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Case StudyLean Methods Improve ProductivityOU Medical Center creates a safer, more effective and efficient anatomic lab

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Change Readiness Assessment

4 of 4 dimensions support a high-to-medium need for change management

How big is this change for the organization culturally and in general?

(Day-to-day Work Activities, Decision Making, Logistically)?

Minor Changes Major Changes

Not a Big Deal Very Severe

High Recognition Low Recognition

High Recognition Low Recognition

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X

X

X

What is the level of severity if the change fails?

(Strategic Alignment, Lost Opportunity, Loss of Credibility)

How widely acknowledged are the risks of the status quo?

(Quality, Patient Safety, Productivity)

How much are the benefits of this change recognized by those involved in the change?

(Cost Reduction, Employee Satisfaction)

X

Errors that occur in an anatomic pathology lab can be deadly.

Slow turnaround times can cost thousands and increase

patient anxiety.

In pursuit of a safer and more efficient lab, the Board-certified

pathologists and their team at Oklahoma University (OU)

Medical Center implemented lean process modifications and

the Ventana Symphony automated staining system. The team

targeted improving quality, productivity and turnaround times

specifically in the hematoxylin and eosin (H&E) staining work

cell. Recognizing that timely and accurate lab results for patients

also means a more competitive lab for OU Medical Center, the

anatomic pathology lab teamed with Ventana Medical Systems

to streamline H&E operations in preparation for an anticipated

growth surge.

Background

The histology lab at OU Medical Center operates 24 hours

a day, six days a week and supports the histology needs for

OU Medical Center, The Children’s Hospital, OU Physicians,

Oklahoma State Health Department, OU Oral Pathology and

some on-campus research operations. With a new OU cancer

center nearing completion, lab demand was projected to surge;

however, space and capacity constraints limited the lab’s ability

to meet the climbing demand.

“Having seen the benefits of throughput improve-

ment in the operating room suites, we knew there

was an opportunity to put lean process improve-

ment to work in the pathology lab to support the

potential increase in demand.”

Figure 1.

Assessing Change

Ventana’s Workflow Consulting Solutions used lean principles to

pull the department together in such a way that the

staff saw the effects of their own actions on others, as well

as on overall turnaround times. The team engaged both senior

leadership from the hospital and physicians as the first step in

assessing change readiness (see Figure 1 on page 2).

Four dimensions of readiness were assessed to match the

level of change management required for a successful imple-

mentation of lean to OU Medical Center’s lab. The team

determined the size of the change and the level of severity

should the change fail. They also assessed the perceived risks

of no change (status quo), and the awareness of the resulting

benefits of lean.

Reaching Operational Efficiency

The team looked at before-and-after productivity comparisons

based on historical workload and quality data. They created a

visual snapshot of how the lab operated in real time by follow-

ing a specimen through the lab, measuring steps, specimen

travel distance and total turnaround time (see Figure 2).

Initially, the team grew weary believing operational efficiency

was too difficult to achieve. However, small teams across

the lab studied and implemented portions of the transforma-

tion, and with findings graphed and charted, they illuminated

nonvalue-added activities and opportunities to eliminate rework.

“Early on, operational efficiency seemed elusive as

we kept documenting wait times for equipment,

staff and pathologist decisions.“

Lean process improvement spotlighted opportunities to reduce

both time and movements from barcoding a specimen block

through processing, embedding, cutting and staining, ending

with assembled case slides.

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Figure 2: New flow saves 357 ft per case or 2.9 miles a day.

BEFORE AFTER

New H&E Workflow Process Reduces Travel Time 42%

For example, in the H&E staining workcell, the team reduced

specimen travel distances from 92 to 53 feet, a 42 percent

improvement. Reconfigurations of workcell instrumentation and

organization was a collaborative effort involving the Ventana lean

consultants, lab team members and leadership.

