Process Improvement Coming to Healthcare

New publication by Institute of Medicine recommends continuous improvement mindset

CEO SUMMARY: One new byword coming to healthcare in the United States is the “continuously-learning healthcare system.” At the upcoming Lab Quality Confab in San Antonio next month, lab managers and pathologists can learn more about how to achieve and sustain continuous improvement in their laboratory organization. Pathologists and lab managers who have been active practitioners of Lean and process improvement will be interested to learn about this new national call to action by the IOM.

IT APPEARS THAT CONTINUOUS IMPROVEMENT IN HEALTHCARE IS POISED to become the next policy priority of health policymakers. For many Lean and Six Sigma practitioners in the nation’s laboratories, this is welcome news.

Powerful evidence of this development is the publication of a study titled “Best Care at Lower Cost: The Path to Continuously Learning Health Care in America” by the Institute of Medicine (IOM). The report was issued on September 6, 2012.

If this IOM report gets the same attention as “To Err Is Human” did back in 1999, then major changes lie ahead for all providers, including clinical labs and pathology groups. Among other things, this new IOM report declares that “by one estimate, roughly 75,000 deaths might have been averted in 2005 if every state had delivered care at the quality level of the best performing state.”

Similarly, “To Err is Human” estimated that between 44,000 and 98,000 hospital patients died each year due to medical and other errors. Thus, the authors of “Best Care at Lower Cost” are putting down the same marker: patient lives are at stake if the healthcare system fails to drive out the sources of errors and mistakes that directly contribute to unnecessary deaths of patients.

Lab administrators and pathologists should consider publication of this IOM report as the opening round of a national campaign designed to move hospitals, physicians, and all providers to adopt and embrace an organizational culture of continuous improvement.

The key term you are going to hear more about is the “continuously-learning healthcare system.” This term is salted throughout the IOM report. Clinical laboratory testing may be front and center in the effort, as one example cited by the study’s authors focuses on the patient experience with lab test results.

In one of its illustrations, the IOM report notes two facts about patients and lab tests. First, “20% of patients reported that test results or medical records were not transferred from one place to another in time for an appointment.” Second, “25% of patients said their healthcare provider has had to re-order tests to have accurate information for diagnosis.” (No source study identified).

However, the IOM pointed out that, “in other industries, online banking allows customers to view their entire financial history and conduct transactions in seconds.” This contrast in how con- sumers access banking information versus getting lab test data and other diagnostic results is a direct challenge to healthcare providers.

A New Management Culture

In a concluding statement, authors of the IOM report wrote “The entrenched challenges of the U.S. healthcare system demand a transformational approach.” They urge providers to adopt continuous improvement techniques and embed this management approach into the organization’s daily culture.

The good news for many clinical laboratory administrators and pathologists is that their respective lab organizations already have established some type of ongoing process improvement or continuous improvement program. Often these programs are anchored in the methods of Lean, Six Sigma, and a quality management system (QMS) like ISO 15189.

Further, there are many examples of hospital or health systems where the clinical laboratory was first to adopt Lean and process improvement methods in its workflow. As the benefits from these improvement projects became known, the lab’s process improvement team was often asked to work with other clinical service departments within the hospital.

Learning about Lean

For lab managers and pathologists wanting to learn more about continuous improvement, the upcoming Sixth Annual Lab Quality Confab will take place in San Antonio, Texas, on November 6-7. (Visit More than 50 speakers will participate in 40 sessions—all focused on effective use of Lean and process improvement methods.

For example, at Henry Ford Health, in Detroit, Michigan, the anatomic pathology department is working to achieve the Lean goal of single piece/small batch workflow in both the histology laboratory and with the surgical pathologists. Richard Zarbo, M.D., Chair of Pathology & Laboratory Medicine, will speak about the remarkable progress his team is making to achieve this goal.

One lab that is a leader in the deployment of QMS is Laboratory Corporation of America. LabCorp now has five lab sites accredited to CAP 15189. Kathy McCloy, Quality Assurance Director, will conduct a special session to share how the adoption of the 15189 QMS is helping these five 15189-accredited labs reduce errors, speed lab test turnaround times, and better meet client expectations.

Head Start at Lab Confab

Given publication of this new IOM report, it would be timely for all clinical labs and pathology groups to send their management and staff leaders to Lab Quality Confab next month. It is a unique opportunity for them to acquire needed skills while learning from case study presentations and networking with other lab professionals already committed to achieving the continuous learning culture in their labs.


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