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To review the application of the principles of benchmarking to the field of laboratory medicine.

Review of the literature on performance management techniques employed in healthcare provision, and specifically in laboratory medicine, including benchmarking.

The review identifies the main performance indicators employed in quality assurance and benchmarking programmes that have been developed in laboratory medicine. Some of these have a clear benefit in improving laboratory performance, whilst others are used for more general management purposes. The emphasis of these programmes is on improving analytical performance, together with pre‐ and post‐analytical performance. The review highlights the fact that benchmarking in laboratory medicine is undertaken largely in isolation from the clinical setting in which it is applied. The benchmarking activities are, therefore, concerned with the process (dealing predominantly with efficiency and productivity) of producing laboratory results and do not probe into the way in which the laboratory services are employed in the care of patients (dealing with outcomes and value). Some examples of health outcomes studies are discussed, which demonstrate the value of the laboratory medicine service. They highlight the complexity of developing a more outcomes orientated approach to benchmarking of laboratory medicine services. These studies would show how the laboratory was used; they give a more holistic view of the role of laboratory medicine in healthcare provision.

The review shows how a more comprehensive and integrated approach to benchmarking of laboratory medicine service would provide valuable information on the effectiveness of the laboratory services.

The motivation for this paper is to better understand the strengths and limitations of quantitative performance measures in a changing environment. The context is one of organisational change and innovative management. Using a case study approach, the paper presents a history of organisational change and focuses on attempts to drive and assess efficiency through performance measures in a public hospital‐based pathology laboratory. The various financial and non‐financial performance measures used in the laboratory are presented. A discrepancy between accounting reports and laboratory management analyses of costs is reported. The notorious difficulties of costing health services are examined through the dispute that arose about whether the mean cost‐per‐test was increasing or decreasing over a three‐year period. Competing representations of performance are analysed. Whilst the case study looks at a New Zealand example, many of the pressures facing pathology services are typical of medical laboratories worldwide. General issues of performance measurement are discussed.

The purpose of this paper is to illustrate a service quality framework that enhances service delivery in clinical laboratories by gauging medical practitioner satisfaction and by providing avenues for continuous improvement.

The case study method has been used for conducting the exploratory study, with focus on the Mauritian public clinical laboratory. A structured questionnaire based on the SERVQUAL service quality model was used for data collection, analysis and for the development of the service quality framework.

The study confirms the pertinence of the following service quality dimensions within the context of clinical laboratories: tangibility, reliability, responsiveness, turnaround time, technology, test reports, communication and laboratory staff attitude and behaviour.

The service quality framework developed, termed LabSERV, is vital for clinical laboratories in the search for improving service delivery to medical practitioners.

This is a pioneering work carried out in the clinical laboratory sector in Mauritius. Medical practitioner expectations and perceptions have been simultaneously considered to generate a novel service quality framework for clinical laboratories.

This paper sets out to evaluate the potential of financial performance benchmarking as an expenditure control tool for a national pathology service comprising both public and private service providers.

Primary data were provided by direct consultation with a wide range of stakeholders, whose experience and perspectives were sought primarily through informal face‐to‐face interviews. The authors analyse these informant contributions alongside official reports and the published literature on dual public‐private health service provision.

Informants identified potential advantages and pitfalls in comparative pathology benchmarking for expenditure control. They also identified some significant negative implications for health service quality and suggested related compromises. Often misunderstood cost benchmarking issues are clarified in the paper.

Several areas of importance for further investigation are suggested.

The paper concludes that appropriate performance benchmarking can be applied to New Zealand pathology services as a useful service rationalisation tool and a realistic price‐signalling device, provided that certain safeguards on health service quality are in place.

General issues complicating financial performance benchmarking across sectors in a mixed economy for health service provision are identified for the guidance of researchers, decision‐makers and planners.

The purpose of this paper is to test the applicability and benefits of benchmarking as a tool for quality analysis in Brazilian laboratory medical services.

A primary observational study is performed in eight hospital laboratories by tracking the receipt, analysis and return to participants of monitoring reports relating to several quality indicators for the years 2005 and 2006. Whenever possible, the paper applies 6σ criteria as an independent assessment of process quality.

Data obtained for the eight laboratories showed a monthly average (±SD) of 178,579 (±153,670) tests performed per laboratory, with 40,256 (±44,858) requisitions and 4.77 (±1.33) tests per requisition. Overall, productivity was 7.35 (±2.46) tests per man‐hour of work (MHW), increasing to 15.36 (±6.00) when considering only the analytical sector staff. An average of 1.63 (±1.14) lost hours per hundred MHW were reported (level 3.6σ), with 3.86 (±5.10) accidents at work reported (AWR) per hundred thousand MHW (level 5.5σ) and 4.22 (±2.61) redraws per thousand requisitions attended (level 4.1σ). The turn‐around‐times were 2.25 (±0.98), 3.29 (±2.12) and 8.54 (±3.25) hours for glucose level, haemogram and human immunodeficiency virus serology, respectively.

Benchmarking proved to be a useful and feasible tool for quality management in Brazilian clinical laboratories, particularly when associated with independent tools for evaluating the quality of laboratorial processes.

This is the first Brazilian study reporting that benchmarking provides useful information on the performance of different clinical laboratory processes and, therefore, could become an important tool for laboratory management.

