Hereford Hospitals
NHS Trust
Reducing turnaround times in Pathology using
Lean Thinking
Want to learn more? Contact - Neil Westwood Clinical Process Consultant neil.westwood@institute.nhs.uk or visit www.institute.nhs.uk
The audit report produced by the Audit OUR APPROACH
Commission 2005/06 stated that there is The Service Improvement team at Hereford
significant scope for improvement in terms of Hospitals facilitates rapid improvement activities
turnaround times in pathology. Improving throughout the hospital. We use a structured
turnaround times will increase throughput, approach to solve problems that staff and patients
improve efficiency and ultimately improve are experiencing. We focus on getting results, use
patient experience. data to measure the effect of improvements and
actively involve staff to identify and solve
Did you know? 70% of clinical decisions in problems. We aim to get results quickly.
hospitals depend on pathology. Pathology plays a
Below (left to right) – Principal Biochemist Heather Clark, Clinical
crucial role in maintaining the flow of patients and Process Consultant Neil Westwood, Director of Pathology Steve
information throughout the hospital and reducing Jones, Director of Operations Alan Dawson, Chairman Cessa
length of stay. Moore, Chief Executive David Rose and Biochemist Andy Nicholls
Biochemist
OVERVIEW
Test results were delayed, impacting on patient
discharge. Staff resources were being used
inefficiently to work around the significant
increase in demand arriving late afternoon at
15.30. Four GP deliveries all arrived at similar
times. This was equivalent to 60% of the daily
workload.
Hereford Hospitals - Biochemistry and Haematology daily demand by Hour (based on 1 week
June 2006)
300
250
Number of specimens
200 Over 40 staff in pathology (biochemistry,
Haem daily demand
150
100
Bio daily demand haematology, microbiology and cytology)
50
participated in a 1 hour training session on
0 improvement principles about improving the flow
Midnight - 1
1-2
2-3
3-4
4-5
5-6
6-7
7-8
8-9
9-10
10-11
11-12
12-13
13-14
14-15
15-16
16-17
17-18
18-19
19-20
20-21
21-22
22-23
23 - Midnight
of work and eliminating waste. Staff were given
Hour (booked in) the opportunity to complete waste identification
forms. These were used to help us identify issues
OBJECTIVES that staff felt were important and needed
to improve turnaround times for all improving.
specimens inpatients, outpatients and GPs
to improve morale and use staff more In total 9 days were spent actively improving
effectively pathology (typically, 2 days a week). To
to improve quality, reduce waste and lower understand how work gets done, the process was
our costs observed from the request being made, to the
smooth the arrival of demand results becoming available. The approach was to
to make best use of the resources available walk the entire process, identify each process
step and the problems associated with those
By reducing turnaround times this will improve steps.
flow, reduce waste and free up beds in the
hospital. This will save thousands of £££s. Several tools and techniques were used to
identify root causes of problems. We looked at
It will also allow clinical decisions to be made the whole system. The approach required staff
quicker. Staff will have more time to spend on from pathology and the transport provider from
direct patient care. the PCT to work through this together.
Turnaround times for A&E patients will also be
reduced.
FINDINGS RESULTS
GP, inpatient and outpatient test results were Metric Before After Improvem Saving
all being delayed change change ent £££ a
Layout of department not based on the year
sequence of the flow of the work Turnaround 62 38 40% 2 beds a
Demand varied significantly by hour, with a time
(from receipt to
minutes minutes reduction day
£365,000
Up to 2
disproportionate amount of GP specimens results hours
A&E
targets
arriving late in the afternoon. available)
met
Specimen reception was unmanned. Time for 13 minutes 1 minute 93% £10,000
Specimens typically waited 30 minutes specimens to Up to 50 Up to 4 reduction Fewer
before they were processed be picked up minutes minutes staff
needed
Hereford Hospitals - Biochemistry - Delays in specimen reception
Double 40 minutes 0 Eliminated At least
Before change After Change
50 handling a day minutes £3000
1 (labeling) a day
1
40
1
Time all work 17.30 16.45 Staff finish More
Delay in minutes
30 complete 15 minutes time to
early improve
20 quality
10 Centrifuge 80 202 252% Less
UCL=3.54
_ productivity Per hour Per hour increase waste
X=0.88
0
1 10 19 28 37 46 55 64 73 82 91
(per hour – (based on (based £ 5000
Observation peak demand) 4 mins on 8
pinning mins
time) spinning
time)
Courier routes were not planned to stagger
the arrival times of specimens SUMMARY OF IMPROVEMENTS & IMPACT
Specimens were put into buckets – it was Improvement Impact
difficult to see which specimens arrived first. implemented
Staff found it difficult to enter all the patient Manned specimen Improved flow – delays almost eliminated
reception in specimen reception. Urgent work,
information and test request details onto the including A&E and ITU is being processed
computers. This was not synchronised and immediately rather than been left in
specimens had to wait before being specimen reception.
analysed. Labelling, centrifuges Duplicate steps removed at labelling
Phlebotomist brought inpatient specimens in
and booking (double handling) Centrifuge optimised to
relocated in specimen improve flow at busy times.
a large batch of about 50 at 11am reception and Rework reduced at scanning stage. Fewer
Unnecessary duplication of activities and a synchronised staff required at labelling and booking in.
Quieter working area. Less interruptions.
lot of wasted movement, time spent More productive staff. Faster turnaround
searching for equipment and staff. times. Staff movement is minimised. Extra
space has been created in lab, 1 whole
section.
WASTE HAS BEEN ELIMINATED
Standard work Work is done in a standard way. Work flow
introduced for is more predictable and problems are
labelling, centrifuging immediately visible.
X X X and booking in
First in First Out All specimens are processed in the same
Non value adding
steps (FIFO system way. This has improved turnaround times
XX Delays and waste
Now all eliminated
X introduced) and reduced variation
X X X Phlebomotist sends Specimens arrive in the lab up to 3 hours
work via POD system earlier – improving the flow of work.
Batches of 50 specimens reduced to 2/3
Before After specimens. No rush at 11am anymore.
Bloods are not walked unnecessarily
around the hospital.
PCT GP demand Improved flow, allows department to
staggered (batches manage the work more effectively. Results
reduced). available earlier for GPs and fewer delays
for inpatient work. Fewer haemolysed
bloods (due to excess travelling time in
Before After van) which improves care and quality.
40 minutes a day saved Visual management Porters are sorting their own specimens
used to optimise and they are not disturbing pathology staff.
specimen reception Staff are putting things in the right place
and specimens are not going missing.
Cleaner work areas and less clutter.
