Dr. Richard Zarbo’s Talk at the Lab Quality Confab


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In November, I blogged about a panel at the Lab Quality Confab that included Dr. Richard Zarbo from Henry Ford Health System  (see their pathology page on Lean). Dr. Zarbo gave a separate keynote address… I found the notes in my computer bag (on a slip of paper… a possible 5S opportunity).

I'll share some of the pearls of wisdom and examples from his talk.

His labs had “1800 process improvements” in the past year, which is a very impressive rate of “kaizen,” or improvement.  This doesn't mean 1800 “rapid improvement events,” but rather 1800 improvements of various sizes.

In keeping with common “no layoffs due to Lean” approaches, the system “closed one of the five hospitals last year with no loss of employment.”

One of Dr. Zarbo's main goals is to improve flow – toward continuous flow and “same day processing.” Some of the challenges to this, include:

  • The need for load leveling (it's hard to change working hours… but they moved from a single shift to running for 20 hours a day)
  • Batch sizes (so they shifted from overnight processing to rapid cycle tissue processing technology)
  • The need to simplify and mistake proof operations (using bar codes and paperless technologies)

They reduced 31% of their steps… simplifying THEN applying technology. After the improvements, “every employee” is expected to work on “daily maintenance kaizen.”

Dr. Zarbo goes on walks “searching for batches,” and working toward the  ideal of one-piece flow. My comment would be that he puts the focus on “ideal” correctly because we can't always jump right to single-piece or one-piece flow in a process (we wouldn't want to spin just one tube in a centrifuge), but we can explore technologies and process changes that make batches smaller.

Dr. Zarbo says each employee is expected “not just to show up to work, but work to redesign the work every day” (which is a very Toyota-like philosophy and it's a core part of kaizen that everybody participates). They “chase the waste out on a daily basis.” It's “a system of work we've created” with “culture, structure, and management.”

There's also a strong focus on employee safety in the lab as they are “doing things we aren't asked to do.” This includes working to remove toxins from the lab, including formalin (which can shut an operating room down for hours, if spilled) and xylene. They are reducing the risk of harm in the O.R.s and labs. They are doing innovative work with vacuum-sealed specimens (sealing them in the O.R. for transport or in the lab). This increases cost to the lab, but DECREASES it for the overall system. They are eliminating formalin buckets and the goal is to use the new method for all specimens.

Dr. Zarbo wrapped up by talking about the need to educate the workforce so they:

  1. Know goals and reasons for change
  2. Know what good work redesign looks like
  3. Are accountable for quality on a daily basis

I've always been impressed with Dr. Zarbo's leadership on these issues and hopefully you'll get to meet him at a conference soon.

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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.


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