Both the clinical laboratory and the pathology laboratory have cut TAT and error rates

It is perfect irony that the Department of Pathology and Clinical Laboratory Medicine at the Henry Ford Health System is among the most effective Lean practitioners in the world of medical laboratory testing. That’s because Lean techniques were developed by Toyota Motor Corporation, which itself based its Lean management methods on its study of Henry Ford’s groundbreaking innovations at his auto manufacturing plant in Detroit.

Thus, the current use of Lean methods at the clinical laboratory at Henry Ford Health System means that these management tools have come full circle. Today, the laboratory at the hospital in Detroit that bears Ford’s name has adopted methods used in auto manufacturing to improve the lab’s processes.

Richard Zarbo, M.D., DMD, is President of the United States & Canadian Academy of Pathology (ASCAP), and Senior Vice President and Chair of Pathology and Laboratory Medicine at Henry Ford Health System in Detroit. (Image sourced from

Pioneering Lean in Laboratory Medicine

Richard Zarbo, M.D., DMD, Chairman of Pathology and Laboratory Medicine at the Henry Ford Health System in Detroit, is one of the early pioneers in applying quality techniques and principles of Lean manufacturing to laboratory medicine. Since 2005, Zarbo has adopted best practices from the auto industry to achieve remarkable gains in efficiency and turnaround times, according to an article by Christine Tierney and Melissa Burden in The Detroit News.

After joining the Henry Ford Health System in 1987 as a surgical pathologist, Zarbo studied the work of W. Edwards Deming, a statistician, professor, author, lecturer, and quality consultant whose principles were adopted by the Toyota Motor Corporation when it developed the Toyota Production System.

As a result of introducing the Toyota Production System, the clinical laboratory at the Henry Ford Health System cut turnaround time (TAT) for results in its core lab from six to four hours, the newspaper reported. In 2009, TAT at the Henry Ford lab was the subject of an article titled “Using Lean at Henry Ford Transforms Pathology TAT” in The Dark Report.

In the Detroit News article, the writers reported that in 2008, the clinical laboratory was sending 74% of test results for specimens that arrived by 5 p.m. to referring physicians by midnight, and 99% of these results were sent to physicians by 6 a.m. the next day. By this past Spring, the clinical laboratory was processing outpatient specimens that arrived by 5 p.m. much more quickly. Results on 85% of tests were sent to referring physicians by 8 p.m. and 98% were sent to physicians by midnight, the newspaper said.

Faster TAT is due in part to the elimination of wasteful procedures—a hallmark of Lean production systems. The number of steps involved in producing a test result (i.e., from taking a patient sample to delivering the result to a physician) were slashed from 35 to 24, the newspaper reported. Also, the clinical laboratory halved the time to get results from blood drawn from outpatient clinics from six-to-10 hours to three-to-five hours.

In addition to improving TAT, Zarbo and his staff cut the defect rate in the histology laboratory as well. In 2006, the lab averaged 50 such defects a day. By 2007, the rate was 30 per day, and by 2008, the rate was five per day. Using barcode technology helped the pathology laboratory cut misidentified samples by 62%, and glass slide tissue misidentifications by 95%.

Process Improvement Techniques Lead to Significant Results

In a medical laboratory as big as at Henry Ford Health System, any process improvements are significant. The lab employs 785 staff members and runs 11.5 million tests annually.

To get some perspective on these enhancements, Tierney and Burden quoted Jeffrey K. Liker, a Professor of Industrial and Operations Engineering at the University of Michigan, and author of The Toyota Way: 14 Management Principles from the World’s Greatest Manufacturer (McGraw-Hill, 2004). “The numbers they’ve been able to achieve [at Henry Ford’s medical laboratory] are world-class,” Liker said. “They’ve gotten to such a low level of errors, and the turnaround time—from the time the test is taken to when the results are sent back to the doctor—is almost always within the same day.”

It is significant when a major newspaper like the Detroit News chooses to recognize the management and operational innovations of a major health system medical laboratory such as at Henry Ford Health System. Too often both the clinical laboratory and the anatomic pathology department go unrecognized, even though in many hospitals across the nation, it was the clinical laboratory that was first to adopt and successfully use Lean techniques and process improvement methods. Thus, the accomplishments of the team at the medical laboratory of Henry Ford Health System should get full recognition—both in Detroit and across the United States.

–Joe Burns

Related Information:

Henry Ford looks to auto industry for lab efficiency

Using Lean at Henry Ford Transforms Pathology TAT

The Henry Ford Production System: Measures of process defects and waste in surgical pathology as a basis for quality improvement initiatives

The Henry Ford Production System: Effective reduction of process defects and waste in surgical pathology