In our clinical lab at the Guangdong Hospital of Traditional Chinese Medicine, we implemented Lean Six Sigma (LSS) to streamline processes, encourage team collaboration and eliminate waste. We started in 2013, and in the years since, we achieved many benefits.

The initial catalyst for our LSS transformation was a survey of employees in the clinical laboratory, which uncovered widespread dissatisfaction with the lab environment. Employees cited concerns including noisiness, humidity, and dust. Uncertainty about job positions and the challenges of heavy workload were also major concerns.

To address these issues, the lab underwent LSS training. The first Lean management training session began in the first half of 2013, and we identified opportunities for Lean principles to be implemented. Known problems were identified and classified, and we brainstormed solutions to address them. As a result, we saw a 12% improvement in work satisfaction between 2013 and 2017. This came with significant increases in satisfaction with income, bonuses, and career development.

Because only key personnel in some departments participated in the training in 2013, however, there was inadequate understanding of Lean principles across our laboratory team, and we eventually saw the return of old bad habits. Owing to these rebounds, Lean training was repeated in the first half of 2017. The latter half of 2017 and six months in 2018 were devoted to improvements based on Lean principles.

To improve laboratory safety during these later improvement periods, the team brainstormed relevant risks within the lab and integrated them into a system for a comprehensive assessment. 336 risks were identified, and 52 priority action plans were made. We split these into achievable short- and medium-term objectives. Examples of risks included complicated sample processing, samples being transferred between different departments, poor sample collection quality and instrument failure.

The result: more efficient and safer workflows

The Lean evaluation process uncovered clear and simple measures to improve the situation. For example, prior to implementing Lean principles, lab operators were walking an average distance of 2345 metres during sample processing. Optimising the process of transportation reduced that to 1546 metres, giving lab personnel more time and energy to address risks and problems.

Our LSS evaluations also convinced us to standardise management processes for reagent labelling. We determined that each reagent should be clearly labelled and stored by batch number. As a visual reminder, a zoning map of locations was posted to the entry of the frozen storage facility. The result was that reagents with the same batch number were used in an ordered fashion, product wastage was reduced, and accessing reagents became more efficient and convenient. 

A third instance of LSS-inspired improvements relates to sample quality. One of the issues was that bone marrow smears had a non-conformity rate as high as 20.3%. The causes of this included operator unfamiliarity with the test and a lack of a quality control. As a result, the lab was incurring resampling costs and creating a need for more invasive examinations that increased the burden on patients.

Applying LSS principles, we brainstormed solutions and determined we needed to improve communication, use EDTA-K2 anticoagulant tubes to prevent sample coagulation, and ensure that all bone marrow smears were prepared by inspection personnel with experience in the task. Within one week of implementing these solutions, we eliminated non-conforming samples. Six months after the improvements, however, non-conformity rates increased to higher than they were before the process was implemented, creating a need for another round of Lean training and evaluation.  

Progress is a process

A key takeaway from our experience is that LSS can improve laboratory efficiency but progress is not guaranteed to be permanent. Lean management is a continuous process and has no defined endpoint. Rather than viewing LSS as a one-time fix, labs should aim to regularly assess their performance and strive for constant improvement.

This article is based on the presentation “Using Lean Six Sigma to improve laboratory efficiency” at the Roche Efficiency Days (RED) 2018 REDefining perspective in Guangzhou, China.