Last updated: 16.12.13

Lean is doing it for the kids

Service Improvement Skills for Organisational Transformation in the Healthcare SectorWith a shift in focus on improving patient experience in the healthcare sector and more recently the call from Robert Francis QC for fundamental change, together with unprecedented efficiency drives, and the monumental re-organisation of the biggest employer in the United Kingdom, the NHS is facing its toughest challenge yet.It will come as no surprise then to the initiated, that the adoption of lean principles is on the up in the healthcare sector. Service improvement techniques are being embraced to help eliminate waste and inefficiencies and bring about radical change in order to improve patient care and services.Public and private healthcare organisations are taking advantage of private companies such as Virtual College who have a dedicated Lean Healthcare Academy delivering specialist lean healthcare training.Lean working methodologies have been proven in building sustainable and continuous service improvement within many healthcare organisations; namely in a reduction of all forms of waste, improvements in safety and shorter, simpler patient journeys culminating in improved patient experience. The University Hospital of North Staffordshire is just one hospital of many to improve its services by applying lean techniques. The following case study outlines departmental leadership in Improving Paediatric Pathways & Patient Experience at the large acute hospital trust.Children’s services were due to move in to the new hospital building in March 2012. Before the move, there were a number of challenges to overcome in making this transition. The bed compliment was smaller and teams and specialities were to be integrated or work more closely. With activity being so diverse across paediatrics, significant change was required. For example, paediatric outpatients would be close to the inpatient area and all inpatient areas would be adjacent to one another, rather than spread across a number of sites. This provided the team with a great opportunity for creating substantial improvements in the service delivered, reducing inefficiencies and improving patient experience. At the start of the project, with its large number of clinical subspecialties, it was essential that staff had a comprehensive understanding of the patient pathways in detail and the interdependencies with other areas both within paediatrics, other departments within UHNS, and the Local Health Economy. Process mapping would facilitate this and enable staff to become involved in improving the pathway where required. The transformation of services has been an absolute necessity for Children’s Services, with invaluable support from the Lean Healthcare Academy (LHA) Examples of improvements to patient experience includeOne-stop Allergy Pathway - Allergy patients formerly had an allergy test (or tests) as an outpatient to check for a reaction, then separately have an allergy challenge in a day case setting to confirm any positive results. Following on from process flow mapping there was a one-stop approach, with patients receiving the test and the challenge on the same day, both within the Outpatient area.Thalassemia patients visited the hospital for a blood transfusion every four weeks and a cross-match approximately two days prior to their transfusion. This meant that two days schooling was missed every four weeks for each patient (and two working days for parents). Through process mapping events the specialty team proposed a solution to extend the use of hospital at home for the cross-match on an evening, and carrying out transfusions at the weekend, thus minimising the impact on education. Families expressed their preference for thisPaediatric sub-specialties pathways that have been mapped included: •Cardiology•Cystic Fibrosis•Child Protection•Complex LTC•CONI•Diabetes•Epilepsy & Neuro Conditions•Gastro•General Paeds•Oncology•PHDU•PICU•Renal•Respiratory•Sleep Studies•Surgical Day case•Surgical Emergency•Surgical Orthopaedic•Allergy•Children"s Outpatients•Endocrinologyal•Haematology•Rheumatology•Thalassemia•Ward reviewsPaediatric Emergency & Urgent Care group focused on the integration of the Children’s Emergency Department and the Paediatric Assessment Unit to reduce onward admissions to wards. Nursing teams are still being gradually integrated to share knowledge and skills.Examples of improvements to patient experience includePatients are able to present at a stand-alone reception, separate from adults in Children’s ED, meaning waiting in a more appropriate and child-friendly environment. The co-locations on one site will reduce inefficiencies and delays when Specialist Paediatrician input is required.The Paediatric Medical & Surgical Inpatients group have reviewed a large number of patient pathways through process mapping events and data analysis. Through improved patient pathways and reconfiguration of the wards, there has been a sustained reduction of six inpatient beds and eight day case beds. Bed modelling using Capacity & Demand techniques has demonstrated the seasonality of paediatric emergency activity enabling better alignment of staffing to flexibly meet peak demand.Day case scheduling is now more evenly spread across the working week; this has improved by 25% as compared with the same time the previous year.Despite an increase in admissions of 2.8%, the overall Average Length of Stay was reduced by 7.8% vs. April to October 2010/11. ConclusionProcess mapping events have definitely helped with staff engagement. Lean techniques recognise that staff have the expertise in the service enabling them to challenge one another. The Process Flow Analysis technique employed by the Lean Healthcare Academy captures the patient flow which is now shared widely in the department. In addition it is now a lot easier to capture issues and convert them to an action plan. With a consistent approach across all subspecialties it can enable one action plan to keep a handle on all changes (nearly 700 issues / ideas / questions for this project alone).Capacity and demand tools have illustrated the variability in patient flow through emergency pathway, both in terms of seasonality and time of day. ERLANG’s rule was used to help plan for this variability in terms of expected activity and staffing.Staff carrying out day to day tasks will know what they are doing. Previously if they were on leave there was confusion and inconsistency of service. Standard Operating Procedures have reduced these inefficiencies and clinical risks. Referee:Dave FryTransformation Project Manager (Child Health)University Hospital of North Staffordshiretel: 01782 552151e-mail: david.fry@uhns.nhs.ukThe 6th Annual Lean Healthcare Conference and AwardsVirtual College host The Annual Lean Healthcare Conference and Awards, next year to be held on Thursday 6th February 2014 at The Marriott Hotel, Trevelyan Square, Leeds.Now in its sixth year, The Lean Healthcare Conference and Awards has become the national annual forum for sharing best practice and rewarding members from the healthcare sector for adopting and sustaining lean service improvement methodologies.The event brings together successful and innovative health professionals from across the country who are involved in service improvement and patient care. It offers the opportunity for delegates to discuss successful Lean improvement projects with improvement specialists, as well as seeing numerous examples of the application and benefits of waste reduction in healthcare.The conference and awards attracts staff from across a broad spectrum of the healthcare sector, with particular interest from service improvement, service development, service transformation, business development, learning and development, ward managers and heads of departments.Attend the Conference and AwardsEvent Venue: Marriott Hotel, Trevelyan Square, LeedsEvent Date Thursday 6th February 2014.For more information contact Clair Barbour on 01943 885086. Or visit the Awards site of this year’s Lean Healthcare projects can be viewed at JeromeMarketing Executive Virtual College