camargo CA, Jr., Brown DF. Applying Lean methodologies reduces ED laboratory turnaround times. Am J Emerg Med. 2015;33(11):1572-6.
16. Moron-Castaneda LH, Useche-Bernal A, Morales-Reyes OL, Mojica-Figueroa IL, Palacios-Carlos A, Ardila-Gomez CE, et al. [Impact of Lean methodology to improve care processes and levels of satisfaction in patient care in a clinical laboratory]. Rev Calid Asist. 2015;30(6):289-96.



1. Inal TC, Goruroglu Ozturk O, Kibar F, Cetiner S, Matyar S, Daglioglu G, et al. Lean six sigma methodologies improve clinical laboratory efficiency and reduce turnaround times. J Clin Lab Anal. 2018;32(1).
2. Saurav Patra MD BM, Ashok Kumar Das. PRE-ANALYTICAL ERRORS IN THE CLINICAL LABORATORY AND HOW TO MINIMIZE THEM. International Journal of Bioassays. 2013;02(03):551-3.
3. Persoon TJ, Zaleski S, Frerichs J. Improving preanalytic processes using the principles of lean production (Toyota Production System). Am J Clin Pathol. 2006;125(1):16-25.
4. Henricks WH. Laboratory Information Systems. Clin Lab Med. 2016;36(1):1-11.
5. Plebani M. Errors in clinical laboratories or errors in laboratory medicine? Clin Chem Lab Med. 2006;44(6):750-9.
6. Grankvist K, Gomez R, Nybo M, Lima-Oliveira G, von Meyer A. Preanalytical aspects on short- and long-term storage of serum and plasma. Diagnosis (Berl). 2019;6(1):51-6.
7. Ellervik C, Vaught J. Preanalytical variables affecting the integrity of human biospecimens in biobanking. Clin Chem. 2015;61(7):914-34.
8. Flegar-Mestric Z, Perkov S, Radeljak A, Kardum Paro MM, Prkacin I, Devcic-Jeras A. Risk analysis of the preanalytical process based on quality indicators data. Clin Chem Lab Med. 2017;55(3):368-77.
9. Teich ST, Faddoul FF. Lean management-the journey from toyota to healthcare. Rambam Maimonides Med J. 2013;4(2):e0007.
10. Goodridge D, Westhorp G, Rotter T, Dobson R, Bath B. Lean and leadership practices: development of an initial realist program theory. BMC Health Serv Res. 2015;15:362.
11. Melanson SE, Goonan EM, Lobo MM, Baum JM, Paredes JD, Santos KS, et al. Applying Lean/Toyota production system principles to improve phlebotomy patient satisfaction and workflow. Am J Clin Pathol. 2009;132(6):914-9.
12. Cankovic M, Varney RC, Whiteley L, Brown R, D'Angelo R, Chitale D, et al. The Henry Ford production system: LEAN process redesign improves service in the molecular diagnostic laboratory: a paper from the 2008 William Beaumont hospital symposium on molecular pathology. J Mol Diagn. 2009;11(5):390-9.
13. Clark DM, Silvester K, Knowles S. Lean management systems: creating a culture of continuous quality improvement. J Clin Pathol. 2014;66(8):638-43.
14. Rutledge J, Xu M, Simpson J. Application of the Toyota Production System improves core laboratory operations. Am J Clin Pathol. 2010;133(1):24-31.
15. White BA, Baron JM, Dighe AS, Camargo CA, Jr., Brown DF. Applying Lean methodologies reduces ED laboratory turnaround times. Am J Emerg Med. 2015;33(11):1572-6.
16. Moron-Castaneda LH, Useche-Bernal A, Morales-Reyes OL, Mojica-Figueroa IL, Palacios-Carlos A, Ardila-Gomez CE, et al. [Impact of Lean methodology to improve care processes and levels of satisfaction in patient care in a clinical laboratory]. Rev Calid Asist. 2015;30(6):289-96.
Published
2020/06/29
Issue
Vol. 40 No. 1 (2021): Journal of Medical Biochemistry
Section
Original paper

Copyright (c) 2020 Pablo Letelier, Neftalí Guzmán, Gustavo Medina, Luis Calcumil, Pamela Huencho, Jonathan Mora, Francisco Quiñenes, Jorge Jara, Cristóbal Reyno, Jorge G. Farías, Lisandra Herrera, Priscilla PBrebi, Ismael Riquelme, Andrés San Martín

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