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  1. LEAN WORKING TVCS meeting Princess Alexandra Hospital 16th June 2009 David Smith - London Cytology Training School Northwick Park Hospital

  2. Cancer Reform Strategy Minimising the time taken to get results back to women, aiming to inform women of the result of their cervical screening test within 2 weeks of it being taken 100% women receiving result letter within 14 days of sample collection 50% women receiving result letter within 7 days of sample collection

  3. Turnaround times • Mean TAT approximately 29 days • Approximately 2 hours ‘touch time’ • 28.9 days waste

  4. Apply lean methodologies to working practice

  5. What is lean? • Management philosophy • Perfected by Toyota by 1970

  6. 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

  7. Lean principles • Key areas of system • Improving flow (pull) • Increase value for user / customer • Get rid of waste • Get it right first time • Continually improve • Customer at heart of the process • Driver for quality and safety

  8. Lean principles • NHS Improvements team • One of 10 centres to work at developing new ways of working

  9. Lean tools • Process mapping • Value stream mapping • Future stream mapping • Spaghetti mapping

  10. 5S • Sort – Clearing the work area • Set in Order – Designating locations • Shine – Cleanliness & workplace appearance • Standardise– All doing things the same way • Sustain – Ingraining the 5S’s into the culture

  11. Lean tools • A3s • TAKT time • Root cause analysis • 5 Whys analysis • Visual management

  12. Lean Overview • Specify VALUE from the customer viewpoint • Identify the VALUE STREAM & remove waste • Make Value FLOW • Initiate PULL in line with customer demand • Pursue PERFECTION in quality & quantity by continuous improvement

  13. Start of Lean project • Core Team • Primary care • PCT • Laboratory • Executive sponsorship

  14. LEAN Methodology Looking at all steps in the process Implementation and monitoring of small changes to eliminate waste and simplify the process.

  15. Data collection • Need to measure everything • Collection to receipt in Lab TAT • Receipt to verification of result TAT • PCT to woman receiving result letter TAT • End to end TAT • Baseline data

  16. Baseline data • 1 – 7 September 2008 • Collection to receipt – 1.36 days • Receipt to verification – 18.9 days • PCT to woman – 8 days • End to End – 28.26 days • Statistical Process Control (SPC) Chart

  17. Statistical Process Control (SPC) Chart • Excellent visualisation tool for measuring and identifying variation and have been used to monitor the impact of changes made to the turnaround times (TAT) for cervical cytology specimens

  18. Points that lie outside the control limits should be investigated with a view to make the process more stable or predictable. Upper process limit Mean Point where change made Lower process limit

  19. Number of cases = 1082 Mean = 28.26 Shortest = 9 days Longest = 61 days

  20. Collection to receipt in Lab TAT data

  21. North West London Hospitals NHS Trust • 54,000 cervical samples per year • 3 PCTs • Brent • Harrow • Hillingdon

  22. Problems identified • Delays in pick up from surgery • Delays in Pathology Reception

  23. Delays in pick up from surgery • Communication with surgery • More frequent pick up from surgery • Communication with primary care staff

  24. Specimen Transport Hospital transport GP NPH Path Reception Lab

  25. The solution • Put cytology in different coloured bags to help separate from rest of Pathology samples

  26. Pathology Reception • Easier to identify cytology cases • Reduced sort out time

  27. Collection of samples from Pathology Reception • 10 minutes five times a day • Approximately 9 days a year • Over 110 miles a year

  28. Delivery of Cytology specimens • Separation of cytology samples from other pathology samples • Direct delivery of samples to cytology • Estimated improvement of 0.1 – 2.5 days in collection to receipt in lab TAT

  29. Receipt to Verification TAT data

  30. Number = 1082 Mean = 18.9 days Shortest = 1 Longest = 51 days

  31. Process • Walked the process • Delays identified at all stages

  32. Gynae Reception • Variable batches of work • Separate urgent / fast track cases • Large piles of slides awaiting booked in request forms • No MLA staff at end of the day

  33. Gynae Reception • Stop separating urgent / fast track cases from routine • Time taken to sort out batch reduced by up to 1 hr • Request forms put in bundles of 10 • Matching up of slides with forms easier • Vacant MLA post filled • Specimens received late in afternoon sorted • Increased use of pre-printed request form

  34. Booking in • Biggest problem • Insufficient staff • Inefficient use of available staff • Inaccurate information on request form • Hard to decipher information on request form • Large number of phone enquiries • Method used for booking in varied