Histopathology business improvement strategy
Histopathology services play a vital part in cancer diagnosis for the majority of tumour streams. Fast, accurate histopathology is crucial in finding cancer early, diagnosing it correctly, and choosing and monitoring the best treatment for each patient.
In New South Wales (NSW) and across Australia, there is a
growing shortage of tissue pathologists. This shortage is placing
histopathology departments under pressure. In response to concern
from the Royal College of Pathologists of Australasia (RCPA) about
the shortage of tissue pathologists, the Cancer Institute NSW
investigated whether process improvements could be made in order to
relieve pressure on histopathology services.
The first step in this project was to engage an external
consultant, Amica Consulting Pty Ltd, to conduct a pilot project at
a public metropolitan histopathology department.
This pilot project identified opportunities to reduce turnaround
times - the time taken between the collection of a specimen and
reporting of results - even though core processes were consistent
with best practice.
Building on the outcomes of the pilot, the consultants were then
engaged to undertake a validation project, with three
components:
- Diagnostic analysis: repeating the pilot at a regional public
histopathology laboratory and to develop processes and methods
applicable to all laboratories;
- Process improvement: implementing the program of improvements
at the public metropolitan histopathology laboratory that had been
identified during the pilot; and
- Management operating system: developing a management operating
system for potential deployment to other laboratories across
NSW.
During the project, quantitative data was collected and analysed
to establish a baseline performance from both sites. Staff members
at each facility were also actively involved in mapping laboratory
processes and identifying opportunities for improvement.
In the validation phase, suggested solutions were tested and the
management operating system was implemented and changes in
performance were monitored.
Key Findings
The key findings of the pilot project were:
- A strong case for change: Even though core processes were
consistent with best practice and turnaround times matched those of
similar Australian public laboratories, there are still
opportunities to reduce turnaround times;
The key improvement opportunities were:
- Reducing the proportion of cases missing cut‐off times for the
next process step
- Accelerating the progress of medium‐sized samples
There were few mechanisms to actively manage turnaround, meaning
that the scope to manage the progress of a case through the
laboratory was limited.
The key findings and outcomes of the validation project
were:
- Similar opportunities identified: The diagnostic analysis at
the regional public laboratory (where core processes were again
consistent with best practice) identified similar opportunities to
the metropolitan facility to reduce turnaround times by
streamlining process steps for cases.
- Streamlining workflow: The process improvement program at the
public metropolitan laboratory streamlined workflow by minimising
interruptions, improving use of space, rationalising code structure
and reducing opportunities for error.
- New guidelines trialed: The process improvement program
established agreed turnaround time guidelines for all categories of
histopathology samples and implemented a number of changes that
will enable immediate gains to be made.
- Better systems management: The development of a management
operating system enabled the flow of cases through the laboratory
to be better monitored and provided generic formats for the use of
KPIs.
Applicability of findings to other pathology services
Pathology services in Australia are provided by both the public
and private sectors. Public laboratories are based in public
hospitals. Private laboratories are predominantly community based,
carrying out tests at the request of GPs, private hospitals,
contracted arrangements with some public hospitals and
community-based specialists.
Whether privately or publicly owned, most histopathology
services are located in large centralised laboratories in capital
cities. These laboratories are commonly associated with a network
of smaller regional laboratories, often located within hospitals
(public and private) or satellite laboratories.
The project methodology and generic solutions developed during
this project are likely to be applicable in similar public
laboratories statewide.
However, the following challenges will influence future rollout
initiatives beyond the project sites:
- Centralised reporting: The network structure of pathology
services in NSW limits the scope for centralised reporting. Each
pathology service tends to use methods that best suit them
locally.
- Consistent information: Partial privatisation of pathology
services in NSW has resulted in the lack of uniformity of
information systems.
- Consistent data: The lack of common procurement systems makes
it difficult to standardise data, information and operating
systems.
- Customer requirements: Pathology services are also driven by
customer requirements, resulting in a diverse reporting
environment.
This report describes the findings and outcomes of the pilot and
validation projects.
