Mapping the Elective Journey
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Mapping the Elective Journey

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by David Fillingham and Mike Maguire of Bolton Hospitals NHS Trust shown at the 2nd Lean Healthcare Forum on 6th June 2006 ran by the Lean Enterprise Academy

by David Fillingham and Mike Maguire of Bolton Hospitals NHS Trust shown at the 2nd Lean Healthcare Forum on 6th June 2006 ran by the Lean Enterprise Academy
www.leanuk.org

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Mapping the Elective Journey Mapping the Elective Journey Presentation Transcript

  • Mapping the elective Journey:Mapping the elective Journey: using lean to avoid needlessusing lean to avoid needless delaysdelays Mike Maguire Director of Commissioning Bolton PCT David Fillingham Chief Executive Bolton Hospital
  • 2am1 4 FRI 2 3 5 DAY 2 6 SUN DAY 3 7 DAY 4 DAY 5 WEEK 6 8 9WEEK 11 10
  • 2am1 4 FRI 2 3 5 DAY 2 6 SUN DAY 3 7 DAY 4 DAY 5 WEEK 6 8 9WEEK 11 10
  • 2am1 4 FRI 2 3 5 DAY 2 6 SUN DAY 3 7 DAY 4 DAY 5 WEEK 6 8 9WEEK 11 10 WaitingTransportation/ Motion Waiting Waiting Waiting Waiting Waiting Waiting Waiting Waiting Waiting Mistakes Mistakes Mistakes Uncoordinated Activity Uncoordinated Activity Uncoordinated Activity Uncoordinated Activity Uncoordinated Activity Uncoordinated Activity Uncoordinated Activity Stock Stock Transportation Transportation Transportation Transportation/ Motion Transportation/ Motion Transportation/ Motion Inappropriate Processing Inappropriate Processing
  • The NHS is full of committed staff who struggle to deliver good care within a set of broken processes
  • Lean can help us to:- • See things through the patients eyes • See the hidden problems and waste • Create safe, clean, calm work environments • Fix our broken processes • Turn every staff member into a problem solver every single day
  • The Beginnings of a Lean Journey……. • 350 staff engaged (10%) over 9 months • Early results promising - Trauma: 50% mortality reduction post #NOF; 33% LOS reduction - Pathology: Blood specimen processing - 40% floor space saving - 20% productivity gain • Antenatal; Radiology; Laundry; Musculo-skeletal • Focus is on quality and safety not cutting cost • We now know just how much we don’t know!
  • We are using lean to:- • Reduce mortality rates • Improve staff morale • Improve patients’ experience • Improve productivity • Achieve (then better) the 18 week wait
  • Achieving an 18 week maximum wait • Wont be achieved just by working harder • Wont be achieved by a 6/6/6 mentality • Can only be delivered by working across organisational boundaries • Requires deep understanding of end to end processes • Demands removal of waste and non-value adding steps and creation of flow
  • The Bolton Approach 1. Understand the current state - analyse, observe and map 2. Design the Future State - cells - linkages - flow 3. Deliver the Future State 4. Repeat the Cycle
  • Lean in practice – A recipe for success The MSK experience
  • ELECTIVE PATIENT JOURNEY: GETTING THE LEAN DATA OPD Tier 2/ ICATs (currently Surgical but ?medical for future): Pre-Assess WLs/ Queue Mngt Ward/ DC IP Beds Tx and/or; Theatre Discharge Diagnostics: •Demand •Activity/throughput •Capacity (planned v supplied) •Queue/inventory •Blockage •Delay •Demand •Activity/throughput •Capacity (planned v supplied) •Queue/inventory •Blockage •Delay •Demand •Activity/throughput •Capacity (planned v supplied) •Queue/inventory •Blockage •Delay •Demand •Activity/throughput •Capacity (planned v supplied) •Queue/inventory •Blockage •Delay •Demand •Activity/throughput •Capacity (planned v supplied) •Queue/inventory •Blockage •Delay •Demand •Activity/throughput •Capacity (planned