7/30/2019 Case Study St Helens
1/2
Pathology ServiceImprovement
NHS
CASE STUDY
Laboratory uses Lean and Six Sigma principles
to improve turnaround times, increase staff
utilisation and reduce space in five days
St.Helens & Knowsley NHS Trustprovides a wide range of
servicesto a population of more than330,000. The clinical
chemistryand haematology departments
process 652,000 specimens peryear. The department engaged
theNational Pathology ServiceImprovement Team to
streamlineoperations and optimise the use ofstaff, technology and
space. Thenational team applied Lean andSix Sigma principles to
improvequality, reduce turnaround times,optimise space utilisation
andreduce health and safety risks.The clinical chemistry
receptionand laboratory team participatedin a five day rapid
improvement(Kaizen) event.
The Pathology ServiceImprovement Team:
Supported the clinical team tointegrate national priorities
intolocal working arrangements
Engaged and motivated theclinical team
Reviewed existing processes and
identified opportunities forimprovement Evaluated the
feasibility of
process change Supported senior managers to
make difficult decisions on howto achieve the best outcomesfrom
their service
Facilitated the five day rapidimprovement (Kaizen) eventensuring
implementation ofsustainable change
Provided advice and support Provided skill and expertise in
Lean and Six Sigma principles.
Increasing the impact of
pathology to support nationalfour hour emergency targets
The clinical chemistry departmentis crucial to supporting the
trust inthe management of patientsarriving in Accident andEmergency
(A&E). To comply withnational targets the A&Edepartment
must see and eitheradmit or discharge patients withinfour hours.
The local target is forany clinical chemistry specimens to
be processed within one hour ofarriving in the
pathologydepartment. There was persistentpressure to improve
performance.
Identifying the contributorsto poor performance
The national team taught theprinciples of Lean improvementand
supported staff tosystematically map the processusing value stream
and processmapping techniques. Processstapling (a photo
journey)immediately illustrated causes ofwaste. It was evident
thatbatching, poor flow, siting oftechnology and layout
werecontributing to poor turnaroundtimes and feeling of stress
andoverwork amongst staff. This wasaccentuated by poor usage
ofautomated transport systems tothe laboratory.
A number of changes wererecommended to support astreamlined flow
of work.
Ringing the changes in
five days
The following changes wereimplemented during the
RapidImprovement Event (RIE).
Improved usage of transportsystems within A&E andpathology
departments andbetween each department
Relocation of pathology officeand administrative services
tofacilitate more appropriate flow
of specimens, staff andinformation through thepathology
department
Capacity was matched todemand in specimen reception
Equipment relocated to ensureoptimum usage
Smooth and levelled flow ofwork to analysers
Ergonomic and standardworkstations developed
Development and
implementation of newprotocols 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
7/30/2019 Case Study St Helens
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Pathology ServiceImprovement
NHS
Substantial gains in 5 days Removing of wasted transportand
staff effort in thepathology reception
Spaghetti maps of specimenreception
Before RIE
After RIE
Pre Lean Post Lean 5 day event
Inpatient data
Lab turnaround time% less than 1 hour 50% 78%
End to endturnaround time% less than 90 minutes 15% 42%
A&E
Lab turnaround time% less than 1 hour 68% 89%
End to endturnaround time% less than 60 minutes 30% 56%
A&E time in lab (daytime)
04.00
03.00
02.00
01.00
00.00
Lean event
Sample number
Hours
1 10 19 28 37 46 55 64 73 82 100 109 118 127 136 145 154 163 172
182 190 208 217 226 235 244 253
Time in lab Average UCL Target
91 199
Next Steps
The rapid improvement event is justthe start of the changes that
will be
made in the St Helens and Knowsley
pathology department. This will besupplemented with further work
toensure long term and sustainableimprovement. Analysis of the
A&Eclinical area highlighted that staff werewalking a
considerable distance toaccess the vacutube system, thuscausing
delays to turnaround times.A capital bid has been submitted
foranother pod station; this will be
supported by funding from theNational Pathology
ServiceImprovement Fund.
The RIE highlighted that transportationwithin the laboratory was
a majorfactor in wasted utilisation of staff andcontributed to poor
turnaround times.Structural limitations mean that it isnot
practical to move the ClinicalChemistry Laboratory; the team
hassought to install an automatic systemto transport specimens from
thereception area upstairs from thelaboratory.
What did the staff think?
It is the intensity requiredto break the operationalinertia
Pathology Manager
It is like having anotherfour to five pathologystaff
Pathology Manager
For further details contact:Patricia Gurney, Quality
Manager.Email: [email protected]
National Pathology ServiceImprovement Team Tel: 0116 222
5122www.pathologyimprovement.nhs.uk
