The direct costs of a glass-slide workflow are easy to see on a budget line. The indirect costs are harder to see. FTE hours spent on retrieval, assembly, transport, and misfiling; TAT delays caused by physical logistics; and staff time lost to avoidable rework can have a substantial impact on lab efficiency, productivity, and costs.

There is a specific pressure that every laboratory manager understands from the inside but struggles to quantify from the outside. Pathology request volumes are rising, with growth estimated at 5–10% annually (Munari et al., 2024). Aging populations, expanding screening programs, and the growing complexity of precision oncology workups are all contributing factors. Simultaneously, the laboratory workforce faces chronic understaffing: more histotechnologists and pathology staff are retiring than entering the field, and recruitment has become a persistent operational challenge in laboratories of every size (Walsh & Orsi, 2024). The result is a gap between what the laboratory needs to produce and the human resources available to produce it. 

Most lab managers are managing this gap through informal means: longer shifts, deferred leave, informal cross-training, and the quiet absorption of excess workload by experienced staff who cannot sustain it indefinitely. What most have not yet done is a rigorous audit of where their current workflow is consuming time and staff capacity that a different infrastructure could recapture. The glass slide workflow is one of the largest sources of hidden inefficiency in the anatomic pathology laboratory. Yet much of that inefficiency remains invisible to the lab managers closest to it.

This article names and quantifies the specific lab efficiency workflow costs that manual slide handling imposes, draws on published operational data to show where the time goes, and makes the case for why addressing these costs is not simply a capital expenditure argument. It is a workforce sustainability argument. 

The Anatomy of a Manual Slide Workflow: Where the Time Actually Goes

A glass slide does not simply travel from the histology bench to the pathologist’s microscope. Between preparation and sign-out, it passes through multiple handling events: physical sorting and assembly into cases, batching for delivery or retrieval, transport between departments or sites, filing in the slide library archive, and later, retrieval for comparison cases, tumor boards, ancillary testing, or external consultation. Each event requires staff time. Each event is a potential source of error. And each event is essentially invisible in a budget that records slides processed per day rather than staff minutes consumed per slide. 

A published time and motion analysis showed that digital pathology implementation saved an overall 13.4% of the pathologist’s workday, approximately 43 minutes and 9 seconds per day, through automation of case assembly, queries, requests, retrieval, and delivery (Hanna et al., 2020). That figure reflects pathologist time alone. The time savings for laboratory technical and administrative staff from eliminating manual slide logistics are substantially larger. 

Improving Lab Workflow Efficiency & Productivity at Scale

That 5-minute-per-case figure may appear modest in isolation. In a laboratory processing 400 cases per day, it represents over 33 staff-hours per day, equivalent to approximately 2.3 FTE positions operating at full capacity. Not absorbed by a single overtime roster. Not compensated through informal effort. It is simply the unavoidable overhead of moving physical objects through a workflow that could instead operate digitally (Schwen et al., 2023).

The Six Categories of Hidden Workflow Cost 

Published operational analyses consistently identify the same categories of avoidable cost in the manual slide workflow. They are not hypothetical. They are measured. 

The Workforce Equation: This Is Not Just About Efficiency 

The laboratory workforce shortage is not a temporary phenomenon. A systematic review of the global pathology workforce concluded that the field faces a structural deficit that will deepen over the coming decade, driven by retirement demographics, inadequate training pipeline capacity, and increasing diagnostic complexity per case (Walsh & Orsi, 2024). This creates a compounding problem for lab managers: the same workflow that currently requires 2.3 FTE in logistics overhead will require those same 2.3 FTE from a shrinking pool of recruitable staff. 

The Schwen et al. (2023) review of lessons learned from lab digitization highlights a dimension that budget analyses often miss: digital workflows are not only a cost-efficiency opportunity. They are also a staff retention and recruitment tool. Laboratory technology infrastructure is increasingly a factor in staff attraction and satisfaction, particularly for younger histotechnologists entering a job market where they can choose which employer offers the more modern working environment. A laboratory that requires 2.3 FTE of staff to perform work that a digital workflow automates is not only inefficient, it is at a competitive disadvantage in the recruitment market. 

