Lean Management Helps to Reduce Errors in Histopathology: A Real-life Experience From a Tertiary Care Public Sector Hospital.

Abstract

Background and objectives: Histopathology has been increasingly playing a vital role in patient diagnosis. Histopathology laboratories have been riddled with multiple problems such as inefficiency, errors, and rising costs. Lean management, a concept derived from the Toyota production systems, helps in improving the operational efficiency by removing waste or errors. The lean concept has been demonstrated to reduce waiting times, improve patient safety and satisfaction, and reduce costs in health care. We aimed to assess the impact of lean management on the frequency of errors in the histopathology laboratory of a tertiary level hospital.

Methods: This was a before-and-after study where the lean process was implemented in a phased manner beginning with an assessment of its need by the senior specialists, data collection, training of staff, post-training data collection and analysis. The various errors that were possible in the workflow of the laboratory were identified. The frequency of errors in 2018 (pre-intervention) and 2021 (post-intervention) was noted and compared.

Results: Data collection from the pre-intervention period revealed that delay in microtomy, incorrect patient identification details on the requisition form, and sample received without appropriate fixative had the highest frequency of events leading to errors in histopathology. After the implementation of lean principles in the laboratory, the error frequency reduced by 30.79%. The highest decline was noted in the delay caused by grossing being performed in the morning hours (64.5% reduction), while the smallest reduction (16.67%) was noted for samples arriving from the clinical departments at erratic times.

Conclusion: The present study emphasizes that the implementation of simple measures of lean management in a histopathology laboratory can be effective in reducing errors and improving efficiency without adding to the cost to the laboratory.