Successful Change Management in Histology Laboratories: University of North Carolina utilizes LEAN Tools for Improved Quality and Efficiency.

Conducting a Lean Assessment or Lean Event (kaizen) is only the first step on the difficult, but rewarding, road to process improvements.

When assessing current processes, the workflow is keenly observed, a baseline for relative metrics is established (e.g. turnaround time), root causes for existing non-value-added activities are identified and process improvement ideas are brainstormed to create an action plan.

What does it take to successfully implement a Lean Initiative?

With guidance from the Leica Lean Consulting team, the IHC laboratory at the University of North Carolina (UNC) succeeded in conducting and implementing a Lean Project that created two major improvements. Firstly, over a 10 month period, there was a 55% improvement in the hands-on cycle time for IHC staining (from 36 minutes to 16 minutes). Secondly, new staining technology (BOND-III) was introduced and, with its full potential realized thanks to Lean Workflow Analysis, staining time reduced from 4.5 hours to 2.5 hours. With the new systems effectively integrated into the entire laboratory workflow, the turnaround time for the overall IHC process was reduced from 5.1 hours to just 2.73 hours.

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A true success story throughout the entire organization

At the beginning of UNC’s IHC Lean project there were doubts and some resistance within the laboratory as it was difficult to predict what issues and obstacles would surface during the initial Lean Assessment.

The most apparent obstacles were:

• Resistance to change

• Working outside their comfort zones

• Lack of time

• Fear of reduced need for staff

The team (management and histotechs) overcome these obstacles by employing the following techniques, which were critically important to the successful implementation of this initiative:

• Leadership support is mandatory – support the techs’ ideas!

• Schedule time to work on lean projects – a little time invested can pay off big; if you don’t schedule it, it just won’t happen.

• Empower employees to make suggestions, experiment with changes and take ownership of their workflow.

• Think outside the box and welcome all ideas

• Use Lean tools to get to the root cause of the issue – the problems may not always be where you think!

• Be open minded

• Break projects into small pieces that are easier to implement

• Create an action plan and keep it updated with statuses for all to see

• Standardize work

• Clean and simplify your work environment

• Reward each small success – make it fun!

• Continually improve – keep momentum going

Marilou Maglione, Director Anatomic Pathology at UNC explains that: “The most critical thing is to engage everyone from the beginning and to provide education about what Lean could help us accomplish. And then by demonstrating some quick and early successes, Lean becomes more integrated into your culture”.

Some of the solutions implemented evolved by trying ideas and then improving upon them if they did not work the first time. It is important never to go back to the original state, but instead to always move forward and continually improve.

As an example of workflow improvement, the team had multiple slide transfers between IHC stainers, de-hydration and cover slipping. This was originally accomplished by first putting the slides in a rack for manual de-hydration in small staining dishes. Then, the slides were transferred to a second rack for loading onto the coverslipper. After brainstorming, they used a set of larger staining dishes from their H&E stainer so that the slides would be racked just once after coming off the IHC stainers.

Figure 1: IHC de-hydration station

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A second example is the Covertile™ cleaning process. Instead of taking the Leica BOND Covertiles off and throwing them onto a big pile to be washed, and cleaned and sorted later, the team re-organized the process. Now the dirty Covertiles are put directly into Covertile cleaning racks that fit into cleaning buckets with cleansing solutions. The individual Covertiles are handled one time as they are stacked in the cleaning racks, then washed and dried as a batch, ready to be used again. This eliminated double handling.

The laboratory no longer runs out of clean Covertiles since there is now always one rack of clean Covertiles and one rack of Covertiles waiting to be washed.

Other Lean ideas UNC implemented were:

• Applying visual management to the re-organization of the control slide library

• Implementing a triage station in histology to prioritize the workload

• Creating an ‘IHC Floater’ role to perform daily, weekly and monthly maintenance and free IHC techs to focus on staining

(This also de-mystifies IHC for Histotechs and keeps all techs included in the process.)

• Installing a Lean Communication Board for posting action items, kudos and customer feedback

• Involving pathologists & administrators as champions to support the effort

All these examples demonstrate how low-cost solutions can yield high rewards.

In the end Lean has become a culture, not just another project, and is viewed as a great tool to:

• Eliminate anything that does not add value to the final product

Figure 2: Covertile cleaning process

Figure 3: Control slide library before re-organization

Figure 4: Control slide library reorganized

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• Remove all kinds of waste (time, money, movement, supplies, etc)

• Get a job done with less work, but the same (or better) quality

• Work smarter, not harder

• Improve efficiency

• Reduce stress and increase job satisfaction

Jamie Cahill, UNC IHC Tech, found the Lean program a very valuable experience commenting: “Implementing Lean practices in our laboratory has had a significant effect on me both in and out of work. My work days are more efficient and I can keep up with our increasing volumes without tremendous overtime and stress. This makes for a satisfying work environment and the positive effect spills over to my home life. At the end of my work day, I can rest assured that I have delivered the very best quality care to my patients and focus on my family without the constant worry that used to hang over my head about work matters. Using Lean has brought me quite a relief and I know my husband appreciates it as well!”

Figure 5: Triage Station in Histology

Figure 6: UNC Comment and Lean Communication Boards