The Workforce Benefits of Digital Pathology 

The 91% of pathologists who, in one survey, reported that digital pathology reduced turnaround times also reflected that it made their practice more satisfying and efficient (Jahn et al., 2020). The staff satisfaction dimension of workflow change does not appear in ROI calculations, but it is consequential for managers trying to retain experienced staff in a constrained talent market. 

The Multidisciplinary Meeting Problem 

One of the most concrete and underappreciated sources of manual workflow cost is the multidisciplinary tumor board (MDT). In a glass slide workflow, MDT preparation requires physical assembly and transport of comparison slides, coordination between pathology and clinical teams for case scheduling, and the sequential presentation of one case at a time as slides are physically managed on a microscope or projector. Published data indicates that digital tumor boards allow substantially more cases to be reviewed in equivalent meeting time, because physical slide management is no longer required (Ardon et al., 2023). 

The operational significance for a lab manager is direct: every MDT that currently requires 90 minutes of pathology staff time for case preparation could require substantially less with a digital workflow. At an institution with multiple weekly MDTs across oncology subspecialties, this translates to measurable hours per week of senior staff time recovered for diagnostic work rather than logistics. 

High Throughput and Scan Quality: Where the Infrastructure Choice Matters

Lab managers evaluating digital pathology infrastructure need to understand that not all scanners impose the same operational burden. A scanner with a high rescan rate creates a new source of manual workflow overhead. When a significant number of slides require repeat scanning because of image quality failures, staff must retrieve, monitor, and rescan those slides. Published comparative data on FDA-cleared platforms shows that rescan rates vary substantially across available systems (Kuhlman et al., 2025).

The Epredia E1000 Dx Digital Pathology Solution demonstrated the lowest rescan rate of all six currently FDAcleared WSI platforms in the Kuhlman et al. (2025) comparative analysis, and is the first FDA-cleared system with an automated focal map rescan that triggers automatically on out-of-focus detection — without requiring manual staff intervention. For a lab manager whose workflow design is focused on minimizing touch points and staff overhead, this capability is directly relevant to the throughput case (US FDA, 2025). A scanner with high throughput and low staff-intervention rescan demands a smaller scan team and creates a cleaner workflow than one that introduces new manual quality management overhead. 

A related and often-overlooked source of hidden staff overhead is the need to monitor the scanner continuously for problem slides, including slides at risk of damage, jamming, or causing an instrument fault. In a conventional workflow, these events stop the scanning run and require immediate staff intervention before continuous operation can resume. The E1000 Dx addresses this through a safety container architecture. When the scanner detects that continued processing could damage the slide or instrument, the slide is automatically moved to a dedicated safety container and the scanning run continues uninterrupted (US FDA, 2025). The operational consequence for a lab manager is direct. Staff are not tethered to the scanner during operation, and the FTE hours that would otherwise be absorbed by monitoring and intervention return to value-added work. In the context of this article’s central argument, this is another category of manual workflow overhead that digital infrastructure eliminates rather than redistributes.

Conclusion: The Hidden Cost Is a Visible Opportunity for Lab Efficiency

The hidden cost of manual slide handling is not small. It is difficult to recognize because it is spread across so many different workflow steps. The slide file clerk. The courier contract. The assembly time. The MDT preparation. The archival retrieval request. Each of these is a real cost, staffed by real people, consuming real hours that the laboratory cannot afford to lose to logistics at a time when its diagnostic output per person needs to grow. 

The lab managers who will be best positioned in 2026 and beyond are those who have already recognized that workflow efficiency is not a nice-to-have. It is the operational foundation that determines whether a laboratory can sustain its diagnostic mission with the workforce it can realistically recruit. Making that foundation digital is not an incremental improvement. It is the structural change that makes the mission more viable.

How to Improve Lab Productivity & Efficiency: Key Takeaways for Lab Managers

References

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2. Schwen, L. O., Kiehl, T. R., Carvalho, R., Zerbe, N., & Homeyer, A. (2023). Digitization of pathology labs: A review of lessons learned. Laboratory Investigation, 103(11), 100244. Read more. 
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