Lab automation and Six Sigma levels: Here's what we learned

Salt Lake City, Utah, July 31, 2017 (GLOBE NEWSWIRE) -- Attaining Six Sigma Levels in the Laboratory: Here’s What We Learned

SALT LAKE CITY, July 26, 2017—This month, ARUP Laboratories published a report in Journal of Applied Laboratory Medicine (JALM) detailing its 25-year journey toward achievement of a Six Sigma score for lost specimens.

“We found that to achieve this level, a laboratory needs automation,” says Charles Hawker, PhD, MBA, who coauthored the article in JALM. The Six Sigma quality method seeks to achieve error rates of no more than 3.4 defects per million opportunities. 

“To my knowledge, ARUP is the first clinical laboratory in the country to achieve Six Sigma quality for any metric,” adds Hawker. For nearly two decades, Hawker has helped develop ARUP’s highly sophisticated automation system.

While the ultimate goal is perfection, particularly in healthcare, making incremental progress toward this goal is the focus of ARUP’s continuous improvement system. In clinical laboratories, mistakes in the analytic area are generally minor contributors to poor laboratory quality and diagnostic error. The majority of mistakes—including lost or misplaced specimens—happen in the realm of nonanalytic processes.

Some 55,000 specimens, destined for testing in 70 specialized laboratories, are processed daily at ARUP, so tracking the precise location of a single specimen is a herculean task. From time to time, one of these samples may lose its way.

The JALM article homes in on lost-sample solutions that involve automation and human behavior controls, but the corporate culture is another important consideration. “It’s a patient-centric culture here; each specimen is a patient,” says David Rogers, who oversees specimen processing and also coauthored the article.

“We want this report to show other laboratories that they too can attain this level of quality,” emphasizes Hawker. Readers learn how the automation of nonanalytic processes decreases the number of lost specimens. In addition, the article covers a variety of engineering and behavioral controls, which relate to how humans work, that have played a role in this remarkable achievement. 

“Every time a human touches a sample it creates an opportunity for error,” explains Bonnie Messinger, ARUP’s process improvement manager and the article’s lead author. She estimates that a specimen could be handled 20 or more times from the point it leaves the client until it is discarded.

Automation Improvements

Using data spanning the 25-year period, the authors show the correlation between lost specimens and the implementation dates for eight major phases of automation, along with 16 process improvements and engineering controls. While implementation of process improvements, engineering controls, and automation all contributed to overall reduction in the lost specimen rate, the data shows that automation was the most significant contributor.

With each automation enhancement, lost specimen rates decreased. It did not happen immediately, but over the succeeding months, each new level of automation led to improvement. Because the automation stages and various process improvements overlapped, it was not possible to look at any particular stage or process enhancement in isolation, but collectively, the various changes have produced a nearly 100-fold improvement in the lost-sample Six Sigma metric.

Error-Proofing and Human Behavior Management

Human behaviors are influenced by process and engineering controls. In collaboration with ARUP’s in-house engineering team, zeroing in on relatively small modifications to the work environment proved to be quite effective.

“We have 18 different behavioral management strategies—ways of encouraging certain behaviors and preventing others,” says Messinger. Such changes can be very simple, such as encouraging people to keep their work areas uncluttered or establishing a lost-sample checklist.

Sharing with Others

The article attributes the remarkable decrease in the frequency of lost specimens not to a single intervention, but to a multifaceted, cumulative approach. “Our results demonstrate that two approaches—automation and designed behavioral controls—working together, can yield remarkable results,” says Messinger.

The article’s coauthors emphasize that even if a laboratory doesn’t have the same level of automation as ARUP, any degree of automation that replaces an error-prone process will help reduce error. They also assert that the main purpose of the article is to share stories of success and spread healthcare improvement ideas. 


About ARUP Laboratories

ARUP Laboratories is a national reference laboratory with more than 90 medical experts who are available for consultation. These experts are faculty at the University of Utah School of Medicine and many participate in care teams at the Huntsman Cancer Hospital and Primary Children’s Hospital. In addition, ARUP is a worldwide leader in innovative laboratory research and development, led by the efforts of the ARUP Institute for Clinical and Experimental Pathology®.




A photo accompanying this announcement is available at

“We found that to achieve this level [Six Sigma], a laboratory needs automation,” says Charles Hawker, who helped develop ARUP’s highly sophisticated automation system.

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