Laboratory Redesign and Waste ReductionThe Authors’ Reply

Abstract

The recent description by Rutledge et al1 of laboratory redesign and waste reduction highlights the improvements achievable by using lean methods but also contains some cautionary advice that deserves amplification and explanation. The authors note that the lean project took an emotional toll on the staff, requiring a second project to address these issues, and resulted in the voluntary departure of at least 1 laboratory professional. Liker (see especially chapter 16),2 Spear and Bowen,3 Dickson et al,4 Zarbo et al,5 and many others note that an essential part of the Toyota Production System is the strong involvement of the “people who do the work” in any process change. Of the 6 members of the “lean” team that undertook the project described by Rutledge et al,1 4 were supervisors and a fifth came from “corporate headquarters”; only 1 team member was a front-line worker. This team proposed changes to the technologists via weekly meetings, with separate meetings to update laboratory and hospital administrators. The lack of sufficient peer representation on the improvement team and the separate presentations to staff and management no doubt had the effect of making the changes seem to be done to the laboratory staff, not by them. The Toyota Production System requires that changes be introduced as experiments. It is essentially the scientific method applied to improving clinical operations, quality, …