If you haven’t seen my previous two posts, I would recommend you start with TIP 1: Understand What Digital Pathology REALLY is and then TIP 2: Identifying Competitive Advantages with Digital Pathology and then proceed with Tip 3 below.

Tip 3: Build a Business Case

A business case is the foundation, a plan for success, disguised as a report.  A business case will explain and illustrate why digital pathology is worth doing now and will identify the consequences of not doing it now.  A project like digital pathology needs attention and must be throughly thought out.   To start you’ve got to have a clear understanding of where you are going; what the end will look like.

Let’s begin with the end in mind.

-Stephen Covey, Seven Habits of  Highly Effective People

Your business case should have the following elements:

• An answer to the Who, What, When, Where, Why, and How (5WH) of digital pathology:  When I consult with clients I often start with creating a detailed answer to the 5W’s and an H, it’s called my 5WH Program.
• A Problem Statement: It’s your elevator pitch- simple and concise.  Articulate the problem(s) that digital pathology will solve.   Based on the size of the project you may have more than one problem statement, however you should limit it to no more than three.  Table the others and use them in the future.
• A Project Scope:  You must clearly define the boundaries of your work.  Do not let scope creep occur; where other ideas or tasks are added on that dilute the ability for the original project plan to be successful.  Stick to the plan!
• Goals and Objectives:  Goals are general statements of a long-range purpose. Goals should directly address needs. Goals are outcome and not process oriented. They clearly state, specific, measurable outcome(s) or change(s) that can be reasonably expected at the conclusion of the project. Objectives state the results (not the activities) to be achieved, and includes a time frame, target of change, specific results to be achieved, method of measuring the results, and criteria for successful achievement. Objectives, when accomplished, lead to the goal. Objectives should be stated in ways that describe what you will do and how you will do it.
• Roles and Responsibilities:  Roles typically are task oriented, leadership, or social roles.  Task oriented and leadership roles are pretty straightforward, however social roles bring people in to handle the personal dynamics of a team.   For example the “harmonizer” mediates differences between group members.  Responsibilities should be specific, clearly defined, realistic and support the role.

You can also include information and key points from identifying competitive advantages (TIP 2) and your ROI strategy (TIP 3) which I will discuss next week.

I am in the process of accomplishing one of my new years resolutions to become Black Belt certified in Lean Six Sigma. I am two thirds of the way done. I became certified as a Six Sigma Green Belt in April and Lean certified in June; both with a focus in healthcare.  I am currently in the process of taking my black belt course and working on a project for certification.  These days Lean Six Sigma methods are constantly running through my head and I have applied several methods to my consulting work.

The power of Post-It's and moveable whiteboards!

One of my favorite tools are Post-its and take anywhere, disposable white boards.  I use them on-site with clients and I also use them in my office, ALL over my office.  So in an ongoing effort to immerse myself more in Lean Six Sigma for the lab I turned to one the leaders of Lean Six Sigma in pathology, Henry Ford Hospital.

Dr. Mark Tuthill, Division Head of Pathology Informatics, was kind enough to give me a tour and WOW was I impressed.  Yes.. it was a big WOW! My last blog post was about creating WOWs instead of waiting for them to happen.  This is exactly what Henry Ford’s department for Pathology and Laboratory Medicine has done and continues to do, because striving to improve is never complete!  You know from the moment you enter the department you have walked into a remarkable place.  Placards are prominently displayed with powerful messages including:

Every Life Deserves World-Class Laboratory Service”

Lean Six Sigma is a management philosophy and their department is lead by prominent pathologist Dr. Richard Zarbo, who clearly embraces the power of Lean Six Sigma.  The entire department is involved and committed to continuous improvement; a fact that would make their founder, and the father of Lean, Henry Ford proud.

Here are some of my take-aways from my visit.

