Error-free pathology: applying lean production methods to anatomic pathology

By definition, "lean" refers to thin or sparse. In business, this word may have a negative connotation. The idea of "trimming the fat" or streamlining usually evokes the elimination of jobs. Employees therefore do not favor such techniques. At Toyota Motor Company, however, employees embrace "lean" as a work philosophy. This work ethic has developed through trial and error and evolved into the successful business practice known as the Toyota Production System (TPS). Lean methods, which include Six Sigma, strive to eliminate waste from a system. How this aim is accomplished varies among different methods, but one of the ultimate goals is a system that generates zero defects or errors. Is error-free pathology possible? The authors think it is. If we do not challenge the current system and strive toward zero errors by experimentation, how will we know what is possible? This article is intended to share the authors' experiences in applying a lean production method to their anatomic pathology department, not only to reduce pathology errors to zero but to change a "blame culture" to one in which frontline staff members become effective problem solvers and the source of system improvements.