Why did we go Lean?

We needed to improve
A Lean Hospital?
Alan Dawson
Director of Operations
Hereford Hospital NHS Trust

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 goals include

Doing work on time
Lean is the process of identifying the least Empowered staff
wasteful way to provide value (better, safer Identify problems (defects
and backlog) before it’s
care, with no unnecessary delays at lower too late
cost) to our customers. Improve flow

Learn by doing
Value must always be determined by the customer

We spend 75-95% of our time doing things that Eliminate waste Right first time, every
increase our costs and create no value for the time
customer
Match resources to meet
demand

Process view reveals the real waste

Lean – focuses on dramatically improving

Real waste
flow in the value stream and eliminating
waste
Flow of
IMPROVED
patients
Radiology

Theatres

SPECIFY
SPECIFY UNDERSTAND
UNDERSTAND EFFICIENCY AND
FLOW
FLOW PULL
PULL PERFECTION
PERFECTION
VALUE DEMAND
Admin

VALUE DEMAND SPEED

wards
Clinic

Clinic

Labs

Is governing the rate of flow for the whole system

1
What do desperate managers do? Implementation of Lean: benefits

Improved quality and safety
Fewer mistakes, accidents and errors, resulting in
better care
Cut costs or else! Improved service experience

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

Improved throughput (more income)

Theatres
The same people, using the same equipment, find they
Laboratories

wards
Radiology

Reduce are capable of achieving more

Clinic

Clinic
Admin

Throughput
= reduced

Accelerated momentum
income Stable working environment with clear, standardised
= longer LOS procedures creates foundations for constant
improvement

Value for money – lower costs, less waste
Is governing the rate of flow for the whole system
Improved staff morale

Hereford Hospitals
NHS Trust

Leaders need to shift the current thinking Value stream maps were created and
CURRENT FUTURE data collected
Biochemistry value Haematology value
• Provider first • Patient first stream stream
• Waiting is acceptable • Waiting is unacceptable
• Errors are to be expected • Defect free processes
• Add resources • No new resources
• Reduce cost • Reduce waste Door to door time
Door to door time (processing
time) = 10 mins
(processing time) = 40 mins
The specimen tracked took 45
• Problems not visible • Problems visible The specimens we tracked mins
typically took 62 mins
• maximise use of capacity • minimise cost of capacity
• Functional management • End to end processes

Hereford Hospitals Hereford Hospitals

NHS Trust Specimen Reception - NHS Trust

Staff identified waste and delays Before

X X X Sorting area
ONLY
Non value adding

XX
steps
Delays and waste
Now all eliminated
X
X X X

2
 Hereford Hospitals Visual management – sorting Hereford Hospitals
Specimen Reception – NHS Trust
area. Laminated blank forms NHS Trust

After help non pathology staff to sort

specimens – saving time

3 Centrifuges

Large specimen Sorting area

drop off

Specimen
FIFO - Lane 1
drop off
FIFO - Lane 2

Dispatch (couriers
pick up parcels 4 Booking In
here)
computers
(right of
centrifuges)

Hereford Hospitals Hereford Hospitals

NHS Trust NHS Trust

Before After Before After

40 minutes a day saved

Specimens were put in rack then taken to
centrifuge, unloaded and put in
centrifuge.
Specimens put directly into centrifuge
carriage - stops double handling (in 20’s at
peak times). These are loaded straight into
centrifuge.
Work waiting to go into centrifuge. Centrifuges moved into specimen reception
Various things left waiting to be freeing up a whole work area. Work place
processed. tidied up.

More courier deliveries from PCT Hereford Hospitals

NHS Trust
Work staggered across the working day
Results:
No extra resources – routes have been reorganised - to be implemented shortly
Huge reductions in delays in specimen
Current red route Current blue route
reception
Hereford Hospitals - Biochemistry - Delays in specimen reception Hereford Hospitals - Haematology - Delays in specimen reception
Before change After Change Before change After change
50 50
1

1
40 40
1
Delay in minutes

Delay in minutes

30 30 11

20 20

10 10

New proposed red UCL=3.54

_
1
UCL=4.66
_
X=0.88 X=1.5
route – Bromyard Bromyard 0

transferred
New proposed 1 10 19 28 37 46 55 64 73 82 91
0
1 10 19 28 37 46 55 64 73 82 91
Observation Observation
transferred to blue to blue run blue route
run
Typical wait reduced from 31 Typical wait reduced from 20
minutes to 4 minutes. Average minutes to about 5 minutes.
less than 1 minute.
Average 1.5 minutes

3
Impact of Lean Improvements Lean in Pharmacy

Turnaround time significantly reduced with no extra
resources
25% reduction in turnaround time for

Delays virtually eliminated in specimen reception standard TTOs

Improved work flow in specimen reception

Improved productivity of staff

57% reduction in turnaround times for

Reduced waste – delays, specimens waiting, WIP (Work urgent TTOs
in Progress), unnecessary movement, less rework, non
value added steps removed
Reduced length of stay

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

Improvements in lead time for fast track TTOs Improvements in lead times for standard track TTO
June 06 Oct 06 Oct 07 June 06 Oct 07
1
500
200 1

400
1

150

300 UCL=301.0
minutes

minutes

100
200 _
X=163.9
Av = 70 UCL=61.2
50
_ 100
Av = 36 X=29.9

LCL=26.8
0 0
F1 F8 F15 F1 F8 F15 F1 F8 F15 F22
S1 S5 S9 S13 S17 S2 S6 S10 S14 S18
Average times reduced
Average time reduced from 215 mins to 163 mins
Upper control limit lowered and variation reduced
Upper control limit lowered

Other results What are the KSF’s?

Radiology
Develop a strategy

Reduced waits for CT, MRI and plain films
Board-level sign up

Sterile Services
Executive lead
Reduced turnaround times by 46%
Aligned to corporate objectives
Improved quality/reduced complaints
Properly resourced
Avoided costs of new equipment
The right skills

Medical Records
Clear objectives
Filing backlog removed
Preparation
Reduced overtime payments

Engagement
Improved quality

4
What next?

Finish departmental work of previous

strategy

Commence whole-pathway transformation
work

Measure benefits throughout

> 14 days

> 14 days

Any questions?