David Hamer: The Bolton approach to improving efficiency
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David Hamer: The Bolton approach to improving efficiency

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In this slideshow, David Hamer, Professional Lead for Laboratory Medicine, Bolton NHS Foundation Trust and National Clinical Lead for Service Improvement (Blood Sciences) at NHS Improvement ...

In this slideshow, David Hamer, Professional Lead for Laboratory Medicine, Bolton NHS Foundation Trust and National Clinical Lead for Service Improvement (Blood Sciences) at NHS Improvement (Diagnostics), outlines his approach to improving the efficiency and effectiveness of hospital services, with a focus on Lean methodology.

David Hamer presented at How can hospitals do more with less? in October 2012.

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    David Hamer: The Bolton approach to improving efficiency David Hamer: The Bolton approach to improving efficiency Presentation Transcript

    • David Hamer Professional Lead for Laboratory Medicine Bolton NHS Foundation TrustNot to be reproduced in whole or in part without the permission of the copyright owners National Clinical Lead for Blood Sciences NHS Improvement (Diagnostics) IMPLEMENTING BEST PRACTICE FOR EFFICIENCY© David Hamer 2012. All rights reserved. LONDON, 17TH OCTOBER 2012
    • © David Hamer 2012. All rights reserved.Not to be reproduced in whole or in part without the permission of the copyright owners Royal Bolton Hospital
    • Some Recent Bolton Awards Laboratory Respiratory Nurse Medicine Ed Hinchcliffe Bolton NHS FT Dr Ian Dufton Fiona Murphy Specialist Team HSJ Efficiency Award Service Innovation of 2012 Europe Process Clinical Leader of the Year Nursing Standard’s National Process Excellence 2012 the Year 2012 Excellence Award Winner British Medical Journal 2011 Nurse of the Year 2011 awards 2011Not to be reproduced in whole or in part without the permission of the copyright owners Noreen Ryan, Lesley Carney Theatre Team CAMHS Team and Cath Ashworth Outpatients Team District Nurse Team Margaret Meadows Excellence in ADHD Award Health Service Journals Health Service Journals Healthcare Caterer of the Year Patient Safety Awards 2011 Champion for ADHD 2011 2011 Efficiency Awards 2011 Efficiency Awards 2011 2010 Bolton Stroke David Fillingham Nicky Ingham Suzanne Lomax Orthopaedic Team BICS Academy Services NHS Quality Champion of the Human Resources Director of NHS North West Leadership Social Care Award Regional Diamond Care Award Winners Diamond Care Award Winners Year 2010 the Year 2010 Academy Award 2010 Finalists 2009 2009 2009© David Hamer 2012. All rights reserved. Patient Experience Bolton Improving Andy Minett Team Care System Diamond Care Award Winners National Health and Social Care TrusTECHs North West NHS 2009 Awards 2008 Innovation Awards 2008
    • © David Hamer 2012. All rights reserved.Not to be reproduced in whole or in part without the permission of the copyright owners American humourist Evan Esar 1899-1995
    • Bolton NHS Foundation Trust Integrated Care Organisation since July 2011 General hospital with 750 Acute beds Community based services delivered at more than 20 sites Serves the population of Bolton and surrounding catchment (around 350,000) Employs approximately 6,000 staffNot to be reproduced in whole or in part without the permission of the copyright owners ‘Supercentre’ for maternity and childrens services for Greater Manchester Accident & Emergency attendances around 110,000/year Circa 1,000,000 patient contacts/year© David Hamer 2012. All rights reserved. Turnover £270M
    • Department of Laboratory Medicine Blood Sciences comprising Clinical Chemistry; Haematology; Blood Transfusion ; Immunology; Serology; Regional Downs Screening Lab; Specimen Reception & Phlebotomy Cellular Pathology comprising Histopathology, Cytology and Mortuary Services; Microbiology comprising Bacteriology, Virology, Mycology and Infection Control.Not to be reproduced in whole or in part without the permission of the copyright owners Admin & Support Services (Secretarial; Admin; Logistics; Patient facing) Quality & Service Improvement Team Combined services employ approximately 170 staff - Biomedical Scientists / Clinical Scientists / Laboratory© David Hamer 2012. All rights reserved. Assistants / Medical staff / Nursing staff / Secretarial, clerical & other support Process approximately 4 million Blood Sciences tests per year
