Cervical Smears and the 14 day Turnaround: Working across organisational boundaries

1. Cervical Smears and the 14 day Turnaround:Working across organisational boundaries Karen McCleod, Sandwell and West Birmingham Hospitals NHS Trust Richard Johnson, Pan Birmingham Cancer Network

2. Cervical Screening • Background • ‘The cervical screening programme will ensure that all women receive the results of their screening tests within two weeks by 2010’ Cancer Reform Strategy, DH, Dec2007 ‘Seize (or create) a crisis to motivate action across your firm’ • Womack & Jones. (2003) ‘Lean Thinking’

3. Baseline • Up to 7 week turnaround time (approx) • Delays throughout the process • 5 days to send the letter • ? Days to receive the sample in Lab

4. How • Value stream mapping • Helps you to see the flow • Highlights ‘waste’ • Forms basis of an implementation plan • Data – highlights where issues are!

5. 14 day turnaround

6. Taking of sample (Primary Care) Screening (Lab) Send results (Call & Recall)

7. ‘value add’ - <4 hours

8. Practicalities • Meetings held at the Cancer Network • (Neutral ground) • Doodle.com

9. Karen McCleod, Sandwell and West Birmingham Hospitals NHS Trust

10. Communication • With PCT’s • With other labs • With primary care/smear takers • With Pan B’ham Cancer Network Service Improvement Team

11. Hub and Spoke • Cytology labs converted to Liquid Based Cytology following NICE evaluation • Processing machine - large volume • Hospitals grouped together in ‘Hub’ and ‘Spoke’ arrangement

12. Improvements in Lab • Sending samples to ‘Hub’ every day instead of every other day • Changing workflow in lab – batch sizes • Involving different groups within the Lab • Non acceptance policy – working with PCT’s/ QA Reference Centre • Discarding of out of scope samples – working with PCT’s/ QA Reference Centre • Smear taker PIN’s - working with PCT’s/ QA Reference Centre

13. Improvements in Lab • Sending results via electronic link to Shared Services and PCT – changed time • FHSA sender codes – some belonged to GP’s no longer practicing • Came up as Test after sender ended at PCT – causes delays • Changed these codes on laboratory system – saw improvement straight away

14. Primary Care • Electronic HMR101 request form • Involved in training sessions organised by PCT’s • Input from Pan B’ham Cancer Network Service Improvement team • From Shared Services/PCT • From Laboratory

15. Primary Care • Give deadlines for starting to use electronic forms • BUT – even with deadlines some people still don’t use them • One to one sessions – even this doesn’t work with some practices

16. Technology • Pre-printed HMR101 form –takes all the patient demographics form the National Exeter system • Staff in the lab don’t have to rely on reading handwriting! • Worked with other labs and the QA centre to get the District of Residence onto the HMR101 forms • Means the result can go directly to the correct PCT

19. Future? • Set up electronic links with other PCT’s for few out of area results • Get all smear takers to use pre-populated HMR101 forms • Continue to work closely with PCT’s and other labs

20. Any questions?