Keen on Lean
University Hospitals of Morecambe Bay
NHS Trust
Helen Pye
Keen on Lean
• Visit to UK/US Summit 06
• TMI presentation – Lean
Implementation within Healthcare – is
manufacturing so, so different?
• Partnership with TMI
• Pilot programme for Lean
methodology and principles
UHMB ……
• Geographically large
• 1000 square miles
• Catchment population
350,000
• Challenging geography
– Urban deprivation
– Rural hinterland
– University city
transient population
UHMB………
• Furness General
• Lancaster Infirmary
• Westmorland
General
• 50 miles between
DGH’s
• Travel time in
excess 1 hour
• Tourist & farm traffic
Pilot Project - Medical Records
• All patient pathways
• Significant customer
dissatisfaction
• Wasted internal capacity
• Clinical governance
Lean Training
• Advanced Route to Lean Healthcare
– Lean awareness
– Understanding Teams
– Concepts of quality
– Planning & scheduling
– 5S, TPM & SMED
– Cell layout
– Blitz events
– Implementation & Policy
Value Stream Mapping
• Identified the patient
journey
– Mapped out current
state, patient &
information flow
– Analysed waiting &
turnaround times, staff
numbers, value added
and non value added
steps.
– Used problem solving
techniques
– Designed future state
map
UHMB Approach
• Small team of 8 • 5 day Kaizen Blitz
training in Lean week - empowering
techniques staff to make fast and
• Value Stream significant changes to
Mapping their working
• 3 Rapid improvement environment and
events with medical ways of working
records / outpatient
and 2 secretarial • Follow up post Kaizen
areas at RLI site Blitz activities
Value Stream Mapping Output
• 3 Rapid improvement events
–Patient Records
–Outpatient Department
–Medical Secretaries
• All inter-linked & dependent
• Duplication of process & effort
Rapid Improvement Events
Objectives
• Medical Records
– To make it easier to and quicker to pull files
– Re-designing Process in Microfilming
• Outpatients Department
– Minimise number missing clinic notes
– Decrease number patients not seen
– Keeping to allotted time
– Clinical governance
• Medical Secretaries
– Create capacity, clear filing backlog
– Return notes in timely fashion
• Create safer, tidier working environment
Medical Records
What we did Learning Points
• Set standards
• 6S
• Staff involvement
• Created the at pre-planning
perfect aisle phase
• Redesigned • Root cause
microfilm flow visibility &
understanding
Microfilming Journey
Learning Point:
• The staff involvement at the planning stage was
crucial to finding the most suitable solutions and to
ensure a continuation of service.
Medical Records
Outpatients Department
What we did Learning Points
• Viewed area with • Creating good first
customer eyes impressions
• 6S • Lack organisation
• Set standards = large inefficiency
• Involved whole • Easier to sustain
team with whole team
• Standardisation engagement
clinic rooms
OPD Outcomes
Medical Secretaries
What we did Learning Points
• 2 Areas Respiratory/ • Contingency planning
ENT & Head & Neck • Panic trigger
• 6S – 130 weeks to clear
• Set standards • Senior support
• Minimise non-value • Standardisation of
added activities clinical dictation
• Removed backlog • Created capacity
Medical Secretaries Outcomes
Post RIE Activities
• Audit & policing
• Interdepartmental workshops
– Sharing experiences & learning
– Fixing root cause not consequence
• Continual staff engagement &
understanding
• Other RIE planned
• Standard Operating Procedures
Lean Results
• Core team trained staff
• Demonstrated ability translate Lean
into healthcare service improvement
• Gained executive board support
• Engaged & stimulated the pilot area
workforce
• Requests for Lean in other areas
Lean Learning Points
• Team working, hearts & minds
• Credible data
• Standard procedures
• Executive sponsor
• Minimisation of waste & non-value added
activities
• Value stream structure Vs scatter gun
• Preventative Medicine
Summary
• Lean more than a process, a way of working &
seeing
• A tool within continuous service improvement
• Positive but painful
• Challenge of sustaining the improvements
• Cultural revolution
• Standards, visual management, policy
deployment
Next Steps
• Lean – recognition at Board Level
• TMI started to scope work with pathology for
process improvement
• Productive Ward / Theatre programmes
– Acting Director of Nursing & Divisional nurses
• Radiology -CT/MRI
• Musculoskeletal services
• Divisional requests for areas of development
Continuous Improvement
Improvement activity
Standardised work
Visual Management
7 wastes
6S
Any Questions?