by Andrew Cottom of Gwent NHS Trust shown at the 4th Lean Healthcare Forum on 9th October 2007 ran by the Lean Enterprise Academy

1. Making it count
Andrew Cottom
Fourth Lean Healthcare Forum
9 October 2007

2. Content
• Context
• Reflection – has it
helped / is it helping
• But what about
savings?
• Future – some
thoughts

3. Visitors from Wales

4. Blaenau
Gwent
76400
Monmouthshire
89200
Newport
140500
Torfaen
93600
Caerphilly
177000
Local Authorities / Health Boards
In Gwent

5. The Gwent Healthcare NHS Trust
• 3 hospitals providing
acute services
• 3 hospitals providing
acute services
• 2 main hospitals
providing mental
health services
• 15 other hospitals
• 3 hospitals providing
acute services
• 2 main hospitals
providing mental
health services
• 3 hospitals providing
acute services
• 2 main hospitals
providing mental
health services
• 15 other hospitals
• 41 health centres
and clinics
• 3 hospitals providing
acute services
• 2 main hospitals
providing mental
health services
• 15 other hospitals
• 41 health centres
and clinics
• serving a population
of around 600,000
• 3 hospitals providing
acute services
• 2 main hospitals
providing mental
health services
• 15 other hospitals
• 41 health centres
and clinics
• serving a population
of around 600,000
• Turnover £0.5bn

6. Last year we treated
Emergency admissions
Non-emergency admissions
Day cases
New outpatients
Follow-up outpatients
Obstetric admissions
Accident & Emergency /Minor Cas.
65,800
16,200
48,400
113,000
287,000
9,700
172,000
712,100
180
65
194
451
1,148
27
471
2,536
Average
weekday
During the
year

7. Financial Position - context
• Deficit
Diverging Income & Costs - 2003 to 2009
-10
-5
0
5
10
15
20
2003/04
2004/05
2005/06
2006/07
2007/082008/09(est)
Cost Pressures Inflation(inc pay)
Service Pressures Income Loss
£17m
£12m£21m
£16m
£8m
Gwent NHST - I&E Position 1999/00 to 2011/12
-8
-6
-4
-2
0
2
4
6
8
99/00 00/ 01 01/02 02/ 03 03/ 04 04/ 05 05/ 06 06/07 07/08
£5m

8. Emergency Pressures
3500
4500
5500
6500
7500
2000/01 2001/02 2002/03 2003/04 2004/05 2005/06 2006/07

9. How could/has “Lean” helped

10. Lean (simply put)Some early expectations (2003)
• Cooks out the fat
(waste)
• More consistently done
• A better taste
• Better for you (Safer)
• Visible performance

11. Some early lessons - (May 2003)
• Our processes complex - years of “adding
solutions”
• Lean = OD
• Techniques in Lean offer genuine
sustainable improvement
• Lean = new skills for management
• Focus of Lean is Quality product
• Lean projects generate spin offs to
continuous improvement

12. Implementing Lean Thinking
Sept’04
• 7 tactics
– Innocuous pilot
– Get an expert
– Lean Network
– 5S/CANDO
– Clinical project
– Management Development
– Whole “Production” System

13. Clinical Consummables Goods
Annual Cost
0
50000
100000
150000
200000
Before After
£s
30%
reduction
CT Scan Lead Time Improvement
0
1
2
3
4
5
6
7
Before After
Delay for off site scan
Days
Patient 'Right First Time on Time'
Diagnostics & Treatment
0
20
40
60
80
100
120
Apr-07 May-07 Jun-07
%
JI Programme No. of Staff Trained
0
20
40
60
80
100
Apr-07 May-07 Jun-07
Productivity Improvement General Medicine
CDMH
0
20
40
60
80
100
May 06 -
Sep 06
Oct 06 -
Mar 07
Apr 07 on
Beds
patients per bed
per week
300%
improvement
Up 24.5%
Up 19%
Up 47%
>90% trained
on time

14. Productivity Improvement
General Medicine CDMH
0
10
20
30
40
50
60
70
80
90
May 06 -Sep 06 Sep 06 - Mar 07 Apr 07 0n
0
0.2
0.4
0.6
0.8
1
1.2
Beds
Patients per bed per week
Up
19%
Up
47%

15. But what about the savings……?

16. Counting the cost – traditional method
• Estimate of savings (Caerphilly)
– CT Scans (patient days saved) £42k
– Outliers (patient days) £98k
– Delayed Transfers £88k
– Agency (actual cost reduction) £500k
– Stock (est. costs) £50k
• Issues
– “Notional”
– Hitting budget?
– Other programmes

17. But what about the savings……?
a hypothesis

18. Theory – Congestion Costs
“On the basis of available data, it is
estimated that the total direct costs
of congestion are around £825m
per annum, which comprises
around £430m incurred by business
users and £395m incurred by other
users.” (Economic Costs of Congestion in the East Midlands –
ATKINS – May 2007)

19. Current State VSM for Patient Journey: Shortness of Breath
Lead Time = 11,055 mins
Process Time = 94 mins

20. NHS Congestion Costs
• Short term / unplanned
– Agency / locum
– Unplanned capacity
– Outliers & lost surgical activity (income)
• Long term / planned
– Administrative systems (inc Medical Records)
– Consumables – drugs; medical supplies;
catering; paper
– Management capacity

21. Counting the cost – futures
• Pathway focus
• Patient level focus
• Lesson from private sector
– “…taken aback by the level of precision, not
just in the engineering process but also in the
approach to costing. …impressed with the
desire of production people to look at every
opportunity to reduce costs…”
(HealthcareFinance – Oct’07)

22. Counting the cost – futures
• Patient Level Costing & Lean @ Caerphilly
– Patient focus
– Pathway / Value stream based
– Engagement with front-line
– Detail, detail – “…the devil is in the detail but
– so is the answer….”
– Charge-out from service departments
– Reconciliation to budgets

23. Current State VSM for Patient Journey: Shortness of Breath
Lead Time = 11,055 mins
Process Time = 94 mins
Cost Cost Cost
Cost
Cost

24. Counting the cost – future savings
programmes

25. Counting the cost – future savings
programmes
Ward X
Roster Project Skillmix Review
Procurement /
Stock Control
Admin Duties
Lean/Ops Management
Plan for Every patient
Every day

26. In conclusion….

27. 4th Lean Healthcare Forum
2007