The Need for Lean Laboratories


    Hospitals move to cut dangerous lab errors

    Here is a free version of a WSJ article from last week. I know I've been posting about “lean healthcare” a lot this week, I hope that is of interest to the manufacturing folks who are reading. Lean is lean, to some extent, so I hope you'll keep reading.

    After transitioning into healthcare, I've seen many hospital labs. The opportunities for errors are all over the place, pre-lean, mainly due to bad processes and batch thinking. Because of batching, it is far too easy to mis-label slides or to put the wrong label on a test tube, which is going to lead to false positives or false negatives.

    I don't think I've seen error rates this high:

    “…studies show that 3 percent to 5 percent of the billions of specimens taken each year are defective, be it a biopsy that doesn't extract the tumor cells, blood that isn't drawn correctly or a mix-up with another patient's sample.”

    The results can be disasterous, as this article highlights.

    “Tests fail because things can go wrong at every step of the process, and there are no checks and balances in place in pathology to catch these errors,” says Stephen Raab, director of the center for pathology quality and health-care research at the University of Pittsburgh Medical Center, who is leading the lab-safety collaborative.

    While only about 1 percent of errors lead to serious harm or delays in treatment, he says, “You wouldn't want to have 1 percent of all airlines crashing.”

    From a lean perspective, I don't think the solution is more “checks and balances” — you can't inspect your way to quality results. We need lean methods and single-piece flow — methods that work in labs and pathology areas, methods that help PREVENT errors or mix-ups from occurring.

    Lean really works in laboratory settings. Lean reduces errors and improves cycle time for getting test results back (known as “turnaround time” in the lab world). Lean works, we just need more of it.

    If you have questions about lean in laboratories, email me.
    I have done a lot of work in hospital and reference laboratories over the past year, it is the focus of my employer. I would love to help you out if you have interest in lean.

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    Mark Graban
    Mark Graban is an internationally-recognized consultant, author, and professional speaker, and podcaster with experience in healthcare, manufacturing, and startups. Mark's new book is The Mistakes That Make Us: Cultivating a Culture of Learning and Innovation. He is also the author of Measures of Success: React Less, Lead Better, Improve More, the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, and the anthology Practicing Lean. Mark is also a Senior Advisor to the technology company KaiNexus.


    1. While you are correct about making the process more lean as a better direction, they may want to consider an 8-D process including extra checks to keep the 3-5% or 1% from impacting the lives of their patients until they can get a lean process in place.

    2. Chet – you’re correct, thanks for pointing that out. Inspection CAN be a strategy, but for the short-term. If you can’t yet guarantee perfect process results, you’d better inspect until you’re at that point. I’d still be careful of “double inspection” and the problems inherent with that — each person thinks the other person will catch the problem. I’d recommend one inspector and put responsibility for patient safety clearly in someone’s scope.

    3. This is interesting. Recently I was donating blood at the local hospital. In the (very comfy) seat where the blood is given, there is a printer on the table next to it, beside the bloodpump. This is to insure that labels that go on the bag(s) or vials are labelled with correct name and information. Also, after the labels are printed two seperate nurses will come and ask if the correct social security number is printed, to prevent mixups. While the last process possibly is not lean, the first one is, printers nowadays are very cheap, and this system certainly helps to avoid mixups.

    4. Peter- that’s a great example of how “single piece flow” can help prevent errors. I’ve seen many cases where labs print out a large batch of labels and then go matching them up to a pile of tubes. That’s “pre-lean” of course. The quality factor is important, but batch labs also have a lot of non-value added work involved in matching labels to tubes. Often, one or the other is “missing” and needs to be found.


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