Categories	Root causes of long TAT	Key Strategies (Suggested Solutions)
MANPOWER	Staff tardiness	Laboratory manager should communicate to staff employees the importance of timely and regular attendance and develop written unit rules with a call-in procedure. These rules apply to all laboratory staff employees, from the chairman (director) on down. The call-in procedure should define when and whom an employee should call if he/she is going to be absent or tardy. It should also address a time frame when an employee who will be delayed is required to notify supervision. Employees must record attendance and absences in the attendance tracking system. Supervisors should be observant and identify pattern absences. Employees will be subject to immediate corrective action for pattern unscheduled absences. Unscheduled absences, tardiness, and unscheduled early departures (whether excused or unexcused), failure to provide appropriate notification, or abuse of sick leave or other paid time off may result in corrective action up to and including termination of employment.
	Employee absenteism
	Insufficient personnel	Laboratory manager should hire new workers to fix the labor shortage.
	Older workers	Hiring young employees can be beneficial to clinical laboratory.
	Non-retrained staff	Laboratory directors should offer training to their existing employees in order to tailor them to fill current gaps. This can mean training offered in-house, where a knowledgeable employee shares with others their valuable expertise, or outside training.
MACHINE	Insufficient number of machines	Laboratory directors should provide sufficient number of machines that meet the operational requirements.
	Defective machines	The technical director of the laboratory should repair damaged machines or replace them altogether with new ones. He must ensure that a back-up is provided for broken machines.
	Not maintained machines	Good maintenance habits and an effective repair system will minimise the amount of time equipment is unusable. The Technical Director is responsible for this.
	Low-power machines	The laboratory should acquire high-powered machines which are capable of developing a large amount of work in a short time.
MANAGEMENT	Non-existent job description	Job descriptions should reflect all skills needed and accurately describe tasks, roles, and authorities. Critical competencies for each task should be identified. First-line supervisors should be involved in this step.
	Delay in the supply of materials	Stocks must be properly assessed: this involves defining a minimum stock level, which once reached triggers replenishment. The laboratory’s stock manager must analyze the remaining stock and issue in order to bring it up to the maximum authorized stock level.
	Poor choice of device	The hospital management should involve experts who have knowledge of laboratory tools in the selection of laboratory equipment.
	Lack of sanctions or impunity	Laboratory manager should establish standards and rules that all laboratory personnel should observe and predict the sanctions for recalcitrant.
MATERIAL	Reagent out of stock	Laboratory should have a system for inventory maintenance and purchasing.
	Syringue not provided
	Micropipette not calibrated
	Lack of material supply
MILIEU	Lack of running water	The technical department of the hospital should set up a drinking water supply system and ensure that there is no shortage of good quality water in the laboratory.
	Heat in the laboratory	The hospital’s technical department should establish a system to maintain the temperature and humidity of the laboratory within acceptable ranges.
	Small sample collection room	The hospital management should expand the sampling area and increase the number of beds and staff.
METHODS	Lack of automation	The hospital management should implement the total laboratory automation.
METHODS	Long-running workflow	The hospital management should implement the Laboratory Information Systems (LIS) and install Middleware. Then, the laboratory manager should reorganize the laboratory process flow to eliminate non-value-added steps or waste (see Figures 1-4).