• Silence is golden! Dr. Tuthill brought to my attention, while standing in the gross lab, how quiet everything was. This quite and calm environment continued throughout the AP lab too.  The department has moved away from transcription and voice dictation and developed templates that integrate into their LIS.
• Process improvement takes time and really is continuous. This is a fundamental of Lean Six Sigma but was reinforced throughout my department tour.  White boards are all over to illustrate how new processes are mapped, monitored, and certain boards engage employees to document defects on an ongoing basis.  Defects, as defined in their publication “Effective Reduction of Process Defects and Waste In Surgical Pathology,” are forms of waste including flaws, imperfections, or deficiencies in specimen processing that required work to be delayed, stopped, or returned to the sender.  Here are some pictures of their whiteboards and process flow charts:

Gross Room: Process Flow Chart

Defect Tracking

• A very visual environment. Everything, and I mean EVERYTHING was labeled- even gauze.  The department loves 5S and Kanbans and you can tell.  You never have to question where something is, where it should go, or if there is more available.  It’s a straight forward concept but is your lab like that?
• A foundation for success! Henry Ford has been working hard to prepare their lab and department for their digital future over the past few years (while also reducing costs, improving patient safety, and laboratory efficiency). Their entire process is barcoded from accession to sign-out.  The laboratory uses barcode technology from General Data, and even assigns barcodes to requisition forms that are scanned to eliminate paper in the lab.  The gross lab is set up with a Milestone gross imaging system,  digital cameras are mounted on grossing tables and pathologists microscopes.  The cameras are then connected via a TWAIN interface to PathPacs, their middleware software by Apollo.  PathPacs is integrated with their Sunquest CoPath Plus LIS and allows the pathologist to choose and select images to be in the LIS and reports.

Can you guess their next step for their digital future? Digital Pathology!   With the foundation described above, a Lean Six Sigma culture, and a management team with vision I have no doubt that they will be successful.  Thank you Henry Ford Hospital for your level of excellence, you truly are a gold standard.

A few weeks ago I blogged about New Year resolutions and declared resolution #1: A New Attitude.  Every month in 2011 I will declare a new resolution and for February it is to get LEAN and share the process with all of you.  This may sound like a typical resolution to loose weight (that would be nice too), however I am referring to Lean in the form of Six Sigma for healthcare.

I am very excited to announce that I have been accepted into a Villanova University Six Sigma Black Belt Master Certification program with a focus in healthcare.  My program begins March 1 and it will be a 32 week online program broken up into three distinct courses:

• Six Sigma Green Belt Healthcare: Effectively collect and analyze data, lead and execute process-level improvement projects, apply critical skills necessary to successfully lead project teams, and generate incremental revenue opportunities.
• Lean Six Sigma: Apply Lean Six Sigma in any type of business or industry. Create a shorter cycle time for production, implement faster response time for services, and lower costs to provide products and services. Improve customer satisfaction and increase productivity from fewer resources.
• Lean Six Sigma Black Belt: Master the Six Sigma core concepts and measure process inputs that affect customer satisfaction. Analyze process parameters using statistical and non-statistical techniques including how to lead and coach quality improvement initiatives. Understand variation and process behavior.

The use of Lean/Six Sigma methods for process improvements in biopharma, clinical, and anatomic pathology is growing in popularity and will become even more important as digital pathology solutions are integrated into the AP workflow.  Improvement in quality, productivity, and a reduction in costs are essential to justify the use of digital pathology for clinical use. In an article from the Dark Daily titled “Lean and New Diagnostic Technologies Fuel Innovations at the Pathology Department at University of Nebraska-Omaha” lab manager David Muirfield said,

…the anatomic pathology department is now capable of reporting a significant number of cases on a same-day basis. The ongoing quality improvement program is delivering continual improvements in turnaround time and quality. The increased productivity also produces worthwhile cost savings.

Six Sigma’s data-driven approach and methodology for eliminating defects combined with the Lean Six Sigma teaching of Total Quality Management (TQM) will be very beneficial to all my customers and produce significant savings.  According to the Six Sigma Academy, professionals with Black Belt certification save companies approximately $230,000 per project and can complete four to six projects per year. For example, General Electric saved $10 billion during its first five years of Six Sigma implementation.

I look forward to sharing my certification process and publishing new knowledge about the use of Six Sigma/Lean in laboratory medicine and for digital pathology.  I hope you will find the the information helpful too!