The Henry Ford Production System: LEAN Process Redesign Improves Service in the Molecular Diagnostic Laboratory Milena Cankovic, Ruan C. Varney, Lisa.

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The Henry Ford Production System: LEAN Process Redesign Improves Service in the Molecular Diagnostic Laboratory Milena Cankovic, Ruan C. Varney, Lisa Whiteley, Ron Brown, Rita D'Angelo, Dhananjay Chitale, Richard J. Zarbo The Journal of Molecular Diagnostics Volume 11, Issue 5, Pages 390-399 (September 2009) DOI: 10.2353/jmoldx.2009.090002 Copyright © 2009 American Society for Investigative Pathology and Association for Molecular Pathology Terms and Conditions

Figure 1 Process map for tissue-based molecular testing: phase I (wasteful phase)—baseline measurements were defined and establishing customer- supplier relationships were established; phase II (leaner phase)—LEAN process improvements were implemented across different disciplines; phase III (leanest phase)—several “Rapid Process Improvement” modifications were added to the initial LEAN work flow to further increase efficiency. LEAN process improvements in histology and molecular pathology resulted in creation of a unidirectional work flow, greatly reduced testing times, and elimination of extra steps. The Journal of Molecular Diagnostics 2009 11, 390-399DOI: (10.2353/jmoldx.2009.090002) Copyright © 2009 American Society for Investigative Pathology and Association for Molecular Pathology Terms and Conditions

Figure 2 Comparison of regional laboratory specimen volumes. Baseline measurements were performed for 12 months, January to December 2007, and 28 blood specimens were received during that time period. Follow-up measurement was done for 5 months, March to July 2008 (a total of 69 blood specimens were received). The Journal of Molecular Diagnostics 2009 11, 390-399DOI: (10.2353/jmoldx.2009.090002) Copyright © 2009 American Society for Investigative Pathology and Association for Molecular Pathology Terms and Conditions

Figure 3 Quarterly average testing turnaround times in the molecular pathology laboratory in 2008. These TATs are estimations of average times (in business days) from the time a testing request was received until results were ready for signing out. KRAS, KRAS mutation detection; TRANS, quantitative RT-PCR assays for detection of t(9;22) and t(15;17) translocations; LOH, 1p/19q loss of heterozygosity; MGMT, MGMT promoter methylation detection; EGFR, epidermal growth factor receptor exon 19 and exon 21 mutation detection; JAK2, JAK2 mutation detection; BCGR, B-cell (IgH) gene rearrangement; TCGR, T-cell receptor γ gene rearrangement. The Journal of Molecular Diagnostics 2009 11, 390-399DOI: (10.2353/jmoldx.2009.090002) Copyright © 2009 American Society for Investigative Pathology and Association for Molecular Pathology Terms and Conditions