Applying the principles of lean production to gastrointestinal biopsy handling: From the factory floor to the anatomic pathology laboratory

Jessica Z. Sugianto, Brian Stewart, Josephine M. Ambruzs, Amanda Arista, Jason Y. Park, Sandy Cope-Yokoyama, Hung S. Luu

Research output: Contribution to journalArticle

6 Scopus citations


Objectives: To implement Lean principles to accommodate expanding volumes of gastrointestinal biopsies and to improve laboratory processes overall. Design: Our continuous improvement (kaizen) project analyzed the current state for gastrointestinal biopsy handling using value-stream mapping for specimens obtained at a 487-bed tertiary care pediatric hospital in Dallas, Texas. We identified non-value-added time within the workflow process, from receipt of the specimen in the histology laboratory to the delivery of slides and paperwork to the pathologist. To eliminate non-value-added steps, we implemented the changes depicted in a revised-state value-stream map. Results: Current-state value-stream mapping identified a total specimen processing time of 507 minutes, of which 358 minutes were non-value-added. This translated to a process cycle efficiency of 29%. Implementation of a revised-state value stream resulted in a total process time reduction to 238 minutes, of which 89 minutes were non-value-added, and an improved process cycle efficiency of 63%. Conclusions: Lean production principles of continuous improvement and waste elimination can be successfully implemented within the clinical laboratory.

Original languageEnglish (US)
Pages (from-to)259-264
Number of pages6
JournalLaboratory Medicine
Issue number3
StatePublished - Aug 1 2015



  • Anatomic pathology workflow
  • Gastrointestinal biopsy handling
  • Histology laboratory
  • Laboratory processes
  • Lean principles
  • Process improvement

ASJC Scopus subject areas

  • Clinical Biochemistry
  • Biochemistry, medical

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