v supplied) •Queue/inventory •Blockage •Delay •Demand •Activity/throughput •Capacity (planned v supplied) •Queue/inventory •Blockage •Delay Select High Volume Groups – Where are your flow problems? The above data gives a current state of delivery and shows the mismatches (this gives you your baseline to measure improvements against. For the future state it is important to work out the essential value steps you are working towards. The pace will need to flex to meet demand (a no waste system), and your data should be focused on this journey. Old ways use data to calculate what we can and do deliver, rather than how we need to work differently to deliver a one piece flow system…. very different!
  • MSK - Current State: MSK - Future State: MEASURE CURRENT STATE FUTURE STATE Total Steps DC: 28 IP: 40 DC: 5 IP: 5 Value Added Steps DC: 7 IP: 11 Key steps only + customer delighters Flow Time Max: DC: 20 weeks IP: 40 weeks Max: DC & IP: 18 weeks Pure Value Added Time: DC: 71 mins IP: 106 mins
  • Lessons from the current state analysis • Multiple OP visits • Diagnostics not fully aligned with OPD • OP wait – 40 to 60% of journey • Patients on waiting lists that need their health optimising first • System not compatible with 18 weeks • Waste and inefficiencies exist within surgical processes
  • Integrated Clinical Assessment Services in GMSHA • Trauma and Orthopaedics (inc Rheumatology) • General Surgery • ENT • Gynaecology • Urology • Range of supporting diagnostics • 2/3 National IS procurement, 1/3 Local procurement or NHS provision
  • SYSTEM TRANSFORMATION USING ICATS Hospital 1 2nd Line Diag 1ry Treat Triage 1st line Diag Assess & Pre op “Choice” C&B Select ICATS (RBMS) Patient Referred by GP, Optometrist or Dentist Community Services Hospital 2 ICATS Hospital 3 Hospital 4 IS provider Free choice 2008 Patient Flow
  • Benefits of ICATs • Patients arrive fully worked up to a common standard in 1 stop shop • Only patients who need, want and are fit for surgery arrive at hospital • Increased predictability and precision through choose and book • Patients make choice with full treatment plan • Removes unnecessary steps and waste
  • But this could still happen…..
  • SYSTEM TRANSFORMATION WITH ICATs Referral Management Patient Referred by GP, Optometrist or Dentist Choose And Book centre IS H 1 H 2 H 3 H 4 ICATS Diagnostics/Initial pre op done here OP Theatre Additional diagnostics Pre op Timeline – 4 weeks Timeline – 6 weeks Present Acute System will not hit 6 week time line ICATS must have a 4 week timeline
  • Using “Lean” to redesign the Acute System • Future state vision • Creation of efficient Preoperative and Surgical Cells • “Lean” length of stay improvements • Implement through Rapid Improvement Events, Projects and “Just Do its”
  • ORTHOPAEDICS – FOLLOWING ICATs and LEAN Referral Management Patient Referred by GP, Optometrist or Dentist Choose And Book centre IS H 1 H 2 H 3 H 4 ICATS Diagnostics/Initial pre op done here Theatre Consenting Visit Final preop Timeline – 4 weeks Timeline – 6 weeks
  • Understanding Real Acute Capacity Operating Capacity GP admissions for surgery % Removals other than Treatment % Conversion from Outpatients % Cancellations & DNAs % Other Referrals % GP referrals Other OP Slots to service Theatres NET RESULT – Know number of GP OP slots to service theatres
  • The Result • An effective predictable system • Transformational change • Fit for purpose for 18 weeks
  • Lessons so far • Lean analysis gives a much better understanding of the real processes and demands • Some radical changes are needed (eg ICATs) • Achieving flow reduces waste but also exposes the problems • Active and enthusiastic involvement of frontline staff is the key to success