Application of lean methodology to frozen section workflow – An audit of present practices at a single large oncology center

This study was conceived to access laboratory Lean concepts (methodology) to assess the process flow for frozen sections in the histology laboratory (located away from main Operation Theatres). To reduce wait times, a future state map was then developed. A few important & modifiable laboratory procedures were examined, waste sources were determined, waiting times were calculated, and waste reduction steps using LMS were suggested.

Based on the Toyota Production System (TPS), a lean management system (LMS) is focused on providing value for the end user by continuously improving operational performance and decreasing waste [1]. In recent years, the implementation of lean at healthcare facilities has boosted overall quality and patient safety, shortened waiting times, and reduced healthcare costs [2]. Because laboratories resemble a processing division of a business, they can be used as the starting point for establishing and implementing LMS in a healthcare setting [3], [4]. Laboratories all around the world have been addressing these issues with a lean methodology for more than ten years [5], [6], [7], [8], [9], [10]. However, many anatomic pathology labs have revised their work procedures and adopted the quality-based manufacturing systems, such as Six Sigma, Lean, and the Toyota production system [11], [12]. Many studies have shown that the histology section became more productive after implementing lean techniques, which decreased the time it took to process a specimen [7], [11], [12], [13]. They also emphasized that although while a great deal of research has been done on the effects of Lean implementation in anatomic pathology labs, very little of it has looked at how well it has improved productivity, quality and cost reduction . They emphasized how efficiently utilizing lean methodologies will reduce the time it takes to analyze surgical pathology specimens, which depends on the proper completion of many sequential but independent stages [7]. The two main quality criteria of a frozen section reporting are diagnostic accuracy and turn-around-time (TAT) [14], [15]. Adhering TAT is very important when reporting on frozen sections. Though the diagnostic effectiveness which measures post analytical factors only of frozen sections has been extensively studied, however few studies have examined their TAT [16]. We focused on the TAT of frozen sections, which is dependent on both preanalytical and analytical factors. No other study proving the application of lean management techniques or principles in frozen section workflow analysis or waste computation has been carried out, despite a thorough examination of the literature.

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