Histology Process Improvement

Histology

The challenges and pressures continue to increase for the histology lab; Lean, Six Sigma, continuous improvement, personalized medicine and now digital pathology are designed to enhance our skills, yet we continue to struggle to create the necessary change in response to the voice of our customer.

Our customers-administration, pathologist, clinician and, most importantly, the patient-want results better, faster and cheaper. Can we deliver? At this time in the change process I believe we should focus on two issues, namely “better and faster,” and let the discussion on “cheaper” continue. Some histology labs already have become better and faster (i.e. Henry Ford Health System, Avera McKennan Hospital and University Health Center), but many more need to follow their example. Once we tip the balance of process improvement in the histology lab, the discussion about cheaper will move to the forefront.

Achievements Realized

To help tip the balance, we must first understand what the few have achieved. Better is all about quality; to improve your lab’s quality you must incorporate Lean techniques and Six Sigma tools. Lean is all about the people, removing waste and creating velocity in a workflow. Six Sigma is all about the process, reducing the defects and errors and creating a decision making process. Put the two together and you get Lean Six Sigma-processes and products with better quality, faster. This is what the few have achieved and the customer most certainly wants. Those that continue to ignore the voice of the customer will suffer the severest cost-lost customers and patients.

The challenges facing the histology lab remain complex, but the solutions are not. To start, we must understand what better really is. Better is all about quality and when we consider improving patient results, histology quality must be an essential part of the process. The tools we apply are simplicity and standardization. By creating better quality, using the simple tools, we construct a precision scientific method based on craftsmanship instead of customization. The improved process:

• allows the pathologist to become more efficient and

• increases the opportunity to introduce even more helpful precision tools (i.e. digital pathology) that allow for a more detailed result.

At What Cost?

Cost and quality are always linked, but what about the cost of not providing better quality and meeting the customer’s and patient demand? Couple simplicity and standardization with the Lean Six Sigma continuous improvement tools and the histology process quickly moves beyond repeatability and reproducibility and evolves into interoperability. The discussion about cost, therefore, must move from the confines of the single lab or department budget to the healthcare system budget. Producing better quality is hearing and listening to the voice of the customer.

As we continue to consider the need for and the cost of better quality, think now about what faster really means to the process and lab. Faster is not so much a separate step, as it must be a coordinated step with better quality. Faster ultimately is improvement in turnaround time (TAT) and TAT is all about the better quality result delivered in the most efficient time. Producing a product faster is moving the product through the lab in the most efficient way, with no defects or errors and the least amount of wasted time. Again, this is where standardization comes in.

Standardization has been proven to reduce costs, improve quality, stop wasting pathologists’ time and, most importantly, improve patient care. Streamlining the histology lab process can only affect TAT so much; creating the faster part of better quality faster is ultimately about creating a culture of communication and responsiveness. Implementation of Lean Six Sigma creates a workflow process that has reduced variation, inefficiency and waste throughout the process to significantly reduce risk to the patient, pathologist and company. The new lab process is prepared to easily adjust and react to the customer need while allowing management to proactively address quality requirements that positively affect the continuous improvement or responsiveness.

Effect of Process Improvement Model

As we continue to see more labs move to implementation of the process improvement model, instrument and supply costs will begin to reduce through standardization with instrumentation and products directly supporting, encouraging and sustaining continual histology process improvement. The focus of the lab to implement the Lean Six Sigma methods and tools, following the example of the few, will drive the supply change and provide better and faster quality care.

The third portion of the desired quality equation-cheaper-will never be achieved unless we expand the cost modeling discussion to effectively equate the value of effort, risk and reliability for both the personnel and instrumentation. We cannot continue to ask histotechnologists and pathologists to work hard, faster and with less if we actually expect to create a process that is better, faster cheaper. The financial discussion about cost must move from simple product cost modeling to complex service parametric cost modeling. This is not a huge leap or change, especially when you consider the voice of the customer and the realistic reduction in risk.

William DeSalvo works for Sonora Quest Laboratories LLC, Tempe, AZ.