The market for health care has been in a state of flux for many decades. There have been constant threats of reimbursement cuts, mergers and acquisitions, and a general uncertainty in the marketplace. We in the laboratory haven't been immune to this uncertainty, either. One could argue it has been especially difficult for laboratory services organizations. Not only do we work behind the scenes with little visibility and accolades for our work, but we face steeper threats of cuts, an acute shortage of qualified personnel, and not enough tech schools to recover our workforce shortages. All of these factors place a high level of importance on stewardship, conservation of resources, and a drive towards efficiency and optimization of workflows.
Unfortunately, there are no modules or training in tech schools on any form of process improvement. Before I sought out any training and education in this topic, I didn't really understand what this even meant. So, to pass along what I've learned, I'm going to discuss what process improvement and systems thinking mean, and offer some background on the two most popular methods: Lean and Six-Sigma.
Let's back up for a quick second. We need to first understand the basics of process improvement. A process is a systematic approach for achieving a desired result by taking inputs and making outputs to the specifications of the customer. Since processes are systematic, they are repeatable and can be managed to minimize variation. A key point to remember is that all processes can be measured in quality and time. These are both drivers of cost in the lab, and everyone wants to reduce costs! Since you can measure processes, process management (and improvement) is key to ensuring they achieve expected results and evolve as your customer's requirements evolve.
As you're starting down the path of process improvement, you may be unsure where to begin. Some key questions to consider:
- What do you do?
- How do you do it?
- Who is your customer?
- How do you know you're doing a good job?
Once you've worked on these questions and you've identified a process that can be improved, there are many options and techniques to use. As I had mentioned, the two most popular are Lean and Six-Sigma. Lean is a philosophy used to define and reduce waste. Most tools used in Lean thinking are qualitative in nature and relatively easy to learn and apply. Six-Sigma, on the other hand, is a quantitative approach to reducing defects using data analysis and statistics. Often times, Lean and Six-Sigma are combined into a single program. Lean "waste" can be viewed as a Six-Sigma "defect", and vice versa. There are many formal training providers for these Lean Six-Sigma programs, where they combine the two methodologies in a "belt" system similar to martial arts. People with a white belt are novices to this type of thinking, yellow and green belts are intermediate practitioners, and black belts are considered experts.
When you examine Lean methods, you will find that these are based on the Toyota Production System developed by Deming in 1950s Japan. Its stated purpose is to eliminate anything that does not add value to the customer. Non-value-added waste (called Muda) have no benefit to the customer and are not necessary to run your operation. Examples of waste include rework, multiple handling, excessive transporting, filing, asking questions, and waiting for approvals. Some tools you can use to help you identify waste in your processes include an 8-Wastes review, Flow Charts, Cause and Effect diagrams, and 5S Methods.
When you examine Six-Sigma techniques, these are all data-driven and statistics derived. Six-Sigma is a philosophy driving towards perfection in all processes. The Sigma Level of a process is based on the number of Standard Deviations (or Sigmas) between the mean and the customer's requirements. Near perfect is considered Six-Sigma, which is 3.4 defects per million opportunities. The tools used in six-sigma take a different look at data to identify trends over time that may not be easily visible. Some tools to use in your data analysis include Bar Charts, Line Graphs, Histograms, Pareto Charts, and Scatter Diagrams.
Once you become a practitioner of Process Improvement Methodologies, it changes your entire perspective. You begin to see things as a systems thinker, always looking for opportunities to integrate processes and optimize your lab's results. Systems thinking is key to connecting mission, vision, and values of the organization to the results and outcomes of the lab.
Combined, Lean Six-Sigma is a tremendous program that is easily amenable to the work we do in histology labs. This program can lead to a significant improvement in department and organizational performance, meeting the needs of the customer, and improved financial outcomes. Improved financial performance is important, no matter your organization. Even not-for-profit organizations have to be mindful of their finite resources, because if they are not run well it takes resources from other areas critical to achieving the mission. And the last thing any laboratorian wants is to distract from the mission. By utilizing these tools and techniques, you can begin to incrementally improve your lab, realizing the potential of your team and understanding that the whole can be greater than the sum of the individual parts.
References:
ets, inc. (2017). ets Lean Six Sigma Yellow Belt Manual. Cocoa, FL. www.etsfl.com
Lean Enterprise Institute. (2023). What is Lean? Accessed from www.lean.org/explore-lean/what-is-lean/
American Society for Quality. (2023). What is Six Sigma? Accessed from www.asq.org/quality-resources/six-sigma
Written By: Jason Molnar, BS, HT(ASCP), QIHC (ASCP)
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