Lean Solutions in NHS – Midland Forum
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The Lean London Forum aims to share Lean solutions in the NHS by engaging in debates about Lean's strengths and weaknesses. The agenda includes presentations on using data to determine appointment needs and on applying Lean thinking in pathology. It concludes with a discussion on Lean questions and networking.
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Lean Solutions in NHS – Midland Forum
- 1. Lean London Forum 11 July 2012 For more information, please email help@leanlondon.org.uk or telephone 0207 824 8448
- 2. - 2 - Confidential not to be used without consent We have some broad aims of the forum • Create the environment where Lean Solutions in the NHS are shared, discussed and acted upon by practitioners in the health service • Engage in a debate about strengths and weakness of lean in the current NHS climate – The QIPP agenda in reducing costs across the health system – Clinical Commissioning Groups that will redefine ‘end to end’ health systems processes • To network with colleagues and friends
- 3. - 3 - Confidential not to be used without consent Agenda • 1800 - 1810 Welcome and introductions • 1810 - 1835 How many appointments do we need to make? Kate Silvester • 1835 - 1900 The Path-ology to Lean Thinking Dr Mathew Diggle – Nottingham University Hospitals • 1900 - 1930 Group discussion: your questions on Lean/Service Improvement • 1930 - 2000 Networking: Nibbles and drinks
- 4. - 4 - Confidential not to be used without consent Introductions • Your Name • Your Role • The one great lean service you experience as a consumer?
- 5. - 5 - Confidential not to be used without consent • Focus on Value from a Customer (Patient) point of view on every step of process • Obsession on removing waste within the ‘whole system’ • Bottom up approach in identifying value and waste – assumption that much of waste and value is hidden • A true lean system would “flow” and need little command and control Recap – What is Lean?
- 6. How many appointments do we need to make? Kate Silvester Lean West Midlands Event Wednesday 11th July 2012
- 7. Issue • Patients living longer with chronic diseases • How do we deliver – Right care • Right clinician and kit – On time – Every time – In full • Complete: one stop shop – At a cost the tax payer can afford • Primary care, secondary care, community care, mental health?
- 8. We make appointments • Healthcare manufactures packets of time – Packets of skill and technology • Clinicians • Kit • Patients book these packets of time • How many packets (appointments) do we need to make?
- 9. What is the demand? • What is the demand for clinic appointments?
- 10. Monitoring demand • Requests for New patients • Requests for Follow up patients • How do we do it?
- 11. How do we do it? • New patients – Easy: count the referrals! • From all sources • Requests for follow-up. – Easy way: count them at the end of the clinic • Demand created ‘today’ – More challenging: Demand created on date follow-up due – Modelling the future
- 12. Monitoring demand for follow-up Number of Follow up requests Today’s clinic Average Average 3/12 6/12 9/12 12/12 time
- 13. Modelling the future clinic date Number of new Number of follow - up Number of Cancellations and DNAs Number of new discharged Number of new to follow up requests at 1 week 1 month 2 months 3 months 6 months 9 months 12 months Number of follow up discharged Number of Follow up to Follow up requests at 1 week 1 month 2 months 3 months 6 months 9 months 12 months
- 14. Stock and Flow Model How many patients have we go in the follow-up pool (work in progress WIP) So is the system levelling off ? Do we need more Capacity? How can we reduce demand?
- 15. Main message • Demand for follow up is not Infinite – When number of discharges from clinic = number of new patient demand – System will be in balance ClinicNew patients Discharged (including deaths) Follow up pool
- 16. NoNo • Do not Confuse activity with demand – Confuse what we did with what we were asked to do – How many patients didn’t get the appointment they/their consultant/GP requested? • Do not Use New to Follow-up ratios. – Activity or demand? – Evidence based? – How much follow-up is failure demand? • Care not complete on the 1st appointment?
- 17. Providing capacity • Fixed capacity – Fixed capacity irrespective of this week’s demand • NHS • Flex capacity – Look at this week’s demand and provide the appointments required • Private sector
- 18. Providing capacity Number of Follow up requests Today’s clinic Average Average 3/12 6/12 9/12 12/12 time Where do we set the capacity to deliver the demand on time?
- 19. Monitoring the future • How are we going to know if the demand has changed? – Un-met appointments – Delays to New or FU appointments – Number in the follow up pool – (SPC chart of the demand: new and follow up)
- 20. Demand for new referrals Comments?
- 21. What have we learned today? • What are we going to differently tomorrow?
- 22. Where can I learn more? • SAAsoft. – http://saasoft.com/moodle/ – I have no financial interest in this company
- 24. Background • Diagnostic service: 24/7, 365 days per year • Population served: >2.5 million • Workload: 970,000 pa • Isolation, identification and detection of medically important bacteria, viruses and parasites.
- 25. • Screening and specialist service: expertise in biological agent detection • Clinical advice -on the diagnosis, management & treatment of infections, with regular ward rounds on intensive care etc. • Infection control- MRSA isolation and Clostridium difficile toxin screening Background
- 26. What is Lean?
