This now five-part case study focuses on improving customer satisfaction at two of a company’s diagnostic clinics – Centers A and B. In Part One, the company worked at Center A to reduce patient turnaround time, a defining component of patient satisfaction. In Part Two, the chain’s improvement story focuses on increasing patient delight at Center B. In Part Three, the story returned to improving the processes of the lab in Center A. In Part Four, turnaround time in a new centralized laboratory is improved. Here, Part Five focuses on increasing efficiency by eliminating problems and reducing rework at the centralized laboratory.

A chain of medical diagnostic clinics was developed from the ground up. After two years of hectic expansion marked by acquisitions and setting up greenfield clinics across a number of cities, it became clear that due to the different inherited processes across those acquisitions, the chain needed to focus on improving and standardizing the quality of service offered, and improving its customer satisfaction rankings.

During the work done in Part 4, the team noticed that rework, often manual, was required on some test samples at some stations in the centralized laboratory. This increased the turnaround time (TAT) – measured from patient arrival to report issuance – while also reducing productivity. Part 5 describes the journey to kill these problems.

The team identified 15 problems that are listed in the table below.

Recurring Problems
Manual reading of test sample barcodes post-machine testing
Machine fell into disuse
Technician manually removed zeros after decimal points in test results before printing report
Tests were sometimes repeated
Two reports issued for one patient (same test with different values)
Technician manually checks values out of standard range to get doctors’ attention
Long time spent tracing samples
Incorrect number of blood samples (too many or too few)
Blood samples going back and forth
Multiple queries regarding individual sample reports from labs
Urine samples were set aside due to blood samples being prioritized (patient reports delayed)
Urine samples from one center repeatedly delayed

Method of Eliminating Problems

The team moved forward in tackling some of the recurring problems by following these steps:

  1. Identify problem
  2. Root cause analysis (5 Whys)
  3. Collect possible countermeasure ideas
  4. Test the idea
  5. If successful, implement throughout system

Problem 1: Manual Reading of Sample Barcodes Post-Machine Tests

  • 1st Why: Why do barcodes have to be read manually? Machine is not reading the barcode.
  • 2nd Why: Why is the machine not reading the barcode? Barcode sticker is not correctly placed on the tube.
  • 3rd Why: Why is it not in the right place? What is the right place? The “right” place had not been identified and documented for staff.

The first countermeasure implemented was to clearly determine the right placement of barcodes. The team retrieved the manuals for the individual machines used to test the medical samples to see what the manufacturers determined as correct placement for barcodes.

  • Machine 1: at least 15 mm from bottom of tube
  • Machine 2: at least 25 mm from top of tube

The team identified a band along the tube that satisfied both machine specs.

Two tube lengths were used – 75 mm and 100 mm. The 100-mm tube had a band width of 60 mm and the 75-mm tube had a band width of 30 mm. The barcode sticker was 23 mm in height.

The question was how to mistake-proof the placement of the barcode so that personnel would be able to stick the barcode sticker so that it always lay in the correct band.

A simple jig was designed for each size of tube. The jig for 75-mm tube is shown in the figure below.

75-mm Length Jig to Ensure Correct Positioning of Barcode
75-mm Length Jig to Ensure Correct Positioning of Barcode

Instructions: For 75 mm-tube, place barcode in central portion between the tube supports.

With the determination of the correct placement of the barcode and a system for correctly applying the barcode, rework was completely eliminated.

Problem 2: Machine Fell Into Disuse

  • 1st Why: Why did the machine fall into disuse? Probes were coated by chemicals that weren’t being washed away and choked the machine.
  • 2nd Why: Why did the probes choke? Tap water was used, which was found to not be of the required quality.

An easy solution was found: distilled water! When the manual was consulted, distilled water was the recommended water to use to keep the probes and machine clean. One the change was made, the probes no longer choked.

Problem 3: Technician Manually Removes Zeros from Printed Report

  • 1st Why: Why does a technician manually remove zeros from printed report? Data is not printed as desired, requiring manual intervention.

Another easy solution was found for this issue. A change was made to the machine’s software to ensure the correct numbers were included in reports.

Problem 4: Two Reports Issued for One Patient (Same Test with Different Values)

  • 1st Why: Why are two reports issued for one patient? It is caused by a software glitch.

A fourth easy solution was found. An error in the software was corrected and no more extra (and incorrect) reports were produced.

Problem 5: Long Time Spent Tracing Samples

  • 1st Why: Why does time have to be spent tracing samples? Some samples would be needed for subsequent tests and were all kept together in big trays.

A new management system was needed to keep closer track of these multi-use samples. There were three types of samples:

  1. Only blood tests
  2. Only serum tests
  3. Blood and serum tests

Confusion arose as samples were taken from station to station for different tests.

The team decided to divide the samples into lots and organized the flow through the lab: 1) blood to 2) serum to 3) serum and blood (in that order).


The other problems were resolved in a similar manner.

The combined effects of Part 4 and Part 5 of this case reduced TAT dramatically while simultaneously improving the productivity of personnel and equipment. Rework was eliminated and manual work was reduced through simple changes and automation using already available resources.

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