    • © David Hamer 2012. All rights reserved.Not to be reproduced in whole or in part without the permission of the copyright owners Laboratory Medicine
    • Challenges to Gtr Manchester Pathology Services (20:20 vision)  Need to reduce costs to GPs by 20%  £600,000 by August 2012 at Bolton  Need to improve quality by 20%Not to be reproduced in whole or in part without the permission of the copyright owners© David Hamer 2012. All rights reserved.
    • © David Hamer 2012. All rights reserved.Not to be reproduced in whole or in part without the permission of the copyright owners Lean Enterprise Academy Professor Daniel Jones a good crisis” “Never waste
    • © David Hamer 2012. All rights reserved.Not to be reproduced in whole or in part without the permission of the copyright owners Holistic approach processes the whole service It’s about improving the not just some elements & efficiency & effectiveness of
    • © David Hamer 2012. All rights reserved.Not to be reproduced in whole or in part without the permission of the copyright owners Lesley Doherty Bolton NHS Foundation Trust Chief Executive “It’s the way we do things around here”
    • Lean basics Eliminating Focussing on Respecting Our Waste the Patient Staff • Capacity  • Value • Enabled • Quality  • Deliver value • Enhanced roles • Defects  • Pathways • Innovate Not to be reproduced in whole or in part without the permission of the copyright owners • Cost  • Reduce TAT • Ideas  • Productivity • Improvements © David Hamer 2012. All rights reserved. Provides capacity Understanding customer & quality value drives further improvement
    • © David Hamer 2012. All rights reserved.Not to be reproduced in whole or in part without the permission of the copyright owners Objectives
    • The Bolton Approach Lean methodology Value Stream Mapping Multidisciplinary Team Customer value Staff engagementNot to be reproduced in whole or in part without the permission of the copyright owners Visual management of progress© David Hamer 2012. All rights reserved. Governance
    • Number Work Stream Lead Work Stream Name 1 Quality & Improvement Lead Next Level of LEAN 2 HR Business Manager Workforce Planning 3 Clinical Chemistry Manager Sendaways, Value for Money, Repatriation 4 Lab Med Professional Lead Customer Service, Marketing & Advice Specimen Reception / Phlebotomy 5 Laboratory Medicine in the Value Stream ManagerNot to be reproduced in whole or in part without the permission of the copyright owners 6 Cell & Infection Science Service Manager Transport 7 Haematology Manager Information Technology 8 Transfusion Lead Demand control, Pathways, Order sets© David Hamer 2012. All rights reserved. 9 Lab Med Clinical Lead New Business, Innovations Finance, Managed Service Contracts, 10 Management Accountant Procurement
    • © David Hamer 2012. All rights reserved.Not to be reproduced in whole or in part without the permission of the copyright owners Quality / Timeliness / Delivery BEST CARE FOR BETTER HEALTH
    • Secure high quality GP services Initiatives Support GPs in Triple Aim Big Bolton Health checkNot to be reproduced in whole or in part without the permission of the copyright owners Provide GP CPD sessions to educate & influence pathways & testing protocols Provide GP newsletter Collect GP practice views & analyse using Kano tool Improved sample collection system/courier service in consultation© David Hamer 2012. All rights reserved. with users Expanded GP domiciliary phlebotomy services
    • Continuously improve Quality Action Improvement Number of agreed clinical requesting pathways 78% Repatriated sample turnaround time 86-90% Number of sendaways (sent to reference lab) 10% reduction Needle to Notes for A&E 74%Not to be reproduced in whole or in part without the permission of the copyright owners U&E 40% reduction Number of tests in GP test profiles Bone profile 25% reduction Increased electronic reporting of tests >95% Meet or exceed RCPath Blood Sciences TAT KPIs 100%© David Hamer 2012. All rights reserved.
