Lean Management: Review of Lean Consciousness for the Clinical Laboratory

  • Praveen Prakash Department of Pathology, Hindu Rao Hospital, Delhi
  • Arpita Joshi Department of Pathology, Hindu Rao Hospital, Delhi
  • Aarzoo Jahan Department of Pathology, Hindu Rao Hospital, Delhi
  • Santosh Kumar Sharma Department of Pathology, Hindu Rao Hospital, Delhi
  • Shakti Kumar Yadav Department of Pathology, National Cancer Institute, Jhajjar, All India Institute of Medical Sciences, New Delhi
  • Ruchika Gupta Division of Cytopathology, ICMR-National Institute of Cancer Prevention and Research
  • Harsh Vardhan Singh Department of Biochemistry, Hindu Rao Hospital, Delhi
  • Namrata Sarin Department of Pathology, Hindu Rao Hospital, Delhi
  • Sompal Singh Department of Pathology, Hindu Rao Hospital, Delhi
Keywords: Clinical Laboratory, Healthcare, Lean Management


Lean management is a work philosophy of continuous improvement to achieve a smooth work flow by minimizing all kinds of waste including time, cost and manpower. The concept of lean management started as early as 1980’s and was soon adopted by production industry. However, incorporation of this concept in healthcare has been very gradual and hesitant, though lean heath care has immense potential to improve operational performance. A clinical laboratory, which is essential in practice of evidence-based medicine, can be efficiently managed using lean management concept. Only a few publications in English literature have studied the effect of implementation of lean management in a clinical laboratory. There are certain challenges that a health care manager is likely to face in the implementation of lean management in clinical laboratory especially in developing nations. The present review discusses the implementation of lean management in a clinical laboratory with identification of various steps which require lean thinking.

Author Biography

Sompal Singh, Department of Pathology, Hindu Rao Hospital, Delhi
Specialist Pathologist, Dept. of Pathology, N.D.M.C. Medical College & Hindu Rao Hospital, Delhi


Anvari, A, Zulkifli, N, Yusuff, RM. A dynamic modeling to measure lean performance within lean attributes. The International Journal of Advanced Manufacturing Technology. 2012;66:5-8.

Santos EF, Lima CAC. DMAICR in an ergonomic risks analysis. Work 2012;41:1632–1638.

Womack JP, Jones DT, Roos D. A máquina que mudou o mundo, 3th ed. Rio de Janeiro: Campus, 1992.

Graban, M. Lean Hospitals - Improving Quality, Patient Safety, and Employee Satisfaction. Nova Iorque: Taylor & Francis Group. 2009.

Ismail AAA, Paul LW, Julian HB et al. Wrong biochemistry results: two cases reports and observational study in 5310 patients on potentially misleading thyroid-stimulating hormone and gonadotropin immunoassay results. Clin. Chem 2002;48;2023–2029.

Womack James P, Daniel T Jones, Daniel Roos, The Machine That Changed The World: The Story Of Lean Production. New York: Harper Perennial 1991.

Zidel T. A Lean Toolbox - Using Lean principles and techniques in healthcare. Journal of Healthcare Quality, 2006;28(1);W1-7.

Yaduvanshi D, Sharma A, Gupta D. Lean Thinking: An Empirical Study for Performance evaluation in Hospital Operations. J of Health Management 2018;19:203-213.

Burgess N, Radnor Z. Evaluating Lean in healthcare. International Journal of Health Care Quality Assurance. 2013;26;220-235.

Govindarajan V, Ramamurti R. Delivering World-Class Health Care, Affordably. Harvard Business Review: Harvard Business Publishing, Nov 2013

Shingo SA. Study of the Toyota Production System from an Industrial Engineering Viewpoint. Norwalk: Productivity Press.1981.

Oppenheim Bohdan. Lean Enablers for Clinical Laboratories. Research in Medical & Engineering Sciences. 2017;2:4.

Gottfredson M, Aspinall K. Innovation versus complexity: What is too much of a good thing? Harvard Business Review: Harvard Business Publishing, 2005;83(11):62-71, 164.

Warade J. Lean management in clinical laboratory. Clinical laboratory. Weblog. [Online]. Available from: https://clinlabworld.blogspot.com/2014/07/lean-management-in-linical-laboratory.html [Accessed 25-Sep-2020]

Arnheiter E, Maleyeff J. The integration of lean management and six sigma. Total Qual. Manag. 2005;17(1):5–18.

Stankovic KA. Developing a lean consciousness for the clinical laboratory. Journal of Medical Biochemistry, 2008;27(3): 354-359. doi:10.2478/v10011-008-0015-2

Inal TC, Goruroglu Ozturk O, Kibar F, Cetiner S, Matyar S, Daglioglu G, Yaman A. Lean six sigma methodologies improve clinical laboratory efficiency and reduce turnaround times. J Clin Lab Anal. 2018 Jan;32(1):e22180. doi: 10.1002/jcla.22180. Epub 2017 Feb 15.

Oliveira K, Santos E, Veraldo L. Lean Healthcare as a Tool for Improvement: A Case Study in a Clinical Laboratory. Adv in human factors and ergonomics in healthcare 2017;482:129-140.

Bowen DE, Youngdahl WE. “Lean” service: in defense of a production-line approach. International Journal of Service Industry Management 1998;9(3):207--225

Bortolotti T, Romano P, Nicoletti B. (2010) Lean First, Then Automate: An Integrated Model for Process Improvement in Pure Service-Providing Companies. In: Vallespir B., Alix T. (eds) Advances in Production Management Systems. New Challenges, New Approaches. APMS 2009. IFIP Advances in Information and Communication Technology. Springer: Berlin, Heidelberg. (2010) https://doi.org/10.1007/978-3-642-16358-6_72

Review Article