The Uganda Makerere University provides clinical laboratory support to over 70 clients in Uganda. With increased volume, manual data entry errors have steadily increased, prompting laboratory managers to employ the Six Sigma method to evaluate and reduce their problems. The purpose of this paper is to describe how laboratory data entry quality was improved by using Six Sigma.

The Six Sigma Quality Improvement (QI) project team followed a sequence of steps, starting with defining project goals, measuring data entry errors to assess current performance, analyzing data and determining data‐entry error root causes. Finally the team implemented changes and control measures to address the root causes and to maintain improvements. Establishing the Six Sigma project required considerable resources and maintaining the gains requires additional personnel time and dedicated resources.

After initiating the Six Sigma project, there was a 60.5 percent reduction in data entry errors from 423 errors a month (i.e. 4.34 Six Sigma) in the first month, down to an average 166 errors/month (i.e. 4.65 Six Sigma) over 12 months. The team estimated the average cost of identifying and fixing a data entry error to be $16.25 per error. Thus, reducing errors by an average of 257 errors per month over one year has saved the laboratory an estimated $50,115 a year.

The Six Sigma QI project provides a replicable framework for Ugandan laboratory staff and other resource‐limited organizations to promote quality environment. Laboratory staff can deliver excellent care at a lower cost, by applying QI principles.

This innovative QI method of reducing data entry errors in medical laboratories may improve the clinical workflow processes and make cost savings across the health care continuum.

Healthcare environments are highly complex and full of variation and inefficiency. However, variation and inefficiency can be measured and improved, providing better quality care at a lower cost. This study aims to report the application of Lean Six Sigma (LSS) in a haematology laboratory in a university hospital in Egypt.

The authors used case study research. Applying the define, measure, analyse, improve and control phases of the DMAIC methodology together with lean tools, the problem was identified, the process mapped, the causes analysed and improvements implemented.

Results show that LSS can be successfully implemented in challenging public sector healthcare settings. Management commitment, generating and implementing ideas from frontline staff, using a variety of quality tools and previous LSS training were all key to success. This is evidence that the LSS methodology is adaptable to any process, people or place.

There are no publications on LSS implementation in health care in Egypt. This study demonstrates the successful use of LSS in a university hospital (public sector) in a developing country, sharing insight into the facilitators and barriers in a real context with others in the healthcare field.

The purpose of this paper is to provide an explanation and understanding of developments in casemix and related information systems at a large regional hospital, Health Waikato (HW), in the centre of the North Island of New Zealand. The themes will be explicated and theorised, drawing on the sociology of translation (Latour). A central idea will be the use of accounting techniques to influence decision makers both within and outside the health institutions. The power of accounting in the translation and inscription of data (the fabrication of accounting systems per Preston et al.), will be a central theme in understanding the role of accounting systems as technology. Drawing from Latour has helped to provide a frame of reference to allow an assimilation of disparate changes and influences as they have come to affect the health sector at a national level, within New Zealand, and also at an organisational level, within a large regional health provider. This paper provides a detailed description of events at the research site, a large regional hospital (HW). The paper consists primarily of a descriptive case study of aspects of the change process as it has impacted on the research site.

The purpose of this paper is to provide an explanation and understanding of developments in casemix and related information systems at a large regional hospital, Health Waikato (HW), in the centre of the North Island of New Zealand. The themes will be explicated and theorised, drawing on the sociology of translation (Latour, 1987a). A central idea will be the use of accounting techniques to influence decision makers both within and outside the health institutions. The power of accounting in the translation and inscription of data (the fabrication of accounting systems per Preston et al., (1992)), will be a central theme in understanding the role of accounting systems as technology. Drawing from Latour has helped to provide a frame of reference to allow an assimilation of disparate changes and influences as they have come to affect the health sector at a national level, within New Zealand, and also at an organisational level, within a large regional health provider. This paper provides a detailed description of events at the research site, a large regional hospital (HW). The paper consists primarily of a descriptive case study of aspects of the change process as it has impacted on the research site.

The purpose of this paper is to investigate the efficiency levels of the decision‐making units within the public hospital laboratories in using their supply chain towards meeting the satisfaction of doctors.

Data were collected from two senior laboratory administrators and 30 doctors of two hospital laboratories in Malaysia using two sets of structured questionnaires, which comprised of two dimensions, i.e. doctor satisfaction dimension (DSD) and supply chain inputs (SCI). The dimensions of DSD and SCI were developed and that SCI has been relabeled as hospital laboratory inputs (HLI) to suit the nature of current study. The resulting data were positioned on an importance‐performance matrix. By using the data envelopment analysis software, the efficient frontier for both hospital laboratories was calculated under different scenarios.

Results reveal that one of the laboratories satisfies doctors efficiently using the present levels of HLI for each scenario while the other failed.

The paper focuses only on two hospital laboratories.

The findings offer insights on the important dimensions of DSD and HLI that the hospital laboratories should concentrate on when measuring doctor satisfaction through the utilization of resources they possess. This will undoubtedly lead to better hospital‐doctor‐patient relationships.

Many prior supply chain studies have focused on patient satisfaction. This paper is probably one of the first attempts that comprehensively examines satisfaction from the perspective of doctors.