    • © David Hamer 2012. All rights reserved.Not to be reproduced in whole or in part without the permission of the copyright owners Cost / Value for Money USING RESOURCES RESPONSIBLY
    • Efficiency savings of 20% Forecast - identified £803K recurrently £517K posted in Year • Reprofiling – skill mix / reorganisation • Procurement – Re-negotiation of contracts (suppliers; referred work;Not to be reproduced in whole or in part without the permission of the copyright owners Managed Service Contracts) • Streamlining efficiencies (better stock management; demand control; removing waste; eliminating defects; repatriation of work) • Income generation (new business with same resource; new services)© David Hamer 2012. All rights reserved.
    • © David Hamer 2012. All rights reserved.Not to be reproduced in whole or in part without the permission of the copyright owners Productivity <<< 62% >>> Last 6 months Productivity rose by 9.5%
    • © David Hamer 2012. All rights reserved.Not to be reproduced in whole or in part without the permission of the copyright owners Morale / Human Dimension VALUED, RESPECTED & PROUD
    • Improve patient/staff experience post in Haematology / Transfusion under Initiative We have secured Scientist Training Modernising Scientific Careers All staff have attended BICS Academy Green training; all senior staff have attended Bronze; all Lab Managers have attended Silver & some are also now on Gold. All senior/supervisory staff have now attended the Engaging Manager programmeNot to be reproduced in whole or in part without the permission of the copyright owners & completed LMSQ Formed a cross discipline/cross grade Lab Med Team to support 100 voices (monthly in-patient interviews) Assigning BMS staff to named wards to support Transfusion safety & education© David Hamer 2012. All rights reserved. Job satisfaction and morale have increased, sickness absence continues to run Willingness to below the Trust target of 3.75%. Staff feel empowered to deliver the services they adapt have developed
    • Innovation in practiceNot to be reproduced in whole or in part without the permission of the copyright owners© David Hamer 2012. All rights reserved. Unique & Innovative Quality Assurance Scheme provided for high street point of care testing services throughout the UK. (GPs, Pharmacies, Health Centres, Supermarkets)
    • Reflections/Insights (Lab Med)  Went well  Team approach  Staff engagement  The work has improved quality and protected jobs  Insights LeadershipNot to be reproduced in whole or in part without the permission of the copyright owners   Voice of the Customer  Break out of your silo  Focus on the Quality  Daily (continuous) Improvements© David Hamer 2012. All rights reserved.  It’s tough
    • Reflections (Trust) It’s too compelling to ignore:  It has to be a cultural change  Board and lean team leading by modelling behaviours  It has to be values and behaviourally led built on engagementNot to be reproduced in whole or in part without the permission of the copyright owners  It requires leaps of faith  It requires leadership courage  It saves lives….and money© David Hamer 2012. All rights reserved.  Lean is all about people and all about quality
    • Insights (Trust) Leadership We already changes have the We don’t experts really know 80% people what’s happening 20% method Narrow and out there Deep v. Other Broad and people have Get good been down It’s not a Shallow – project advice; the the path build balancing before usNot to be reproduced in whole or in part without the permission of the copyright owners knowledge act and skill It feels Patients Leadership good (even know what Sustainment from the though it’s value is is hard top is tough) essential© David Hamer 2012. All rights reserved.
    • © David Hamer 2012. All rights reserved.Not to be reproduced in whole or in part without the permission of the copyright owners do things around here” “It’s the way we
    • © David Hamer 2012. All rights reserved.Not to be reproduced in whole or in part without the permission of the copyright owners Questions