Building a smart FNA cart: When Google meets cytology

Mehrvash Haghighi, Varsha Nair, Simran S. Mashiana, Twisha Oza, Maureen F. Zakowski

Research output: Contribution to journalArticlepeer-review


Background: The appropriate management of a fine needle aspiration (FNA) supply cart and equipment set up is essential to ensure the smooth and optimal operation of a busy FNA clinic. We applied Lean strategies such as value stream mapping (VSM), the 5S method (Sort, Set in order, Shine, Standardize, Sustain), and Kanban to remove waste and improve patient flow in an FNA clinic. Methods: The workflow analysis suggested that existent problems such as suboptimal inventory management and unavailability of standard operating procedures (SOPs) caused a 10% to 85% increase in total procedure time. To improve inventory management, we created a 2-bin Kanban system. We used the “Scan to Web” app and a Google Drive form to create a cost-effective electronic inventory management system. We distributed the essential SOPs in the format of video clips using our YouTube channel and leveraged barcode technology to access the links. Results: Upon completion of our process improvement project, we succeeded to eliminate the stock-out events and maintain a process cycle efficiency of 87%. The 5S audit checklist result increased from 6% to 100% implementation, which is consistent with focused improvement. The developed inventory system enabled us to track the supply usage, forecast demands, and improve the accuracy of orders. Conclusions: Lean methods such as VSM, 5S, and Kanban combined with open source technologies can be implemented to ensure material availability, track inventory, and provide immediate access to SOPs on demand. The developed system also led to increased efficiency and improved flow, as well as responsiveness to changes in demand.

Original languageEnglish
Pages (from-to)948-961
Number of pages14
JournalCancer cytopathology
Issue number12
StatePublished - Dec 2020


  • 5S
  • FNA
  • Kanban
  • Lean
  • VSM
  • barcode
  • informatics
  • quality
  • technology


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