Pathology and "The Toyota Way"

[lipomas]

---

Members don't see this ad.

Has anyone else had this experience? I found myself chortling with delight when I starting hearing more and more about Toyota's troubles. Not because I was happy that the car maker was in trouble and all the people who bought cars had to deal with it, but because of what it said and meant about the whole "system." If you are like me, in residency you heard about Lean and Six Sigma and The Toyota Way and all that, as if it was some miracle cure for inefficiency and a great way for labs and pathology departments to put themselves at a competitive and safety advantage.

But now it turns out that Toyota cared more about success and money. All that other stuff was just window dressing that they tossed aside once it became standard practice and they got comfortable with it. They assumed that LEAN would prevent these problems. To me, it was no surprise that while LEAN can make good changes to a lab when they are first instituted, the benefits rapidly dissipate once instituted because workers simply fall into familiar patterns. Only this time, because it is under a LEAN system, there are as many if not more opportunities for failure because everyone thinks someone else is watching for errors.

Anyone else get Lean training? Any residents getting LEAN training now and is there any mention of this catastrophic set of Toyota failures? I would pay attention to these failures because they say an awful lot about Lean training.

 

[JPR22]

There was a recent AJCP article that talked about the LEAN implementation. We discussed it in journal club. I think as far as labs go, the implementation process can be very painful. Im not sure about the long term benefits.

 

[yaah]

Kind of an interesting point - I admit it crossed my mind too when I started hearing about Toyota's problems. Particularly with the most recent Lexus recall when they basically were clueless about the problem. So much of laboratory management is automation now, but still so many things can go wrong. It would be interesting to hear what actually happened at Toyota. Did they abandon Lean? Did they push it aside or marginalize it? Or did it just become second nature and comfortable so that it was no longer effective? Because if it is the latter, that is an important lesson to learn!

 

[Euchromatin]

Anyone else get Lean training? Any residents getting LEAN training now and is there any mention of this catastrophic set of Toyota failures? I would pay attention to these failures because they say an awful lot about Lean training.

I know the residents at Henry Ford Hospital get LEAN training because Dr. Zarbo, the chair (and I think he is USCAP president this year?), was one of the first pathologists to implement LEAN techniques in the management of their laboratory. I've also been in their lab, and, as a medical student (with n= several other labs I saw while on pathology rotations and quick tours of labs on interviews) it seemed extremely efficient, organized, and the lab staff was mostly pleased with how things were run. I heard Dr. Zarbo speak about the Toyota/LEAN techniques applied to the lab at a conference last fall, but that was before any of the fallout of these recalls had broken.

 

[Necromonger]

I am a resident at Henry Ford and the LEAN system seems to work very well. There isn't much wasted time and redo work to deal with (unless you screw something up on grossing). The sample turnaround is ridiculously fast. recuts ordered before about 11am usually come out before 4pm same day. The H&E slides are usually out the day after you gross a large (mid morning if it is standard and mid afternoon if it is a fatty, breast, or prostate). The turnaround time from grossing to final sign out generally less than 24 hours. If you get the fatty stuff in before 2pm, it comes out the next day mid-morning. If you need IHC, the turnaround is generally less than 24 hours.

This is good in surgicals because you generally don't have carryover going more than one day into your next rotation.

Dr. Zarbo has volumes of material on this process and will likely send it out to you or if your home department is interested, he has a very active speaking schedule on this topic.

FYI. The toyota problem is more of a quality control issue rather than a process issue, likely political within the organization. The Detroit media has been having a lot of fun with this one.

 

[lipomas]

I am not sure I would call any of that "ridiculously fast" turnaround time. I am in private practice and if I turn in levels before 11 am they are usually back in 2 hours. H&E slides are usually out by 9am, and sometimes an hour or two later if it is an exceptionally busy day, no matter what the type of specimen. We process over 50,000 surgical specimens a year.

I think where the lean type of stuff is much more important is in routine clinical path specimens - no wasted time. Basically everything is treated as a stat specimen. Many labs operate this way nowadays.

I agree the toyota problem is a quality control issue, but at the same time the whole purpose of their system is to improve quality control, and it failed massively. Your department may stay on top of things, particularly because so much of the department's reputation is vested in it, but we thought the same thing about Toyota now, didn't we?

 

[icpshootyz]

Toyota lost their LEAN way and got caught up in the same sales chart hype that bankrupted the American automakers. They used to be about providing quality products, then got excited about becoming the #1 world automaker and lost their focus. GM, Ford, etc have all fallen into this trap. Maybe this recent flop will wake Toyota up to restore their prior primary mission.

