Knowlton Project Support

Lean in the NHS – it can work!

The challenge

The challenge for this hospital trust was to reduce day to day operating costs and at the same time increase capacity & patient throughput in Day Case wards. The online Lean Benchmark Report was an excellent starting point (see sample report)

Two day case teams across two hospitals worked together to assess the current value stream, identify non value added activity then rationalise into one coherent future state process.

In addition to this process rationalisation, at the same time other teams implemented 5s within the wards, theatres, prep rooms, Anaesthetic areas, clinical stores and equipment washrooms.

Tangible outcomes through 5S Activity

  • £12K saving through optimisation of stock levels in clinical stores
  • £22K saving following  a review of stock required in the theatre drugs cabinets (Typically £500 overstocking in each drugs cabinet)
  • 15% reduction in motion and distance walked in prep rooms and stock areas

 Day case wards

  • 2 week reduction in patient waiting time due to new ‘on demand’ Adhoc pre assessment service
  • Capacity for pre assessment  increased from 20 patients a day to 30 a day without any increase in staff hours
  • 655 patients failed to attend (booked) appointments costing an estimated £237K per annum. Now reduced by 50% after one month and expected to reduce to 0 when pre assessment process is fully implemented across all clinics at both hospitals

Intangible out comes

  • Change agents equipped with new lean skills, some now have the confidence and capability to lead projects.
  • Staff are working much more effectively as a team and recognise the benefits of rationalising processes across different departments to meet a common goal
  • Patients are a having ‘A brief encounter’ when they visit day case, flowing from clinics through pre assessment and onto the ward.

 What happened?

The teams identified 19 lean projects, some were ‘quick wins’ and other more complex projects were implemented over a period of 3 to 4 months.

To improve the flow of patients through the day case ward, the first step was to qualify and scope out the project. The team was encouraged to complete a RACI plan (Responsible, Accountable, Consult, and Inform) which ensured there was buy in across all areas and the right people were engaged in the project work. In addition to this a Project Charter was developed, a one page document which summarised the scope, objectives, deliverables, critical success factors and most importantly key measures demonstrating the real impact of the teams work.

The next step was to identify waste within the current value stream and develop a new process which would allow day case patients to be pre assessed ‘on demand’ and no longer ‘booked in’ and added to the waiting list.

Over the next 8 weeks the team took time out of their day to day activity to develop the new process and associated standard operating procedures. Key factors impacting the project success was the regular monthly meeting with the  project manager supported by effective communication between the project teams and the staff affected by the new systems.

The new ‘on demand’ pre assessment process required greater flexibility from the clinical staff. This could have been a difficult management issue in terms of changes to current working arrangements. However, new shift patterns were developed by the staff themselves, they spoke directly to various clinics across the hospitals, assessed the volume of patients to be referred daily and then discussed and planned their hours accordingly.

The 5s activity ran parallel to the process improvement work and  delivered  financial savings, provided a better working environment in day case wards, improved infection control and indirectly helped to  improve moral of the day case teams.

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