Continuous Improvement in the Clinical Laboratory

Frequently, as managers of medium and high throughput laboratories, we are faced with challenges that lead us to change and improve the processes.

The demands of the health environment, most of them common to almost all systems, such as being increasingly efficient, reducing costs, and achieving best practices, are not external to our operation. On the contrary, those demands are so frequent that they generate permanent interest and motivate us by triggering changes and improvements in our laboratories.

Thus, in an increasingly evolving environment, laboratories are not exempt from change. We have heard it said that ‘the only constant is change’ and this tends to become increasingly real in the conditions of clinical laboratories. Especially considering that technological renewal is faster than ever and automatization, as well as specialization of services, are almost mandatory. If we do not want to appear to be stuck in time or be put out of business, out of the market, or using obsolete methodologies that take us away from the necessary precision, specificity, and sensitivity we need to lead changes and make improvements.

This is how in the case of laboratories, the drivers of change, in addition to those above, are also the need to update technologically, the limited physical infrastructure, and the need to make better use of our team’s skills.

Ironically, our staff is trained to focus on details, which contributes to the highly precise work that they do every day. On the other hand, their profiles also make it more difficult for them to face changing situations that could result in innovative practices. However, what appears to be a disadvantage, offers us the opportunity to understand all the risks involved in improvement processes, based on the point of view of highly trained teams who know the operation in detail.

An important part of the work of managers and decision-makers in the labs is to be able to take advantage of the valuable input and information we receive from our teams. Managers should analyze this information in the light of their comprehensive view to extract from this the best solution that fits their lab, as much as possible, with both perspectives.

However, what are the key factors of change for improvement in the clinical laboratory?

This article will try to present what, in my view, are the main key factors from my experience as a medical director of this service for more than ten years, many of them applicable to other health service improvement processes:

1. Involve your team, and by involving, I mean mainly two aspects: the first relevant aspect is listening. Include the divergent position that many will have, as well as the day-to-day needs of the people in the area of interest. I suggest listening with an open mind that can contribute to understanding the problem.

The second relevant aspect is to be open-minded to possible solutions that the team may bring up.

Please keep in mind that I am not saying that we have to leave our comprehensive perspective. Instead, I am asking you not to forget that those who are in front of the processes may have perfectly applicable, much simpler solutions and innovations that can easily fit with our general improvement objective.

Thus, listen to them, listen to their objections and understand them, do not fail by making decisions that are isolated from the reality of your teams. If you must decide against it, which sometimes happens, you will need to be clear about all the risks and consequences after having listened to their point of view.

2. Take advantage of other’s experiences. Most of the time, we tend to close ourselves off and think that our problems are unique and our circumstances different and therefore, it is impossible to be compared to other labs. In my opinion, most of the time, it is not true.

Thinking out of the box helps us to take advantage of others’ experiences and to learn from solutions designed to solve similar problems. We just have to adapt them to our own contexts.

Sharing experiences and knowledge does not jeopardize what we do, as some may imagine. I truly believe that in a framework of trust with our colleagues and with the laboratory industry (which we must be able to build), we can be open and share experiences in a mutual benefit scheme (win/win), that can be very useful if it is preceded by an honest business environment.

3. Allow yourself and your team to adjust the path of improvement. Although in our context, sometimes failures are not well tolerated, especially due to the impact on costs that they may have; we must be able to establish ‘pilot mode’ work schemes that allow us to test ourselves and fail. Improvement processes, such as the implementation of new tests, have steps of verification or validation that give us the opportunity to measure performance in similar scenarios to real ones, assuring better results.

4. Do not expect perfection: another characteristic of laboratory teams is to want everything to be perfect, as our test results and rules of 6-sigma demand. However, in real life and especially in the improvement of processes, most of the time we must operate with certain flaws that can be efficiently corrected. Do not forget that improvement is a cyclical process in which you have to start over permanently.

5. Remember to measure the impact. Sometimes in the labs, we have several changes in progress simultaneously: infrastructure changes, the launch of new methodologies, automatization, technological modernization, the opening of new services, and more. For this reason, it is relevant to measure the impact of every improvement action that we carry out. To do that, we have at hand any of the quality methodologies that have been proven so many times. Ensuring that all projects are measured, checking their impacts, and making the necessary changes, is a critical part of the improvement process.

Even though these steps seem very simple, I would like to invite you to evaluate by asking yourself the following question: How many of the items above do you do in a standardized way to lead the process of continuous improvement in your laboratory?