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Applying Lean in Healthcare An Irish & International Perspective Thursday June 2nd 2011. Process Improvement across an NHS Acute Care Trust. Simon Dodds Consultant Surgeon Clinical Director for Outpatients Clinical Lead for the Lean Academy [email protected]. - PowerPoint PPT Presentation
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Process Improvement across an NHS Acute Care Trust
Simon DoddsConsultant SurgeonClinical Director for OutpatientsClinical Lead for the Lean [email protected]
Applying Lean in HealthcareAn Irish & International PerspectiveThursday June 2nd 2011
Personal Journey 2000 Started improving my outpatient clinic
2004 NHS Service Improvement Award
2005 Wrote the story ...
2006 Heard about "Lean Thinking"
2007 Lean Academy born at HEFT
Does Lean Deliver?
1. Safety and Quality2. On Time Delivery3. Financial Viability
#Neck of Femur
Mar 2005
Apr 2005
May 2005
Jun 2005
Jul 2005
Aug 2005
Sep 2005
Oct 2005
Nov 2005
Dec 2005
Jan 2006
Feb 2006
Mar 2006
Apr 2006
May 2006
Jun 2006
Jul 2006
Aug 2006
Sep 2006
Oct 2006
Nov 2006
Dec 2006
Jan 2007
Feb 2007
Mar 2007
Apr 2007
May 2007
Jun 2007
Jul 2007
Aug 2007
Sep 2007
Oct 2007
Nov 2007
Dec 2007
Monthly
0
50
100
150
200
250
300
350
400
HSMR Good Hope #NOF Mortality Ratio (Ind)
34
344
4
34 43
#Neck of Femur
Mar 2005
Apr 2005M
ay 2005Jun 2005Jul 2005A
ug 2005Sep 2005O
ct 2005N
ov 2005D
ec 2005Jan 2006F
eb 2006M
ar 2006Apr 2006M
ay 2006Jun 2006Jul 2006A
ug 2006Sep 2006O
ct 2006N
ov 2006D
ec 2006Jan 2007F
eb 2007M
ar 2007Apr 2007M
ay 2007Jun 2007Jul 2007A
ug 2007S
ep 2007O
ct 2007N
ov 2007D
ec 2007
Monthly
0
50
100
150
200
250
300
350
400
HSMR Good Hope #NOF Mortality Ratio (Ind)
31/05/200623/06/2006
13/07/2006
16/08/2006
12/09/200612/10/2006
10/11/2006
30/11/200611/01/2007
21/02/2007
04/04/200703/05/2007
12/06/2007
18/07/200728/08/2007
25/09/2007
23/10/2007
19/11/200719/12/2007
30/01/2008
26/02/200826/03/2008
25/04/2008
28/05/200809/07/2008
13/08/2008
17/09/2008
20/10/200812/11/2008
16/12/2008
26/01/200924/02/2009
01/04/2009
11/05/2009
16/06/200920/07/2009
04/08/2009
22/09/200903/11/2009
Booked
0
6
12
18
24
30
36
Weeks Time on Surgical Waiting List (Ind)
Waiting Time for Operation
Outpatient Clinic - before
Outpatient Clinic - after
Mr H: “You’ve performed a
miracle. With this
number of patients
we’d normally be
seeing patients until 2pm”
Ms S: “Today has been so much more bearable, I’ve had time dictate letters and do the admin work which I would normally have to do after clinic.”
Registrar: “I’ve
actually enjoyed
clinic today. I
haven’t felt as if I
need to rush”
What the Docs said ...
What Finance asked ...Have you saved more than you have cost us?
A&E Performance
20/08/2009
09/09/2009
29/09/2009
19/10/2009
08/11/2009
28/11/2009
18/12/2009
07/01/2010
27/01/2010
16/02/2010
08/03/2010
28/03/2010
17/04/2010
07/05/2010
27/05/2010
16/06/2010
06/07/2010
26/07/2010
15/08/2010
04/09/2010
24/09/2010
14/10/2010
03/11/2010
23/11/2010
13/12/2010
02/01/2011
22/01/2011
11/02/2011
03/03/2011
23/03/2011
12/04/2011
02/05/2011
22/05/2011
Date
0
5
10
15
20
25
30
35
40
45
50
% Breach Good Hope - 4 hour A&E Target Performance (Ind)
A&E Arrivals
20/08/2009
09/09/2009
29/09/2009
19/10/2009
08/11/2009
28/11/2009
18/12/2009
07/01/2010
27/01/2010
16/02/2010
08/03/2010
28/03/2010
17/04/2010
07/05/2010
27/05/2010
16/06/2010
06/07/2010
26/07/2010
15/08/2010
04/09/2010
24/09/2010
14/10/2010
03/11/2010
23/11/2010
13/12/2010
02/01/2011
22/01/2011
11/02/2011
03/03/2011
23/03/2011
12/04/2011
02/05/2011
22/05/2011
Daily
0
50
100
150
200
250
300
350
400
450
Arrivals GHH A&E Arrivals (Data)
Emergency Admissions
20/08/200909/09/200929/09/200919/10/200908/11/200928/11/200918/12/200907/01/201027/01/201016/02/201008/03/201028/03/201017/04/201007/05/201027/05/201016/06/201006/07/201026/07/201015/08/201004/09/201024/09/201014/10/201003/11/201023/11/201013/12/201002/01/201122/01/201111/02/201103/03/201123/03/201112/04/201102/05/201122/05/2011
Daily
0
10
20
30
40
50
60
70
80
90
100
Patients GHH Emergency Admissions (Ind)
What are the traps? Biting off too much.
Transformation teams.
Do once then roll out.
Under estimate the learning time.
What are the traps? Discounting the relationship stuff.
Assume the cash will just follow.
Impatience.
Operations Management blindness.
What are the gaps? Tools for Finance.
Tools to predict the QTC benefits.
Blue Sky goals are Aspirations.
Management of Variation.
What are the gaps? "Catch-22" effect.
Limited strategic capability.
Peer reviewed publications.
Operations Management blindness.
Lean Worked for Uspartly
and next time I would also ... Adopt a more Systemic approach.
Actively develop Trust Relationships.
Get Operations Management skills.
Use all of Improvement Science.