 

[Necromonger]

I am not sure I would call any of that "ridiculously fast" turnaround time. I am in private practice and if I turn in levels before 11 am they are usually back in 2 hours. H&E slides are usually out by 9am, and sometimes an hour or two later if it is an exceptionally busy day, no matter what the type of specimen. We process over 50,000 surgical specimens a year.

I think where the lean type of stuff is much more important is in routine clinical path specimens - no wasted time. Basically everything is treated as a stat specimen. Many labs operate this way nowadays.

I agree the toyota problem is a quality control issue, but at the same time the whole purpose of their system is to improve quality control, and it failed massively. Your department may stay on top of things, particularly because so much of the department's reputation is vested in it, but we thought the same thing about Toyota now, didn't we?

I can't speak intelligently about private practice turnaround times. The competing universities in our area end up with at least double the turnaround times (we hear this from their rotating residents and med students in pathology). My medical school had numbers similar to theirs. The upside is we don't have CAP breathing down our necks regarding turnaround times, even for autopsy.

 

[yaah]

I can't speak intelligently about private practice turnaround times. The competing universities in our area end up with at least double the turnaround times (we hear this from their rotating residents and med students in pathology). My medical school had numbers similar to theirs. The upside is we don't have CAP breathing down our necks regarding turnaround times, even for autopsy.

A longer turnaround time in a department with a residency program is often an indication of better resident training. Not always, but often. An extra day is often built in for resident previewing. Places that have quicker turnaround times will often say they also have "preview time" but this often consists of an hour or two in the morning before signout. You don't really know the benefits of extended preview time until you experience it. Of course, for a lot of trainees it doesn't make much difference because they don't use the time very well, but for most it is an added educational experience.

 

[lipomas]

I can't speak intelligently about private practice turnaround times. The competing universities in our area end up with at least double the turnaround times (we hear this from their rotating residents and med students in pathology). My medical school had numbers similar to theirs. The upside is we don't have CAP breathing down our necks regarding turnaround times, even for autopsy.

Yeah, but, as said above, you have residents, no? Having a quicker turnaround time doesn't help you at all. Sounds to me as though the competing universities have longer turnaround times because of resident training. Many academic centers have clinicians who understand this and accept it - they call the lab if there is a case they want turned around quicker or is more urgent to have an answer on. And in truth, having a quicker turnaround time of 1 day doesn't really impact clinical management in the vast majority of outpatient specimens. But that's neither here nor there because most of the clinical management impact depends on clinicians actually contacting the patient. It is better for a marketing standpoint to have quicker turnaround time - but as I said not good from a standpoint of resident teaching.

 

[Substance]

Thought-terminating cliches like "lean" have no place in medicine. Sure, the MBA suit types love to spout their buzzword-du-jour, but medicine is not about blind submission to corporate jargon. It is about diligence, not "productivity".

In any case, "lean" should only apply to the lab monkeys. It should not apply to the physicians or residents. A case should take as long as it needs to take.

"Lean" is just a stupid slogan that describes "being efficient". Why does that need a buzzword to explain it? Argh.

 

[yaah]

Thought-terminating cliches like "lean" have no place in medicine. Sure, the MBA suit types love to spout their buzzword-du-jour, but medicine is not about blind submission to corporate jargon. It is about diligence, not "productivity".

In any case, "lean" should only apply to the lab monkeys. It should not apply to the physicians or residents. A case should take as long as it needs to take.

"Lean" is just a stupid slogan that describes "being efficient". Why does that need a buzzword to explain it? Argh.

Lean principles have actually done wonders in many clinical path labs. There are ways that parts of it can be applied to AP too. I think it's all in how you look at it and being able to recognize the limitations as well as what you are doing.

In truth though, medicine from the perspective of the clinical lab IS about productivity to a large extent. Diligence is assumed.

 

[deleted314957]

A longer turnaround time in a department with a residency program is often an indication of better resident training. Not always, but often. An extra day is often built in for resident previewing. Places that have quicker turnaround times will often say they also have "preview time" but this often consists of an hour or two in the morning before signout. You don't really know the benefits of extended preview time until you experience it. Of course, for a lot of trainees it doesn't make much difference because they don't use the time very well, but for most it is an added educational experience.

I really agree with yaah.Our surgical path rotation (day-by-day) was #1 Frozen section, 2# Gross, #3 Read out your cases that you grossed (a prelim day) and #4 sign out cases with staff. In our 4th year on our last surg path rotation we signed out alone(but those were the good old days of the 70's and I don't think it could be done today). If there was a really "rush" case it would be "pulled" on your read day and you and the attending would handle it. Worked fine for many years.