Lean production principles originated from Toyota, the Japanese auto manufacturer, to eliminate waste and inefficiency in its manufacturing operations. The terminology, coined in the 1990s, was meant to improve manufacturing efficiency on the production line. But since that time, Lean production principles have been applied to business or production processes in many domains, including lab management.

“The application of Lean to improving productivity and solving quality problems in laboratories has become increasingly popular and prevalent. It has been widely implemented to great success in many laboratories.” — Dr. Hung S. Luu

These applications of Lean production principles were put into place in our laboratory to manage the increasing volume of hematology specimens and to better meet the needs of our clinicians and patients. We started by introducing Lean culture into our laboratory. This was accomplished through the introduction of Lean principles during new employee orientation, reinforcement of learning during book club discussions, implementation of the Kanban system for inventory management and establishment of an employee-driven process improvement procedure.

Next, we applied the Lean production principles of streamlining processes, cost reduction, and operation optimization through a six-month Digital Hematology Project at Children’s Health which focused on how two labs in different locations could work in tandem to create a delivery method to improve patient’s care. Evaluation of the success of the Digital Hematology Project was based on comparison of the total number of manual counts performed, average turnaround time and percentage of manual counts taking greater than 60 minutes (outliers) during the pre- and post-implementation time periods.

In six short months, through the implementation of the Digital Hematology Project, the average turnaround time was reduced by 2.5 minutes. The percentage of outliers greater than 60 minutes dropped from 11.3% to 5.7% despite a manual differential volume increase of 299% from baseline. One of the most profound improvements from the Digital Hematology project was the creation of a single work queue for the performance of manual differentials across all campuses, which increased staff flexibility as it cut waste from clinical workflows, maximizing quality and efficiency in the hematology laboratories.

The project also benefited our clinical colleagues in the Center for Cancer and Blood Disorders in Dallas. Prior to having remote viewing access to the manual differential images, clinicians often had to wait for an extra peripheral blood smear to be prepared in the laboratory and sent to them via pneumatic tube. This caused significant delays in seeing and treating the patients. By using remote viewing software, however, clinicians are now able to see the digital cell images without the need of having a peripheral blood smear slide prepared by the laboratory. This has resulted in the elimination of several steps in the daily workflow of the clinic and significantly improved patient throughput.

Connectivity has been key. Through remote digital morphology connectivity in the laboratory, we have been able to increase both productivity staff flexibility. Having rapid access to cell images has improved clinician workflow and aided in the rapid diagnosis and treatment of patients. For us, being able to show patients the effect of treatment has improved compliance at our hospital.

This article is based on the presentation: Utilizing Lean Production Principles and Digital Hematology to Maximise Quality and Efficiency in Hematology Laboratory at Roche Efficiency Days (RED) 2017 in Taipei, Taiwan.