- 27. LEAN • Perfected by Toyota – from 1928 • ‘Lean’ coined by Jones & Womack in 1990s • Lean is about improving flow and eliminating waste • getting the right things to the right place, • at the right time, • in the right quantities, • while minimising waste and being flexible and open to change. • Customer at heart of the process • Driver for Quality and Safety
- 28. LEAN?
- 29. CHANGE
- 30. DANGER!
- 31. FEAR
- 32. RESISTANCE
- 34. The Path-ology
- 35. The Path-ology • High Volume testing – Urines and MRSA screening • Highly visible – Reception area • Highly productive – What matters to me! • Highly effective!
- 36. High Volume testing – Urines and MRSA screening One piece flow
- 37. Results from Urines Oct-11Sept-11Baselin e Aug- 11 Oct-11Sept-11Baselin e Aug- 11 Oct-11Sept-11Baselin e Aug- 11 95.786.985.977.466.158.739.239.840.9 % reported within 48 hrs % reported within 24 hrs % reported day of receipt
- 38. Results from Reception Negative urines from PCTs: Total time from receipt to authorisation 0.0 5.0 10.0 15.0 20.0 25.0 30.0 10:15 12:30 12:30 12:30 14:15 14:15 14:15 14:15 14:15 15:45 15:45 15:45 16:00 16:00 16:00 16:00 16:00 16:00 16:00 16:00 16:00 Time of receipt Hours Negative urines from hospital patients: Total time from receipt to authorisation 0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 8.0 09:15 09:15 10:00 10:30 10:30 10:30 11:00 11:45 13:00 14:15 14:15 14:15 14:15 15:30 16:30 16:30 16:30 Time of receipt Hours Most GP specimens’ turnaround time (TAT) < 5h (median=3.1h). Overnight storage results in TAT c. 25h Most in-patient specimens’ TAT <4h, but may be as high as 7h (median=3.1h). Negative urines from PCTs: time from receipt to authorisation 0.0 5.0 10.0 15.0 20.0 25.0 09:00 12:30 12:45 12:45 14:00 14:00 14:30 14:30 15:30 15:30 16:15 16:15 16:15 16:15 16:30 16:30 16:30 Time of receipt Hours Then Now Negative urines from in-patients: time from receipt to authorisation 0.0 1.0 2.0 3.0 4.0 5.0 09:00 09:00 09:45 10:30 10:30 10:30 10:30 11:00 13:00 14:00 14:00 14:00 15:00 16:15 16:30 Time of receipt Hours Most GP specimens’ turnaround time (TAT) < 4h (median=1.7h). Overnight storage results in TAT c. 20h i.e. median TAT reduced by 45% (mean TAT reduced by 29%) Majority of in-patient specimens’ TAT<3h (median=2.4h) i.e. median TAT reduced by 23% (mean TAT reduced by 23%) Overall, TAT for all negative samples has been reduced by 45% (median 3.1h to 1.7h) Number of samples processed via UF100 increased by 11% on dates sampled.
- 39. Highly visible – Reception area
- 40. Highly visible – Reception area
- 41. Improved process • Post-Lean, there is improved prioritisation of in-patient samples, as the time from receipt to UF100 processing has been reduced by 50% (median 0.8h to 0.4h) and time from receipt to registration has been reduced by 25% (median 0.8h to 0.6h). • Removal of excessive checking (demo-checking) has reduced the processing time for negative samples by 43% (from 2.3h to 1.3h). • Positive feedback from staff as process runs more smoothly and calmly.
- 42. The Path - Key Challenges • Maintaining momentum / energy / time • Communication with all stakeholders • Support laboratory staff and stakeholders
- 43. - 43 - Confidential not to be used without consent Your Questions on LeanYour Questions on Lean What is the impact on CCG on end to end transformation? Can Lean fail?, and for what reason? We have no budget to start Lean – what can we do? We have low morale and no one is willing to change, what can I do? What the one thing that makes the biggest difference?
- 44. - 44 - Confidential not to be used without consent What’s Next? • Today’s presentation and feedback survey sent out by email within 72 hours • The Next Lean Midland Forum will be held in January 2013. – We will send out reminders to all participants from today – We have a Lean London Forum on 18 September 2012 taking place at the Royal College of Surgeons – If you’d like to take up one our presentation slots, please do let us know. We are keen to hear from Community Trust and GP Groups • Find us on Linked In and Twitter - LeanNHS
- 45. - 45 - Confidential not to be used without consent Big Thanks To Our Presenters and Supporters Mathew Diggle Kate Silvester Jazz Singh ..and to you all for attending
- 46. - 46 - Confidential not to be used without consent Thanks to Our Sponsors Assisting with Lean Transformations in the health sector and beyond www.kinetik.uk.com www.leanexecutives.co.uk