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Cpc lean at the christie

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    Cpc   lean at the christie Cpc lean at the christie Presentation Transcript

    • Introducing Lean to improve Service Delivery and Patient Experience at the Christie Mike Hughes
    • The Christie is Europe’s largest single-site cancer centre Registering 12,500 new patients and seeing over 40,000 patients every year
    • We deliver 50,000 chemotherapy treatments a year in six different locations on our site
    • The Lean project for chemotherapy provision at the Christie is fundamentally changing the way that chemotherapy is delivered
    • We have an ambitious, whole system programme which is producing a new improved patient pathway
    • and a significantly improved patient experience
    • This pathway eliminates £1.2 million of waste from service provision This pathway eliminates £1.2 million of waste from service provision
    • It has also given a process base to plan a new £35 million chemotherapy centre
    • So, how did the Lean project come about at the Christie?
    • Initial Problems
      • Patient waiting times – at all stages within the patient pathway (‘Christie time’)
      Disparate ward and support services logistics
      • Inefficient use of resources & inadequate systems
    • “ I felt nervous enough coming to hospital but waiting all that time, just made me really worried and anxious”
    • “ and then waiting again, this time for 45 minutes in pharmacy was too much. I just wanted to go home”
    • Patient admitted to CS for treatment Scheduler records details Scheduler passes on notes to coordinator Has been ‘ go-ahead’ signed? Patient goes home W1 W2 2a No E Coordinator briefs patient on process and timings Yes Is script correct? No Is treatment on hold? Yes No Yes No Treatment arrives. Coordinator records time Does patient return? Is there time for patient to be treated? Nurse checks script and batch number Patient taken to treatment area Is patient new? Yes No Yes Treatment starts Treatment finishes Does patient have TTO’S? Nurse gives ‘new patient’ talk No No Yes Yes No W3 W4 W7 W8 W10 W5
      • Arrival time on CS
      • Nature of treatment
      • Arranges next appt and gives to patient
      W6
      • Arrival time on CS
      • Nature of treatment
      • Arranges next appt and gives to patient
      Does patient have transport No Yes W11 Yes Is patient well enough for treatment? W9 Example of part of the chemotherapy process Patient waits whilst bloods / treatment is checked by coordinator Coord. contacts Day Services / Pharmacy to locate script Coordinator chases up to get completed Patient given pager (if wait is long) Patient paged (if not present) Patient sent home and asked to return next day Coordinator answer queries and contact relevant staff Patient appointment re-scheduled Nurse organises transport Nurse carries out checks Patient goes to pick up TTO’S Treatment comes off hold
    • W1 W2 Patient waits whilst bloods / treatment is checked by coordinator Coord. contacts Day Services / Pharmacy to locate script Coordinator chases up to get completed Patient given pager (if wait is long) Patient paged (if not present) Patient sent home and asked to return next day Coordinator answer queries and contact relevant staff Patient appointment re-scheduled W3 W4 W7 W8 W10 W5 W6 Nurse organises transport W11 Nurse carries out checks Patient goes to pick up TTO’S W9 All of these boxes were areas of waste
    • Patient admitted to ward for treatment Scheduler swipes bar code and schedules next appointment Patient goes home 2a E Coordinator briefs patient on process and timings Is treatment on hold? Treatment comes off hold Yes Treatment arrives. Coordinator records time Nurse checks script and batch number Patient taken to treatment area Is patient new? Yes Treatment starts Treatment finishes and patient handed blood form for next visit Nurse gives ‘new patient’ talk No Yes
      • Arrival time on CS
      • Nature of treatment
      • Arranges next appt and gives to patient
      Does patient have transport No Yes Is patient well enough for treatment? Co-ordinator checks bloods Are patients on protocol? No Yes Asst Practitioner carries out checks
      • HCA contacts Chemo department
      • new treatment prescribed
      • HCA checks script for next appointment
      Patient sent home and Deferred Patient picks up TTO on ward Patient provided with transport No No Processes made Lean
    • Qualification and quantification of waste Total waste identified = £1.2 million
        • Waiting ( £124,964)
        • Motion/Transportation ( £186,125)
        • Over-production ( £888,911)
    • Methodology
      • Stage 1
        • Map as is processes
        • Challenge waste and current working practices
        • Staff interviews
      Stage 2 Identify new processes Quantify current savings Rapid Improvement Events
      • Stage 3
        • Map new value streams
        • Quantify future savings
        • Development & implementation of process register
    • Through focusing on the patient and ensuring comprehensive clinical engagement, we have dramatically streamlined the patient pathway And the unique element is that this Lean project has led the design of our new £35 million chemotherapy centre which will open in 2010
    •