Delving into the world of Continuous Process Improvement (CPI) immerses you in a dizzying array of methods and terms…DMAIC, Kaizen, Kanban, Lean, PDCA, Six Sigma, and so on. Many of these terms indicate activities or orderly clusters of behaviors which, upon examination, overlap with or are shared by other systems. While this may seem confusing at the outset, a consideration of an operational definition of CPI, coupled with a determination of one’s own specific process management goals, will suggest what tools to use at what time.

CPI at its most essential is a well-designed, ongoing, iterative program of incremental improvements in business processes, which are aimed at reducing various forms of waste (e.g., waste of time, space, human resources, all of which, in turn, waste money) to improve customer satisfaction, while remaining aligned with the financial objectives of the organization.

Of course, in the laboratory, we may interpret "customer satisfaction" to indicate "improved patient outcomes." While fiduciary responsibility is of high importance in the overall CQI plan, it is always subservient to improving the health and wellness of patients.

As one reads the literature concerning CPI, a short-list of "musts" begins to emerge:

• A CPI initiative must have buy-in at all levels of administration. Although not explicitly stated, it is implied that the lab manager or supervisor, before approaching upper administration, carefully craft a CPI proposal which includes all salient goals, needs, and anticipated outcomes (both patient-centered and fiduciary). A simple format, such as the familiar "Situation, Background, Analysis, and Recommendation" ("SBAR"), is ideal for this purpose.

• An appropriate, cross-functional team should be assembled, a project leader chosen, and a team charter indicating qualitative and quantitative goals (patient-centered and financial), time frames, etc., be drawn up and agreed-upon.

• The selection of specific problem-solving tools, including process- mapping, in order to fully understand the current state of the system being analyzed.

A particularly robust problem-solving methodology is the DMAIC method, which outlines the five phases of Six Sigma improvement:

D: Define the project, develop the plan, keeping in mind the patient-centered goals as of highest importance, while remaining aligned with institutional goals and their financial outcomes.

M: Measure the existing process, as it currently is carried out. No effort is made to gloss over gaps, redundancies, or disagreements about the process; rather, these are valuable discoveries to be addressed in the next step.

A: Identify and analyze all bottlenecks, gaps, redundancies, multiple ways of performing the same task, etc., and revise the workflow to eliminate the inefficiencies and gaps.

I: Improve the current process by implementing the revised workflow.

C: Control is established by measuring the output of the revised workflow, using quantitative methods to establish baselines of performance and determine best-practices. Establish adequate performance parameters around those values using the Six Sigma method.

The real strength of CPI is in its iterative nature. By continually, proactively, and critically examining complex processes, such as occur in the clinical laboratory, we are able to accomplish two important tasks; first, we are always positioned to ferret out waste and inefficiencies Moreover, we remain in a state of readiness to accommodate the changing environment in health care.

The ingress of new staff and new technologies, not to mention consolidations and mergers, often outpace the rate at which we examine and revise our methods for practicing appropriate, cost-effective lab medicine.

By using tools such as DMAIC/Six Sigma, in the context of iterative continuous improvement schemata (e.g., Plan-Do-Check-Act (PDCA), or Identify – Plan – Execute – Review (IPER)), the clinical laboratory is well-prepared to continually streamline workflows, increase the quality of patient care while reducing health care costs.