Lean Results from the Wirral
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This document provides a progress report on efforts to improve the quality of patient journeys through the Lean Green Stream at Clatterbridge Elective Surgery Centre. It describes the current state of hernia procedures, results from a rapid improvement workshop including reduced touches in pre-op assessment and the day case unit, increased throughput in theaters, and positive patient and staff satisfaction surveys. Next steps include reconfiguring ward space and maintaining momentum with bi-weekly staff meetings.
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Lean Results from the Wirral
- 1. Wirral Hospital NHS Trust Lean Green StreamLean Green Stream Clatterbridge Elective SurgeryClatterbridge Elective Surgery CentreCentre Progress report August 2006Progress report August 2006 Carol Makin, Terry Tarr, Paul Kutarski, MartinCarol Makin, Terry Tarr, Paul Kutarski, Martin Greaney, Glyn Thomas, Jo Goodfellow, Jeanette Berry,Greaney, Glyn Thomas, Jo Goodfellow, Jeanette Berry, Pam Leonard, Angie Tilston, Kath Shirley, Jo Hardman,Pam Leonard, Angie Tilston, Kath Shirley, Jo Hardman, Frank Hoey, Gaynor Westray, Gaynor Williams, SheilaFrank Hoey, Gaynor Westray, Gaynor Williams, Sheila O’Neill, Nicki McAllister, Jenny O’ConnorO’Neill, Nicki McAllister, Jenny O’Connor
- 2. Wirral Hospital NHS Trust AimAim To improve the qualityTo improve the quality of the patient’s journeyof the patient’s journey
- 3. Hernia CurrentHernia Current StateState GP PracticeGP Practice ReferralReferral OutOut PatientPatient AppointAppoint-- mentment Pre OpPre Op AssessAssess-- mentment AdmissionAdmission (Day Case)(Day Case) ProcedureProcedure DischargeDischarge Follow UpFollow Up NationalNational Choose & BookChoose & Book Local BookingLocal Booking ServiceService List 2 wksList 2 wks BeforeBefore AppointmentAppointment PatientPatient GetGet DateDate ConsultantConsultant SecretarySecretary Letter to PatientLetter to Patient Letter to GP &Letter to GP & Patient &Patient & ConsultantConsultant Letter to GPLetter to GP Follow upFollow up DateDate Daily ListDaily List Come In ListCome In List List 2 WeeksList 2 Weeks BeforeBefore AppointmentAppointment Letter to GPLetter to GP Wirral Hospital NHS Trust Lead TimeLead Time = 65.5 days= 65.5 days Process TimeProcess Time = 193 Min= 193 Min 5 Min5 Min 22 Min22 Min 32 Min32 Min 5 Min5 Min 7 Min7 Min 3 Weeks3 Weeks 70 Min70 Min 90 Min90 Min 20 Min20 Min 60 Min60 Min 12 Min12 Min 6 Weeks6 Weeks4 Weeks4 Weeks 18 Week target18 Week target Max 6 MonthsMax 6 MonthsMax 13 WeeksMax 13 Weeks
- 4. Wirral Hospital NHS Trust 15th15th -- 19th May 200619th May 2006 Rapid improvement workshopRapid improvement workshop – the green stream – out patients and pre-op assessment – day case unit – niggles
- 5. Green StreamGreen Stream 4.2% of procedures account for 52% of4.2% of procedures account for 52% of theatre throughputtheatre throughput – LA flexible cystoscopy 15% – GA cystoscopy 11% – hernias & varicose veins 7% – hip/knee replacements/arthroscopy 9% – excision lumps & bumps 4% – lower GI endoscopy 3% – carpal tunnel 3% Wirral Hospital NHS Trust
- 6. Wirral Hospital NHS Trust Rules supporting green listsRules supporting green lists individually agreed and embeddedindividually agreed and embedded • In a true green operating list the only weekly variation should be the patient’s name and laterality • Aim to achieve transparency and rigidity for routine work, in order to obtain flexibility for extra ordinary events • Booking process centralised as lists go green – supports Trust’s plans for centralised admission/discharge /transfer “Economies of repetition”“Economies of repetition”
- 7. Wirral Hospital NHS Trust Visual displayVisual display
- 8. Wirral Hospital NHS Trust Theatre coTheatre co--ordinatorsordinators 8.30 am8.30 am daily meetingdaily meeting • Review previous day’s lists – discuss any problems that arose and solutions – did all green lists start on time and if not why not? – numbers of issues logged on a chart • Scan today’s lists – anticipate any potential problems and discuss prevention Allows expert knowAllows expert know--how to be shared by all staffhow to be shared by all staff
- 10. Wirral Hospital NHS Trust PrePre--op assessmentop assessment • Touches reduced • All phlebotomy now undertaken by pre-op nursing staff • Chest x-rays performed locally • ECG machine evaluation in progress prior to purchase • in future approximately 200 ECGs per month will be performed by pre-op assessment freeing up slots in ECG department
- 11. Wirral Hospital NHS Trust Touches on the day case unitTouches on the day case unit •• Pre LeanPre Lean – 34 touches for both GA and LA •• Post LeanPost Lean – 13 touches for GA • continues to be higher than expected due to poor signage – 10 touches for LA – freeing up staff to offer a more individual patient focused approach and improving customer satisfaction
- 12. Wirral Hospital NHS Trust Total numbers through Day Unit 10 weeks beforeTotal numbers through Day Unit 10 weeks before and following Lean eventand following Lean event Total numbers through LDSU 10 weeks pre lean and 10 weeks post lean (date of lean indicated) 0 50 100 150 200 250 Wk 1 Wk 2 Wk 3 Wk 4 Wk 5 Wk 6 Wk 7 Wk 8 Wk 9 Wk 10 Wk 1 Wk 2 Wk 3 Wk 4 Wk 5 Wk 6 Wk 7 Wk 8 Wk 9 Wk 10 Horiz title MeanCentre: Calculate sigma using:Mean moving range
- 13. Wirral Hospital NHS Trust Satisfaction surveySatisfaction survey All patient and staff groups support day ward changesAll patient and staff groups support day ward changes Separation of LAs from GAs and male and female areasSeparation of LAs from GAs and male and female areas All agree patients flow through unit betterAll agree patients flow through unit better • 54 patients • 18 ward staff • 14 theatre staff • 10 surgeons • 1 anaesthetist
- 14. Wirral Hospital NHS Trust Next stepNext step Switch wardsSwitch wards -- orthopaedicsorthopaedics upstairs, general surgery &upstairs, general surgery & urology + LA day case unit downstairsurology + LA day case unit downstairs -- advantages:advantages: • orthopaedics – Gain an extra bay - 6 more beds – Number of side rooms increase from 2 to 4 • general surgery & urology + LA unit – facilitates flexible staffing arrangements for GA, LA and in-patient areas • one nurse manager is currently in charge of all 3 areas – avoids HCAs running up and down stairs – areas can be used flexibly in response to daily variation in cases
- 15. Wirral Hospital NHS Trust Keeping the momentumKeeping the momentum 22--weekly meetings with key staffweekly meetings with key staff – review status of open action items from project plan – review process metrics to ensure improvements are being achieved – discuss additional opportunities for improvement – continue to improve the process
- 16. Next project?Next project? Creating flow through the Accident & Emergency Department Wirral Hospital NHS Trust