An Introduction to LEAN

By Blecker-Shelly, Deborah; Mortensen, Joel E. | Journal of Continuing Education Topics & Issues, August 2008 | Go to article overview

An Introduction to LEAN

Blecker-Shelly, Deborah, Mortensen, Joel E., Journal of Continuing Education Topics & Issues

Cincinnati's Children's Hospital and The Children's Hospital of Philadelphia are large, urban, tertiary care pediatric hospitals, each with more than 400 in-patient beds that serve patients from throughout the world. Some of the specialized pediatric services and programs offered at our institutions include fetal diagnosis and surgery, metabolic diseases, solid organ transplant, and pediatric eosinophilic disorders. In addition, our pediatric systems include a patient care network of primary and specialty care centers that serve ambulatory patients. The extensive patient population served contributes to some unique clinical and laboratory challenges, including antimicrobial susceptibility testing (AST). Identifying a reliable, cost effective and efficient susceptibility testing regimen for our pediatric patient populations that also provided clinically useful data was necessary for both of our laboratories.


LEAN thinking and Six Sigma have been utilized by manufacturing industries to decrease cost and improve quality and productivity by reducing variation and production defects. Because of the dramatic successes in manufacturing, there is rising interest in the healthcare industry about institutions implementing LEAN to accomplish such goals as decreased wait time in the Emergency Room, improved bed capacity, and decreased wait for patient phlebotomy and laboratory services. In this article, we will discuss the basics of LEAN, a bit of Six Sigma, and suggest how to apply the concepts to the microbiology laboratory in order to work "smarter," more cost-effectively, and provide timely clinically relevant accurate results.


Process improvement initiatives have been in existence for quite some time and include continuous quality Improvement (CQI), Process Improvement (PI), Quality Assurance (QA), Quality Management (QM) and Re-engineering. In the mid-1900s, the term Six Sigma was coined by a Motorola Engineer, Bill Smith, to describe a new quality control process that emerged from the Total Quality Management (TQM) strategy and was very successful in improving profits. LEAN was founded by Taiichi Ohno in the 1950s and arose from the Toyota production System with key aspects including the never-ending quest for perfection, continuous search to eliminate waste and the recognition and importance of employee contributions.

Why do we now care?

The 1999 Institute of Medicine report "To Err is Human" began much discussion on how to reduce errors in the healthcare setting and resulted in an increased focus on improving patient safety. In the clinical laboratory, the challenge to provide accurate and useful test results was compounded by a decreasing and aging medical technologist population and reduced provider payments. In the laboratory, we responded by creating core and STAT laboratories with consolidated services, cross-trained technologists and automated methodologies. What's left to do? To further increase quality and accuracy, and reduce expenses, process improvement is needed.

Implementing LEAN

Meeting the needs of the customer is a vital component of LEAN and Six Sigma. The goal is to reduce, if not eliminate, unnecessary, time-consuming steps that are not Critical to Quality (CTQ) for the customer (patient, family, physician, nurse, administrator). There is much overlap in LEAN and Six Sigma processes, but basically, Six Sigma is data driven and makes use of a structured, focused approach and statistical tools to find the root causes behind problems and to drive processes toward near-perfection. LEAN is meant to streamline processes and eliminate unnecessary, time-consuming steps or "waste" (see box below). LEAN standardizes work flow and as a result, decreases variation, a common cause of error. A hybrid between a Six Sigma project and LEAN combines aspects of both methodologies. Do LEAN first, then the process problems will be easier to identify. …

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