Transforming to a Quality Culture The Henry Ford Production System

We describe the cultural transformation of the surgical pathology laboratory at Henry Ford Hospital, Detroit, MI, to one that has adopted an expectation for empowered workers to see their daily work in the context of continually learning and making effective process improvements that are designed and tested by the scientific method. This transformation has been achieved by creating an organizational and educational framework for implementing guiding principles originally systematized as the basis of lean manufacturing by our founder, Henry Ford, at the turn of the century, and incorporating the innovations of the Toyota Production System. We present novel data collection techniques to establish baseline states by which to gauge the success of changes and lessons from rapid process improvement studies. Herein, we share our experiences, lessons learned, and successes to date in the pathology-based Henry Ford Production System. We do not make changes for the sake of making them, but we never fail to make a change once it is demonstrated that the new way is better than the old way. We hold it our duty to permit nothing to stand in the way of progress. —Henry Ford1 The Laboratory as Production Line In a sense, the pathology laboratory is a production line dedicated as much to reverse manufacturing, that is, reducing human parts into their basic components for analysis, as to then manufacturing or synthesizing those pieces of data back into an informational product for subsequent therapeutic decision making. Yet, surgical pathology laboratories struggle to consistently meet 2-day turnaround times for this only product. Not even 80% of the simplest of routine biopsy specimens were completed in 1 working day in the 1993 College of American Pathologists Q-Probes study performed by 525 surgical pathology laboratories.2 Despite the throughput and efficiency pressures of modern health care delivery, that performance level in biopsy turnaround time in our own laboratory has remained largely unchanged in the subsequent 13 years. The focus on quality improvement in anatomic pathology during the last 17 years has been on the identification of benchmarks of performance that describe current practice and has attempted to satisfy accreditation requirements for continuous quality improvement.3 This often has meant striving to perform at median or mean benchmark performance levels. Multi-institutional, peer-derived goals, like Q-Probes or QTracks, often set the bar too low, aiming to match mediocre performance, and are without granular data allowing insight for laboratory leaders to recognize and adopt best practices.4 Transforming to a Quality Culture The Henry Ford Production System Richard J. Zarbo, MD, DMD, and Rita D’Angelo, MS, ASQE, SSBB