Improving Papanicolaou test quality and reducing medical errors by using Toyota production system methods

Objective: The objective of the study was to determine whether the Toyota production system process improves Papanicolaou test quality and patient safety. Study design: An 8-month nonconcurrent cohort study that included 464 case and 639 control women who had a Papanicolaou test was performed. Office workflow was redesigned using Toyota production system methods by introducing a 1-by-1 Continuous flow process. We measured the frequency of Papanicolaou tests Without a transformation zone component, follow-up and Bethesda System diagnostic frequency of atypical squamous cells of undetermined significance, and diagnostic error frequency. Results: After the intervention, the percentage of Papanicolaou tests lacking a transformation zone component decreased from 9.9% to 4.7% (P = .001). The percentage of Papanicolaou tests with a diagnosis of atypical squamous cells of undetermined significance decreased from 7.8% to 3.9% (P = .007). The frequency of error per correlating cytologic-histologic specimen pair decreased from 9.52% to 7.84%. Conclusions: The introduction of the Toyota production system process resulted in improved Papanicolaou test quality. (c) 2006 Mosby, Inc. All rights reserved.