Applying Lean in Pathology


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Peter Gray and Dave Slater of Royal Bolton Hospital shown at the 2nd Lean Healthcare Forum on 6th June 2006 ran by the Lean Enterprise Academy

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Applying Lean in Pathology

  1. 1. Royal Bolton Hospital Blood Sciences Lean project Peter Gray Dave Slater
  2. 2. Bolton Hospitals NHS Trust Covers a population of 265,000 Employs 3100 staff Emergency admissions of >38000 Total beds = 779 Pathology total workload >1.4 m requests 2004/5 Blood Sciences = 50% of above
  3. 3. Pathology lab history Pathology is split in 2 buildings across the hospital main corridor Due to increasing workload, we believed that the size of the building and staffing needed to expand (business case showed spend of £650,000 was required) The laboratory is CPA accredited
  4. 4. Value Stream analysis Team of various grades from pathology, pathology users and external staff worked on value stream analysis over 4 days
  5. 5. Mean of all deliveries MEAN of all deliveries all routes for all Pathology departments 0 50 100 150 200 250 300 350 400 GPvan Air tube Reception GP vans GP vans phlebotomy
  6. 6. Current state
  7. 7. Unnecessary movement Urgents (Biochemistry) Sample 75 steps approx 40x daily =3,000 Information 135 steps once a day GP van (all labs) Samples 4924 steps per day Information 135 steps x2 daily Routine (Microbiology) Sample 309 steps x7 daily Information 362 steps x 7 daily This is the minimum, it could be higher
  8. 8. Future State
  9. 9. Value statement The delivery of a correct result for a blood sample, for the correct patient to the correct clinical team within 1 hour of receipt unless precluded by current technology
  10. 10. Staff Communication After the week, feedback sessions were held with staff. One per day for 5 days Staff were asked for comments to be written on feedback sheet in Staffroom Analysis of comments showed 2 categories of concern: Staff roles New laboratory design
  11. 11. Week two - 3P planning event Revisited first Blood Sciences laboratory design Reviewed staff comments Re-calculated waste(s) Used a lean project management tool to produce a 1-decision implementation plan 4 phases Individual task definition and detail
  12. 12. Redesigned the Lean laboratory
  13. 13. Benefits from New Design Achieves process flow Reduced Steps Urgent Blood Samples - reduced from 75 steps to a maximum of 57 steps Routine Blood Samples – reduced from 309 steps to a maximum of 57 steps GP vans maximum of 57 steps from 2462 steps for 1 run Strategic grouping of analysers – better utilisation , require reduced numbers of analysers
  14. 14. Predicted benefits from new design New laboratory design accepted by all staff Reduced number of staff required Reduction of floor space (40%) Reduction of travel distance (80%) Opportunities to utilise skill mix of staff in new ways
  15. 15. Current progress Understand the type of equipment required for flow processes Reduction of sample processing time from an average of 5 hours to approximately 60 minutes. (Routine) Reduced the turnaround time for some tests e.g. HbA1c from 30 hours to 3 hours The design of the lean laboratories will have flexible benching and analysers will be on trolleys. Reduced re-work
  16. 16. Additional benefits for Blood Transfusion
  17. 17. Value stream mapping for Blood Transfusion Cross Matching Broken into 28 stages 323 steps Touch time – 176 secs Flow time – between 25min – 2hrs 51min Group & Save 14 Stages 90 – 111 steps Touch time – 210 sec Flow time – 70 min Hand offs – 2 or 3 dependent on staffing levels
  18. 18. Lean Blood Transfusion Lab Runners Repeaters Strangers
  19. 19. Benefits from New Design Improved flow Reduced waste Stocking Blood bank – reduced steps from 160 to 50 steps (70%) XM – reduced from 323 to 69 steps (79%) G&S – reduced from 95 to 7 steps (91%) Abnormal antibodies – reduced from 111 to 30 steps (73%) Less re-work Reduced number of hand offs Designed area for flow stoppers Dedicated pod station
  20. 20. 6S for Flow Sort (get rid of what’s not needed) Straighten (A place for everything..) Shine (clean and wash) Safety (checking for hazards and defects) Standardise (build into acceptable routines) Sustain (maintain the standards set by the 6S event)
  21. 21. 6S event for Specimen Reception
  22. 22. Current state
  23. 23. After 6S
  24. 24. Benefits of 6S in Specimen Reception 6S score has improved from 24% on Monday to 87% on Thursday Staff involvement As the week progressed staff became more involved and enthusiastic Visual Management introduced Labelling Cupboard fronts removed Clear boxes introduced Colour coding 6S board introduced Working Environment Cleaner Brighter Better organised “Waste” removed
  25. 25. Is Lean Easy ?
  26. 26. Issues Extremely complex project Reconfiguration of services Project delays due to external suppliers issues Scanning software for request forms not ready (external supplier) Continuing to provide a service 24/365 whilst under going major change Plenty of strangers due to configuration issues IT issues e.g. analyser interfaces
  27. 27. Issues cont’d Changing the way staff work Integration of previously discrete departments HR issues (many to be addressed) Getting ALL staff to understand lean Staff on shifts, part time staff, staff using batch techniques for many years Some staff are very receptive Others are less receptive and see it as a means of reducing staffing levels (particularly in the current NHS climate)
  28. 28. General lessons Huge changes in very short time scales have had (are having) a profound effect on all the staff. Some have adapted very quickly, some not at all yet. The magnitude of the task of managing the human issues cannot be over emphasised. It is a credit to the staff & their managers that we have progressed so far so quickly.
  29. 29. General lessons It has been (is still) a roller coaster ride of emotions & stress & tension usually all within the same day. Mutual support especially within the senior management team has played a vital role.
  30. 30. Lessons learnt Don’t leave the staff as they will revert back to their customary working practices Must have a team leader responsible for each area who wears a “lean hat” Don’t expect the new “flow” to work to the reduced waste calculated – it will take time Document the new working practices – standard work
  31. 31. Is lean easy ? NO Changing mindsets Changing a 24/365 service But this project has been achieved in 8 months Previously it would have taken years!! Pathology and this Trust are at the beginning of a journey