Time to first available slides decreased from 12 hours to four

hours, providing more time for resident review of slides prior

to sign-out. By shifting 17 percent of total workflow from a

nighttime shift to the afternoon, the team improved the average

time at which the last case was presented to the pathologist for

diagnosis. This meant 50 percent of slides/cases arrived

on the pathologist’s desk for diagnosis one hour and four

minutes earlier. This improvement resulted in patients receiving

their results sooner, leading to a better patient experience for OU

Medical Center.

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Figure 3: Symphony reduced nonvalue-add process steps (green) at the microtomy workbench; future state eliminates 8 steps.

Figure 4: Symphony streamlined process steps removing nonvalue-add steps (green) at the H&E staining workbench; future state now includes a fully-automated H&E staining process

Additionally, OU Medical Center removed errors at the tail end

of the histology sequence by implementing the Symphony

automated platform. Errors in assembly were common despite

meticulous care by even the most experienced histologists.

Previously, the chaos introduced between grossing, process-

ing trays, embedding stations, cutting areas and batch stainers

often meant that a case was scattered over several runs (see

Figures 3 and 4).

“Our patients receive the greatest benefits of lean.

The time and efficiency savings, coupled

by improvements in safety generated by lean,

translate into timely and accurate lab results

for our patients.”

Total Process Turnaround Time Improves in Microtomy and H&E

BEFORE AFTER

BEFORE AFTER

Receiving Accessioning 9ft 3ft 6ftCassette 32ft 16ft 16ftMarking Grossing 38ft 20ft 18ftTissue Processing 88ft 68ft 20ftCreate Slides 22ft 4ft 18ftEmbedding 18ft 5ft 13ftMicrotomy 42ft 14ft 28ftH&E Staining 32ft 20ft 12ftCase Assembly 126ft 100ft 26ftReview/Archival 270ft 120ft 150ftRecuts, SS, IHC 96ft 25ft 71ftTotal 773ft 395ft 378ft

Step Dist. Lean Op. Final

Embedding 18ft 5ft 13ft

Microtomy 42ft 14ft 28ft

H&E Staining 32ft 20ft 12ft

42% Improvement

one-touch automated H&E staining system. This system

replaced OU Medical Center’s previous installation of separate

drying oven, linear stainer and coverslipper. Today, 13 staining

steps are now automated.

Both the microtomy and H&E staining workbenches were

greatly impacted by this combination of technology and lean

workflow improvements. Based on travel time alone, which in

lean is considered pure waste, a total of 23 minutes per slide

rack of manual and semi-automated work were absorbed by

Symphony. This translates to a savings of approximately three

hours per day. Lean Six Sigma resulted in a 42 percent improve-

ment in the H&E staining workcell; overall a 51 percent improve-

ment was achieved (see Figure 5).

These significant improvements represent only the beginning

of a longer-term and broader project to break through other

bottlenecks in the anatomic pathology lab. OU Medical Center

continues to use lean principles in an iterative process to find

and sustain improvement throughout the lab.

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Results

Implementing lean workflow, a relatively low-tech change in

process produced significant results for the histology lab at OU

Medical Center:

• Average time from gross station to completely assembled

slide cases ready for pathologist sign-out decreased 2.9

hours (12 percent).

• Total process turnaround time reduced 28 minutes per case

(4 percent).

• Mean quarterly productivity increased 8.5 percent from

2312 slides and blocks/FTE to 2509.

• Manual steps reduced from 219 to 182 (17 percent).

• Specimen travel time distance reduced 49 percent overall

to 395 ft/case and 42 percent in the H&E cell.

• The number of days in which new slides/cases arrived on

the pathologist’s desk for diagnosis after 10 a.m. was

reduced by 50 percent, more than a one-hour

improvement.

Approximately 25 percent of these improvements were a direct

result of implementing a high-tech solution: The Symphony

Lean Six Sigma Results in a 51% Improvement in Distance Traveled

Figure 5.

Ventana Medical Systems, Inc.1910 E. Innovation Park Drive Tucson, Arizona 85755USA +1 (520) 887 2155(800) 227 2155

www.ventanamed.com

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