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Cpc lean at the christie

Date post:03-Nov-2014
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  • 1. Introducing Leanto improve Service Delivery and Patient Experienceat the Christie Mike Hughes

2. The Christie is Europes largest single-site cancer centreRegistering 12,500 new patients andseeing over 40,000 patients every year 3. We deliver 50,000 chemotherapy treatments a year in six different locations on our site 4. The Lean project for chemotherapy provision at the Christieis fundamentallychanging the waythat chemotherapyis delivered 5. We have an ambitious, whole system programmewhich is producing a new improved patient pathway 6. and a significantly improved patient experience 7. This pathway eliminates 1.2 million of waste fromservice provisionThis pathway eliminates 1.2 million of waste fromservice provision 8. It has also given a process base toplan a new 35 million chemotherapy centre 9. So, how did the Lean project come about at the Christie? 10. Initial Problems

  • Patient waiting times at all stages within the patient pathway (Christie time)

Disparate ward and support services logistics

  • Inefficient use of resources & inadequate systems

11. I felt nervous enough coming to hospital but waiting all that time,just made me really worried and anxious 12. and then waiting again, this time for 45 minutes in pharmacy was too much. I just wanted to go home 13. Patient admitted to CS for treatment Scheduler records details Scheduler passes on notes to coordinator Has been go-ahead signed? Patient goes home W1 W2 2a No E Coordinator briefs patient on process and timings Yes Is script correct? No Is treatment on hold? Yes No Yes No Treatment arrives.Coordinator records time Doespatient return? Is there timefor patient to betreated? Nurse checks script and batch number Patient taken totreatment area Is patient new? Yes No Yes Treatment starts Treatment finishes Doespatient haveTTOS? Nurse gives new patient talk No No Yes Yes No W3 W4 W7 W8 W10 W5

  • Arrival time on CS
  • Nature of treatment
  • Arranges next apptand gives to patient

W6

  • Arrival time on CS
  • Nature of treatment
  • Arranges next apptand gives to patient

Doespatient havetransport No Yes W11 Yes Is patient wellenough fortreatment? W9 Example of part of the chemotherapy process Patient waits whilst bloods / treatment is checked by coordinator Coord. contacts Day Services / Pharmacy to locate script Coordinator chases up to get completed Patient given pager(if wait is long) Patient paged (if not present) Patient sent home and asked to return next day Coordinator answer queries and contact relevant staff Patient appointment re-scheduled Nurse organises transport Nurse carries out checks Patient goes to pick up TTOS Treatment comes off hold 14. W1 W2 Patient waits whilst bloods / treatment is checked by coordinator Coord. contacts Day Services / Pharmacy to locate script Coordinator chases up to get completed Patient given pager(if wait is long) Patient paged (if not present) Patient sent home and asked to return next day Coordinator answer queries and contact relevant staff Patient appointment re-scheduled W3 W4 W7 W8 W10 W5 W6 Nurse organises transport W11 Nurse carries out checks Patient goes to pick up TTOS W9 All of these boxes were areas of waste 15. Patient admitted to ward for treatment Scheduler swipes bar code and schedules next appointment Patient goes home 2a E Coordinator briefs patient on process and timings Is treatment on hold? Treatment comes off hold Yes Treatment arrives.Coordinator records time Nurse checks script and batch number Patient taken totreatment area Is patient new? Yes Treatment starts Treatment finishes and patient handed blood form for next visit Nurse gives new patient talk No Yes

  • Arrival time on CS
  • Nature of treatment
  • Arranges next apptand gives to patient

Doespatient havetransport No Yes Is patient wellenough fortreatment? Co-ordinator checks bloods Are patientson protocol? No Yes Asst Practitioner carries out checks

  • HCA contacts Chemo department
  • new treatment prescribed
  • HCA checks script for next appointment

Patient sent home and DeferredPatient picks up TTO on ward Patient provided with transport No No Processes made Lean 16. Qualification and quantification of waste Total waste identified = 1.2 million

    • Waiting ( 124,964)
    • Motion/Transportation ( 186,125)
    • Over-production ( 888,911)

17. Methodology

  • Stage 1
    • Map as is processes
    • Challenge waste and current working practices
    • Staff interviews

Stage 2 Identify new processes Quantify current savings Rapid Improvement Events

  • Stage 3
    • Map new value streams
    • Quantify future savings
    • Development & implementation of process register

18. Through focusing on the patient and ensuring comprehensiveclinical engagement, we have dramatically streamlined thepatient pathwayAnd the unique element is that this Lean project has led the design of our new 35 million chemotherapy centre which will open in 2010 19.

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