Four Lean Hospital Stories from the UK
By Andrew Castle:
Mark's note: Today's guest blogger is a friend of the blog and a consultant who does Lean work for the UK's National Health Service.
The following link takes you to an article on the BBC website. Essentially the government set a target that patients with suspected breast cancer (and others but the focus of the study was Breast Cancer) should be seen by a specialist within two weeks.
The result was naturally that urgent referrals increased. However the percentage of cancers detected decreased suggesting that more people were being referred as urgent but that they were inappropriate. In the meantime in the group of patients that did not qualify as “urgent” the percentage of cancers increased.
This is a classic interruption to flow. They carved out one group and prioritised them over another which in and of itself increases the longest wait. In addition, because it is so difficult to tell whether a suspected case really qualifies as urgent or not, unsurprisingly it goes wrong and non-cancers are referred and cancers are not. The lesson is that all need to be seen in a timely fashion and that as far as possible they need to be seen in the chronological order that they presented at the GP's First In First Out.
The following three links are all related to NHS Scotland.
In the above article, NHS Lothian has been nominated for a Human Resource Excellence Award in the “Best Change Management Programme” Category in recognition of its improvement program which involves front line staff in generating ideas and implementing improvements to the service provided to patients.
Again a more focused story on NHS Lothian that demonstrates that by implementing the ideas generated by staff the organisation has managed to increase productivity to such an extent that they have reduced a waiting list for CT from a maximum of 21 weeks to 4 weeks, and seen an additional 20 patients per week. Had they not made these changes the additional cost of seeing these patients would have been in excess of £1m. ($2m). These accomplishments are again attributed to the involvement of the front line staff in the improvement process.
The final article is on the implementation of a one stop clinic in Lothian. Essentially patients with suspected breast cancer can attend a clinic and receive a physical exam, mammogram, ultrasound, and biopsy and receive the result all in one day.
The benefits of this are self evident. Rather than a wait to receive test results or a wait between specific tests, all can be taken care of at the same time and there is no wait to find out if it is serious.
This change in working practice has come about by again involving front line staff involved in the provision of the service and after a week long examination of the current and desired future state, data has been collected and changes in the working practice were implemented.
Andrew Castle is a consultant with Applied Angle Consulting