Lean methodology in health care practice: an example of application for clinical laboratory urinalysis processing.

Background: Improving quality and laboratory testing turnaround time (TAT) is a constant challenge for a clinical laboratory. The formulas that describe the best way to manage these goals are outlined in International Organization for Standardization standards. According to standards, improvement must be timely and continuous. Lean methodology is a tool to meet this requirement. One of the fundamental elements of Lean is a systematic approach to process improvement by removing waste to create value for the end-user (eg, patient) of the service. This methodology can be adapted in resource-limited settings.

Objective: The aim of this study was to test the application of Lean methodology in urinalysis.

Methods: Lean has various collections of tools and concepts. We applied the most useful for the clinical laboratory: Gemba walk, Takt time, cycle time, and value-stream mapping. Finally, we created and approved workplace standards to improve the performance of urinalysis.

Results: We compared the TATs of urinalysis tests before optimization, immediately after, and long after (~5 months). We found that TATs had significantly shortened. The TATs of emergency (STAT) urine tests immediately after optimization improved: automated microscopy to 16% (P =.194), fully automated test-strip to 23% (P = .0172), and standardized urine sediment examination to 20% (P =.0048). The TATs of routine urine tests also improved immediately after optimization: automated microscopy to 18% (P <.0001), fully automated test-strip to 11% (P =.0025), and standardized urine sediment examination to 18% (P =.0011). After 5 months of Lean application within the urinalysis laboratory, TATs of routine urine tests remained improved; however, the improvement of STAT urine test TATs dropped to approximately 4%.

Conclusion: The application of the Lean methodology shows significant improvement in TATs of processes in our laboratory.