NHS

CASE STUDY

Pathology Service Improvement

Laboratory uses Lean and Six Sigma principles to improve turnaround times, increase staff utilisation and reduce space in five days
St.Helens & Knowsley NHS Trust provides a wide range of services to a population of more than 330,000. The clinical chemistry and haematology departments process 652,000 specimens per year. The department engaged the National Pathology Service Improvement Team to streamline operations and optimise the use of staff, technology and space. The national team applied Lean and Six Sigma principles to improve quality, reduce turnaround times, optimise space utilisation and reduce health and safety risks. The clinical chemistry reception and laboratory team participated in a five day rapid improvement (Kaizen) event. The Pathology Service Improvement Team: Supported the clinical team to integrate national priorities into local working arrangements Engaged and motivated the clinical team Reviewed existing processes and identified opportunities for improvement Evaluated the feasibility of process change Supported senior managers to make difficult decisions on how to achieve the best outcomes from their service Facilitated the five day rapid improvement (Kaizen) event ensuring implementation of sustainable change Provided advice and support Provided skill and expertise in Lean and Six Sigma principles. Increasing the impact of pathology to support national four hour emergency targets The clinical chemistry department is crucial to supporting the trust in the management of patients arriving in Accident and Emergency (A&E). To comply with national targets the A&E department must see and either admit or discharge patients within four hours. The local target is for any clinical chemistry specimens to be processed within one hour of arriving in the pathology department. There was persistent pressure to improve performance. Identifying the contributors to poor performance The national team taught the principles of Lean improvement and supported staff to systematically map the process using value stream and process mapping techniques. Process stapling (a photo journey) immediately illustrated causes of waste. It was evident that batching, poor flow, siting of technology and layout were contributing to poor turnaround times and feeling of stress and overwork amongst staff. This was accentuated by poor usage of automated transport systems to the laboratory. A number of changes were recommended to support a streamlined flow of work. Ringing the changes in five days The following changes were implemented during the Rapid Improvement Event (RIE). Improved usage of transport systems within A&E and pathology departments and between each department Relocation of pathology office and administrative services to facilitate more appropriate flow of specimens, staff and information through the pathology department Capacity was matched to demand in specimen reception Equipment relocated to ensure optimum usage Smooth and levelled flow of work to analysers Ergonomic and standard workstations developed Development and implementation of new protocols Retraining of staff Removal of waste from the patient pathway Identification and removal of excess inventory Visual management systems introduced Risks of accident and injury reduced.

www.pathologyimprovement.nhs.uk

NHS
Pathology Service Improvement

Substantial gains in 5 days Pre Lean Inpatient data Lab turnaround time % less than 1 hour End to end turnaround time % less than 90 minutes A&E Lab turnaround time % less than 1 hour End to end turnaround time % less than 60 minutes 68% 89% 50% 78% Post Lean 5 day event

Removing of wasted transport and staff effort in the pathology reception Spaghetti maps of specimen reception Before RIE

15%

42%

30%

56%

A&E time in lab (daytime)

Time in lab
04.00

After RIE
Target

Average

UCL

Hours

03.00

Lean event
02.00

01.00

00.00
1 10 19 28 37 46 55 64 73 82 91 100 109 118 127 136 145 154 163 172 182 190 199 208 217 226 235 244 253

Sample number

What did the staff think? Next Steps

The rapid improvement event is just the start of the changes that will be made in the St Helens and Knowsley pathology department. This will be supplemented with further work to ensure long term and sustainable improvement. Analysis of the A&E clinical area highlighted that staff were walking a considerable distance to access the vacutube system, thus causing delays to turnaround times. A capital bid has been submitted for another pod station; this will be supported by funding from the National Pathology Service Improvement Fund. The RIE highlighted that transportation within the laboratory was a major factor in wasted utilisation of staff and contributed to poor turnaround times. Structural limitations mean that it is not practical to move the Clinical Chemistry Laboratory; the team has sought to install an automatic system to transport specimens from the reception area upstairs from the laboratory.

For further details contact: Patricia Gurney, Quality Manager. Email: patricia.gurney@sthk.nhs.uk

National Pathology Service Improvement Team Tel: 0116 222 5122 www.pathologyimprovement.nhs.uk

Pathology Manager Pathology Manager

It is the intensity required to break the operational inertia

It is like having another four to five pathology staff