Using lean to make an ongoing difference, achieve targets and improve staff morale
With a deficit of £13m on an income of £90m, Bedford Hospital needed to change.
In 2007-08, its radiology department employed 64 staff and conducted 111,601 x-ray/imaging exams. Demand increased significantly in that 12-month period and is forecast to grow considerably.
Following the application of the lean approach to continuous improvement, facilitated by Alturos, the radiology department at the hospital enjoyed a gain of £1.2m, a reduction in waiting times in plain x-ray from two weeks and two days to zero, the release of 639.9 staffing hours, and an increase in staff morale and pride in the department.
The trust had previously adopted best practice models of care and turnaround approaches. Although it reported a cost saving, staff morale fell. A different approach to long term change and efficiency was needed.
Focusing on a review of the radiology department, the chief operating officer made contacts with healthcare lean enthusiasts in the UK and US. The lean approach to continuous improvement has a patient focus and aims for non-management led improvement - which had been absent during the earlier turnaround efforts at the trust.
Lisa Hunt, trust chief operating officer, said “Everyone thought that because we were going to be sticking post-it notes on the wall that this was just service redesign or business process re-engineering all over again.
“Service redesign has caused problems in the past because it selected a single element of a service and changed it without a thorough examination at the cause and effect in terms of the patient journey.”
The trust had 60 staff trained in the principles and techniques of lean. These “lean champions” then took lean forward in focused projects. The initiative was called Every Patient Matters.
Focusing on a review of the radiology department, the radiology team and management identified a number of questions and requirements:
- Are we operating in the most efficient and effective way?
- Are we spending our budget properly?
- Do we have the funded resources to deliver what is required now, in the short, medium and long term?
- Are we giving a quality service to our customers?
- How do we match up against our competitors?
The challenges faced by the department were caused by a number of internal and external factors. Some of these challenges were:
- a demand-led department with demand on the increase
- block contract
- old fashioned and restricted physical layout
- some old equipment that often failed
- reporting backlog
- increasing demand on staff time i.e. presence at multi-disciplinary team meetings
- 18 week referral to treatment target
- two week cancer wait
- need to respond to changes in technology
- competition from other trusts and independent providers
- new service developments in the wider trust
- demand to provide more complex procedures
While the team worked hard on a number of initiatives to alleviate pressure, it was clear that a transformational redesign of the end-to-end radiology processes was needed to address root causes rather than symptoms.
In response to the requirements of the trust, Alturos designed a skills transfer change programme. This comprised a number of components from our application framework, patient and staff surveys, and a benchmarking exercise.
Working with the radiology teams and stakeholders, Alturos helped to redesign their services.
Examples of the new designs were:
- plain X-ray waiting abolished by operating a walk-in service for outpatients
- eliminating the need to purchase a further CT scanner in the current year by increasing capacity (with no additional staff or working hours) through pre-cannulation and agreed standard working practices
- reducing check-in waits for patients by creating a separate appointments office
Several months on, Alturos examined the financial impact of the lean radiology programme.
The study focused on both the macro and the micro position, calculated the pound value of activity prior to the lean work and identified the value of the activity for each month during which the lean work was in progress. It showed that the potential net financial gain from lean in the department was £1.2m.
Tim Franklin is director of Alturos.