Royal Bolton HospitalBlood Sciences Lean project

Peter GrayDave Slater

Bolton Hospitals NHS Trust

Covers a population of 265,000Employs 3100 staffEmergency admissions of >38000Total beds = 779

Pathology total workload >1.4 m requests 2004/5

Blood Sciences = 50% of above

Pathology lab history

Pathology is split in 2 buildings across the hospital main corridor

Due to increasing workload, we believed that the size of the building and staffing needed to expand (business case showed spend of £650,000 was required)

The laboratory is CPA accredited

Value Stream analysis

Team of various grades from pathology, pathology users and external staff worked on value stream analysis over 4 days

Mean of all deliveriesMEAN of all deliveries all routes for all Pathology departments

0

50

100

150200

250

300

350

400

GP van Air tube Reception

GP vans

GP vans

phlebotomy

Current state

Unnecessary movement

Urgents (Biochemistry)Sample 75 steps approx 40x daily =3,000Information 135 steps once a day

GP van (all labs)Samples 4924 steps per dayInformation 135 steps x2 daily

Routine (Microbiology)Sample 309 steps x7 dailyInformation 362 steps x 7 daily

This is the minimum, it could be higher

Future State

Value statement

The delivery of a correct result for a blood sample, for the correct patient to the correct clinical team within 1 hour of receipt unless precluded by current

technology

Staff Communication

After the week, feedback sessions were held with staff.One per day for 5 daysStaff were asked for comments to be written on feedback sheet in StaffroomAnalysis of comments showed 2 categories of concern:

Staff rolesNew laboratory design

Week two - 3P planning event

Revisited first Blood Sciences laboratory design

Reviewed staff commentsRe-calculated waste(s)

Used a lean project management tool to produce a 1-decision implementation plan

4 phasesIndividual task definition and detail

Redesigned the Lean laboratory

Benefits from New Design

Achieves process flow Reduced Steps

Urgent Blood Samples - reduced from 75 steps to a maximum of 57 stepsRoutine Blood Samples – reduced from 309 steps to a maximum of 57 stepsGP vans maximum of 57 steps from 2462 steps for 1 run

Strategic grouping of analysers – better utilisation , require reduced numbers of analysers

Predicted benefits from new design

New laboratory design accepted by all staffReduced number of staff requiredReduction of floor space (40%)Reduction of travel distance (80%)Opportunities to utilise skill mix of staff in new ways

Current progress

Understand the type of equipment required for flow processesReduction of sample processing time from an average of 5 hours to approximately 60 minutes. (Routine)Reduced the turnaround time for some tests e.g. HbA1c from 30 hours to 3 hoursThe design of the lean laboratories will have flexible benching and analysers will be on trolleys.Reduced re-work

Additional benefits for Blood Transfusion

Value stream mapping for Blood Transfusion

Cross MatchingBroken into 28 stages323 stepsTouch time – 176 secsFlow time – between 25min – 2hrs 51min

Group & Save14 Stages90 – 111 stepsTouch time – 210 secFlow time – 70 minHand offs – 2 or 3 dependent on staffing levels

Lean Blood Transfusion Lab

RunnersRepeaters

Strangers

Benefits from New Design

Improved flowReduced waste

Stocking Blood bank – reduced steps from 160 to 50 steps (70%)XM – reduced from 323 to 69 steps (79%)G&S – reduced from 95 to 7 steps (91%)Abnormal antibodies – reduced from 111 to 30 steps (73%)Less re-workReduced number of hand offs

Designed area for flow stoppersDedicated pod station

6S for Flow

Sort (get rid of what’s not needed)Straighten (A place for everything..)Shine (clean and wash)Safety (checking for hazards and

defects)Standardise (build into acceptable routines)Sustain (maintain the standards set by

the 6S event)

6S event for Specimen Reception

Current state

After 6S

Benefits of 6S in Specimen Reception6S score has improved from 24% on Monday to 87% on Thursday

Staff involvementAs the week progressed staff became more involved and enthusiastic

Visual Management introducedLabellingCupboard fronts removedClear boxes introducedColour coding6S board introduced

Working EnvironmentCleanerBrighterBetter organised“Waste” removed

Is Lean Easy ?

Issues

Extremely complex projectReconfiguration of services

Project delays due to external suppliers issuesScanning software for request forms not ready (external supplier)Continuing to provide a service 24/365 whilst under going major changePlenty of strangers due to configuration issuesIT issues e.g. analyser interfaces

Issues cont’d

Changing the way staff workIntegration of previously discrete departments

HR issues (many to be addressed)

Getting ALL staff to understand leanStaff on shifts, part time staff, staff using batch techniques for many yearsSome staff are very receptiveOthers are less receptive and see it as a means of reducing staffing levels (particularly in the current NHS climate)

General lessons

Huge changes in very short time scales have had (are having) a profound effect on all the staff.Some have adapted very quickly, some not at all yet.The magnitude of the task of managing the human issues cannot be over emphasised.It is a credit to the staff & their managers that we have progressed so far so quickly.

General lessons

It has been (is still) a roller coaster ride of emotions & stress & tension usually all within the same day.Mutual support especially within the senior management team has played a vital role.

Lessons learnt

Don’t leave the staff as they will revert back to their customary working practicesMust have a team leader responsible for each area who wears a “lean hat”Don’t expect the new “flow” to work to the reduced waste calculated – it will take timeDocument the new working practices –standard work

Is lean easy ?

NOChanging mindsetsChanging a 24/365 service

But this project has been achieved in 8 monthsPreviously it would have taken years!!

Pathology and this Trust are at the beginning of a journey