The Lean machine

Sarah Ellis , manager of the Lean Healthcare Academy , explains how the introduction of pioneering Lean thinking within NHS Trusts across the academy’s Yorkshire heartlands have transformed working practices and reduced patient waiting times – and why the time is now right to roll out the “Lean Machine” to other trusts across the country.

The Lean Healthcare Academy was established in August 2006 to accelerate the adoption of Lean principles and methods in the healthcare sector by focusing on the elimination of wasteful practices. It develops flagship private and public sector partnerships , delivering a comprehensive range of services , including staff training , development and implementation support , complemented by a range of flexible online e-learning programmes.

From the outset , we have been working with our founding partner , Airedale NHS Trust , to develop a series of pilot projects through our new training facility based at Airedale General Hospital. A number of these have now been successfully introduced with overwhelmingly positive results.

The first , the Intrauterine Growth Restriction (IUGR) Project, involved the hospital’s midwifery unit where pregnant women with undersize baby concerns had to wait between two and six weeks for exploratory scans.

We initially identified that we could make a significant improvement in scan waits. A meeting was called between all stakeholders-community midwives , GPs , the hospital’s midwifery unit , the labour ward , ANDAU , ante-natal Clinic , consultants , ultrasound and maternity administration personnel. Patients were also involved.

Existing procedures went under the microscope to identify any areas where real improvements could be made. The end result represented a major achievement. By bringing together and working closely with internal and external stakeholders , timescales for small-for-date baby scans were reduced dramatically to just 24 hours , some even on a same-day-seen basis.

The IUGR project completely transformed small for date baby scan procedures for both patients and staff and , in particular , has made a real difference in helping to ease the anxieties facing new parents.

Buoyed up by the success of the IUGR project, a second major breakthrough was achieved at Airedale Hospital when a group of staff went on to tackle the Colorectal Cancer Fast Track Pathway.

Challenged to map the current process , then redesign and implement a new “Leaner Pathway ,” the team was then able to design how they wanted the pathway to run – one that was easier to follow , better for the patient and clearer for all staff.

Again , the outcome was a revelation. The maximum time span for referral to diagnosis for patients with suspected bowel cancer was halved from 81 days to 41 days though, in reality , referral to diagnosis dropped from a typical 34 days to just 14.

Importantly , the project was delivered within the space of a normal working week - in itself seen as a major achievement within the NHS. Understandably , there was a real sense of pride at what had been achieved in such a short space of time , coupled with the fact that most individuals and departments involved gave their wholehearted support and help in progressing the initiative.

We were delighted when Airedale NHS Trust chief executive Adam Cairns personally congratulated all staff involved on their remarkable achievements in not only reducing waiting times , but also raising the safety , quality and delivery of patient care.

The success of our work with Airedale NHS Trust has now seen a further eight NHS-related bodies across west, north and south Yorkshire and Humberside join the Academy as they seek to adopt Lean thinking.

Our remit is expanding rapidly and we are currently working successfully with many member NHS Trusts to help them meet key objectives as they strive towards delivery of the 18 Week Patient Pathway, the most ambitious reform in the history of the NHS.

There is little doubt that achieving an 18 Week Pathway for all by December 2008 requires a contribution from everyone working in the NHS. It remains a massive task , but the academy is well equipped to provide the tools and the knowledge required to achieve and sustain 18 weeks.

Back at Airedale Hospital , Lean has further been adopted as part of the Orthopaedics Project , purposely chosen because it is the toughest pathway challenge and has the longest waiting lists. Areas that cause the biggest backlogs have already been diagnosed and action is being taken to tackle these problem areas and make the pathway much more efficient.

As Bradford Teaching Hospitals NHS Foundation Trust works to meet its 18 weeks targets , Lean has also been taken on board as part of its patient administration review , with particular reference to its ENT/EYE Pathway Project.

We are delighted to welcome on board Hull and East Yorkshire NHS Trust as our newest member. Their first project is the Orthopaedic Trauma Pathway and while it is still very early days there is a great deal of optimism that the Lean ethos will have a major beneficial impact in helping to streamline working practices.

A key element within the Lean adoption strategy being driven by us is the use of spotlight projects which help an organisation establish quick ‘wins’ and spread the message of the benefit of Lean thinking and procedures , also encouraging the healthcare sector in general and local health communities at all levels to collaborate , co-operate and share best practice ideas.

Indeed , fa cilitating the sharing of such ideas remains one of our keynote aims. It is a ground-breaking process intended to create solutions that are less time consuming, much more cost-effective – and make better use of public money.

In fact , methodologies we have already helped put in place have yielded very positive results at little or no extra cost. They can actually be seen to have saved both time and money that can be invested in other areas of patient care - a vital consideration as far as public perceptions are concerned.

We are clearly and constantly demonstrating how Lean practices can have an impact on the NHS from grass roots level upwards by significantly reducing process times. Our overall aim is to unlock the potential thinking and enthusiasm in everybody and let them make the improvements for themselves.

We truly believe that the work we are undertaking is unique and can be held up as a shining example of best practice and a Lean role model worthy of adoption by other NHS Trusts across the UK.

We are now looking to expand our remit nationwide and create a network of regional training centres operating on similar lines to the one already in place at Airedale General Hospital.

The word is spreading and many others are sitting up and taking note of our achievements and successes. The Lean blueprint is firmly in place and we are now in a position to roll Lean out nationally to other NHS Trusts and healthcare sector providers.

The Lean Healthcare Academy is based in Ilkley , West Yorkshire and is part of the Virtual College , one of the UK’s leading developers of e-learning solutions , which works widely within the public sector including the NHS , Police and Fire Service.

For full details of the Academy and e-learning courses currently available visit www.leanhealthcareacademy.co.uk

Sarah Ellis

Lean Healthcare Academy

T: 01943 605976

E: sarah.ellis@virtual-college.co.uk

“We are clearly and constantly demonstrating how Lean practices can have an impact on the NHS from grass roots level upwards by significantly reducing process times. Our overall aim is to unlock the potential thinking and enthusiasm in everybody and let them make the improvements for themselves”

“the academy is well equipped to provide the tools and the knowledge required to achieve and sustain 18 weeks”