1

A Lean Hospital?

Alan Dawson

Director of Operations

Hereford Hospital NHS Trust

Why did we go Lean?

�We needed to improve

�We had the skills

�We got offered some resources

�Service improvement background

�Organisation open to change

�The Chief Executive told me to!

What is Lean?

Lean is the process of identifying the least wasteful way to provide value (better, safer care, with no unnecessary delays at lower cost) to our customers.

Value must always be determined by the customer

We spend 75-95% of our time doing things that increase our costs and create no value for the customer

Lean goals include

Identify problems (defects

and backlog) before it’s too late

Learn by doing

Doing work on time

Right first time, every time

Match resources to meet

demand

Eliminate waste

Improve flow

Empowered staff

IMPROVED

EFFICIENCY AND SPEED

Lean – focuses on dramatically improving

flow in the value stream and eliminating

waste

SPECIFY VALUE

SPECIFY VALUE PULLPULL PERFECTIONPERFECTIONUNDERSTAND

DEMAND

UNDERSTAND DEMAND FLOWFLOW

Process view reveals the real waste

Clin

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Clin

ic

Is governing the rate of flow for the whole system

Real waste

Flow of patients

2

What do desperate managers do?

Clin

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ries

wa

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Clin

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Cut costs or else!

Is governing the rate of flow for the whole system

Reduce

Throughput= reduced

income

= longer LOS

Implementation of Lean: benefits� Improved quality and safety

�Fewer mistakes, accidents and errors, resulting in better care

�Improved service experience

� Improved delivery/ timeliness�Better work gets done sooner (meets targets)

� Improved throughput (more income) �The same people, using the same equipment, find they

are capable of achieving more

� Accelerated momentum�Stable working environment with clear, standardised

procedures creates foundations for constant improvement

� Value for money – lower costs, less waste� Improved staff morale

• Provider first

• Waiting is acceptable

• Errors are to be expected

• Add resources

• Reduce cost

• Problems not visible

• maximise use of capacity

• Functional management

• Patient first

• Waiting is unacceptable

• Defect free processes

• No new resources

• Reduce waste

• Problems visible

• minimise cost of capacity

• End to end processes

Leaders need to shift the current thinking

CURRENT FUTURE

Door to door time

(processing time) = 40 mins

Biochemistry value stream

The specimens we tracked

typically took 62 mins

Hereford Hospitals

NHS Trust

Door to door time (processing

time) = 10 mins

Haematology value stream

The specimen tracked took 45

mins

Value stream maps were created and data collected

Staff identified waste and delays

Hereford Hospitals

NHS Trust

X

X

X X X

X

X

X

X

Non value adding

steps

Delays and waste

Now all eliminated

Specimen Reception -

Before

Sorting area

ONLY

Hereford Hospitals

NHS Trust

3

Dispatch (couriers

pick up parcels here)

Specimen

drop off

Sorting area

FIFO - Lane 1

FIFO - Lane 2

Large specimen

drop off

4 Booking In

computers

(right of

centrifuges)

3 Centrifuges

Hereford Hospitals

NHS TrustSpecimen Reception –

After

Visual management – sorting

area. Laminated blank forms

help non pathology staff to sort specimens – saving time

Hereford Hospitals

NHS Trust

Specimens were put in rack then taken to

centrifuge, unloaded and put in

centrifuge.

Hereford Hospitals

NHS Trust

Before After

Specimens put directly into centrifuge

carriage - stops double handling (in 20’s at

peak times). These are loaded straight into

centrifuge.

40 minutes a day saved

Work waiting to go into centrifuge.

Various things left waiting to be

processed.

Hereford Hospitals

NHS Trust

Before After

Centrifuges moved into specimen reception

freeing up a whole work area. Work place

tidied up.

More courier deliveries from PCT

Work staggered across the working day

No extra resources – routes have been reorganised - to be implemented shortly

New proposed blue route

Current blue routeCurrent red route

New proposed red route – Bromyard transferred to blue

run

Bromyard

transferred to blue run

Results:Huge reductions in delays in specimen

reception

Observation

Delay in minutes

918273645546372819101

50

40

30

20

10

0

_X=0.88UCL=3.54

Before change After Change

1

1

1

Hereford Hospitals - Biochemistry - Delays in specimen reception

Observation

Delay in minutes

918273645546372819101

50

40

30

20

10

0

_X=1.5

UCL=4.66

Before change After change

1

11

Hereford Hospitals - Haematology - Delays in specimen reception

Hereford Hospitals

NHS Trust

Typical wait reduced from 31

minutes to 4 minutes. Average less than 1 minute.

Typical wait reduced from 20

minutes to about 5 minutes.

Average 1.5 minutes

4

Impact of Lean Improvements

� Turnaround time significantly reduced with no extra resources

� Delays virtually eliminated in specimen reception � Improved work flow in specimen reception

� Improved productivity of staff� Reduced waste – delays, specimens waiting, WIP (Work

in Progress), unnecessary movement, less rework, non value added steps removed

� More patients can be discharged quicker, benefiting patient care and staff

� More motivated and engaged staff

� Significant amount of extra time created to do quality work

Lean in Pharmacy

�25% reduction in turnaround time for standard TTOs

�57% reduction in turnaround times for

urgent TTOs

�Reduced length of stay

minutes

F22F15F8F1F15F8F1F15F8F1

200

150

100

50

0

_X=29.9

UCL=61.2

June 06 Oct 06 Oct 07

1

1

Improvements in lead time for fast track TTOs

Av = 70

Av = 36

Average times reduced

Upper control limit lowered and variation reduced

minutes

S18S14S10S6S2S17S13S9S5S1

500

400

300

200

100

0

_X=163.9

UCL=301.0

LCL=26.8

June 06 Oct 07

1

Improvements in lead times for standard track TTO

Average time reduced from 215 mins to 163 mins

Upper control limit lowered

Other results

� Radiology

�Reduced waits for CT, MRI and plain films

� Sterile Services

�Reduced turnaround times by 46%

�Improved quality/reduced complaints

�Avoided costs of new equipment

� Medical Records

�Filing backlog removed

�Reduced overtime payments

�Improved quality

What are the KSF’s?

� Develop a strategy

� Board-level sign up

� Executive lead

� Aligned to corporate objectives

� Properly resourced

� The right skills

� Clear objectives

� Preparation

� Engagement

5

What next?

�Finish departmental work of previous strategy

�Commence whole-pathway transformation

work

�Measure benefits throughout

> 14 days

> 14 days

Any questions?