ConferenceTalks

1	Lean Phlebotomy Doing More with Less PAI Conference Red Cow March 6^th 2010 Tom Moloney
2	Case Histories 1. Mater Phlebotomy and Haematology Haem end to end TAT reduced by 57% Phlebotomy trollies standardised+stocked in pm Phlebotomists now use the pneumatic tube to send specimens from each ward Haem specimens labelled + processed in small batches 5S exercise created space
3	Ask Haem+Phleb to Improve TAT
4	Case Histories 2 Hereford NHS Trust: MRI waiting time down 42% CT waiting time down 60% Pathlinks Lincolnshire Histology: TAT down 40% Specimens up 40% No staff increase
5	Case Histories 3. Argent Consultants USA 100 labs over 3 years TAT improved 40%-90% Output/person up 20%-50% Error reduction up to 100% ROI 2-10 times
6	Case Histories 4. Cleavland Clinic USA Histology Over 5 yrs surgical specs up from 57 000 to 87 000 pa No increase in technical staff
7	Case History 5. Virginia Mason Med Centre Seattle TAT on AE reports improved by 50% Distance walked by Haem staff down 62% Histo labelling errors down 52% Dictation time on gross OP specs improved by 67%
8	Case Histories 6. Find 40 Critical Items in HDU UK 2 docs new to unit asked to find 40 items 28 mins later they gave up having found only 32 Senior sister on ward found all in 8 mins but was running from end to end of the ward.
9	Case Histories 7.Bolton NHS Lab Case to expand lab, cost £0.65m,rejected. Four Lean projects over a year, blood sciences Floor space required reduced by 40% Staff travelling distance down 80% Av.sample processing time down from 5 hours to 1 hour TAT on some tests(HbA1c) down from 30 to 3 hrs Routine work now ends at 1645,previously1730
10	Case Histories 8. Wirral Hosp UK High level mapping exercise on a patient’s treatment journey: Time spent treating patient 100 mins Patient took 6 trips and spent 600minutes Process took 31 weeks
11	The Problem in Labs Expanding workload Static budgets Staff embargo Lack of space Media focus on errors Increasing regulation Privatisation
12	A Significant Solution Lean and Six Sigma Not new.Well tested Widely used in: Industry Services Healthcare
13	Lean and Six Sigma Process Improvement methods Lean: Improve flow and reduce waste Six Sigma: Reduce variation and errors Six Sigma=3.4 DPMO=99.9997%(Airplane) 3.9 Sigma Healthcare =10 000 DPMO=99.4%
14	What is Lean
15	Lean Techniques Value stream mapping Measure and analyse. PDSA Interviews with clients 5 Whys Statistical Process Control Charts 5S Visual controls Rapid Improvement Events
16	5S Sort Set in Order Shine Standardise Sustain
17	Mater Lean Phlebotomy 1- 10/06
18	Mater Lean Phlebotomy: Outcome
19	Lessons From Lean 1 Need top level commitment Need to involve all staff Need to provide protected time for staff to implement Sustaining progress is difficult Talk to users including patients Lack of capacity rarely the problem Mismatch between capacity and demand is
20	Lessons From Lean 2 Often the quickest wins are outside the Analytical area Phlebotomy,Specimen Transport,and Specimen Reception are common bottlenecks Continuous Improvement essential
21	Lessons From Lean 3 Toyota “ The 7 Deadly Mudas”: Defects Overproduction Excess Inventory Unnecessary Processing Excess motion Unnecessary travel or transportation Waiting
22	Sources of Information 1 Lean Academy www.leanuk.org Lean Thinking for the NHS, The NHS Confederation www.nhsconfed.org/publications NHS Pathology Service Improvement Team www.pathologyimprovement.nhs.uk
23	Sources of Information 2 Several companies provide consultancy BD,SQT,Lean Healthcare Services,Ortho,J+J,Melvin Consultancy,Olympus,Siemens,NHS Pathology Service Improvement Team.