going beyond: project management business consulting construction and property services

Introducing Lean to improve Service Delivery and Patient

Experience at the Christie

Mike Hughes

The Christie is Europe’s largest single-site cancer centre

Registering 12,500 new patients and seeing over 40,000 patients every year

We deliver 50,000 chemotherapy treatments a yearin six different locations on our site

The Lean project for

chemotherapy provision

at the Christie

is fundamentally

changing the way

that chemotherapy

is delivered

We have an ambitious, whole system programme which is producing a new improved patient pathway

and a significantly improved patient experience

This pathway eliminates £1.2 million of waste from service provision This pathway eliminates £1.2 million of waste from service provision

It has also given a process base to plan a new £35 million chemotherapy centre

So, how did the Lean project come about at the Christie?

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

“I felt nervous enough coming to hospitalbut waiting all that time,

just made me really worried and anxious”

“and then waiting again, this time for 45 minutes

in pharmacy was too much. I just wanted to go home”

Patient admitted to CS for treatment

Patient admitted to CS for treatment

Scheduler records details

Scheduler records details

Scheduler passes on notes to coordinator

Scheduler passes on notes to coordinator

Has been ‘go-ahead’

signed?

Has been ‘go-ahead’

signed?

Patient goes homePatient goes home

W1

W2

2a2a

No

EE

Coordinator briefs patient on process and

timings

Coordinator briefs patient on process and

timings

Yes

Is script correct?Is script correct?No

Is treatmenton hold?

Is treatmenton hold?

Yes

No

Yes

NoTreatment arrives.

Coordinator records time

Treatment arrives. Coordinator records time

Does patient return?

Does patient return?

Is there time for patient to be

treated?

Is there time for patient to be

treated?

Nurse checks script and batch number

Nurse checks script and batch number

Patient taken to treatment area

Patient taken to treatment area

Is patient new?Is patient new?Yes

No

Yes

Treatment startsTreatment starts

Treatment finishesTreatment finishes

Does patient have

TTO’S?

Does patient have

TTO’S?

Nurse gives ‘new patient’ talk

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 appt and gives to patient

W6

• Arrival time on CS• Nature of treatment• Arranges next appt

and gives to patient

Does patient have

transport

Does patient have

transport No

Yes

W11

Yes

Is patient well enough for treatment?

Is patient well enough for treatment?

W9

Example of part of the chemotherapy process

Patient waits whilst bloods / treatment is

checked by coordinator

Patient waits whilst bloods / treatment is

checked by coordinator

Coord. contacts Day Services / Pharmacy

to locate script

Coord. contacts Day Services / Pharmacy

to locate script

Coordinator chases up to get completed

Coordinator chases up to get completed

Patient given pager (if wait is long)

Patient given pager (if wait is long)

Patient paged(if not present)

Patient paged(if not present)

Patient sent home and asked to return next day

Patient sent home and asked to return next day

Coordinator answer queries and contact

relevant staff

Coordinator answer queries and contact

relevant staff

Patient appointment re-scheduled

Patient appointment re-scheduled

Nurse organises transport

Nurse organises transport

Nurse carries out checks

Nurse carries out checks

Patient goes to pick up TTO’S

Patient goes to pick up TTO’S

Treatment comes off hold

Treatment comes off hold

W1

W2

Patient waits whilst bloods / treatment is

checked by coordinator

Patient waits whilst bloods / treatment is

checked by coordinator

Coord. contacts Day Services / Pharmacy

to locate script

Coord. contacts Day Services / Pharmacy

to locate script

Coordinator chases up to get completed

Coordinator chases up to get completed

Patient given pager (if wait is long)

Patient given pager (if wait is long)

Patient paged(if not present)

Patient paged(if not present)

Patient sent home and asked to return next day

Patient sent home and asked to return next day

Coordinator answer queries and contact

relevant staff

Coordinator answer queries and contact

relevant staff

Patient appointment re-scheduled

Patient appointment re-scheduled

W3

W4

W7

W8

W10

W5

W6

Nurse organises transport

Nurse organises transport

W11

Nurse carries out checks

Nurse carries out checks

Patient goes to pick up TTO’S

Patient goes to pick up TTO’S

W9

All of these boxes were areas of waste

Patient admitted to ward for treatment

Patient admitted to ward for treatment

Scheduler swipes bar code and schedules

next appointment

Scheduler swipes bar code and schedules

next appointment

Patient goes homePatient goes home

2a2a

EE

Coordinator briefs patient on process and

timings

Coordinator briefs patient on process and

timings

Is treatmenton hold?

Is treatmenton hold?

Treatment comes off hold

Treatment comes off hold

Yes

Treatment arrives. Coordinator records time

Treatment arrives. Coordinator records time

Nurse checks script and batch number

Nurse checks script and batch number

Patient taken to treatment area

Patient taken to treatment area

Is patient new?Is patient new?Yes

Treatment startsTreatment starts

Treatment finishes and patient handed blood

form for next visit

Treatment finishes and patient handed blood

form for next visit

Nurse gives ‘new patient’ talk

Nurse gives ‘new patient’ talk

No

Yes

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

Does patient have

transport

Does patient have

transport No

Yes

Is patient well enough for treatment?

Is patient well enough for treatment?

Co-ordinator checks bloods

Co-ordinator checks bloods

Are patients on protocol?

Are patients on protocol?

No

YesAsst Practitioner carries

out checks

Asst Practitioner carries out checks

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

Patient sent home and Deferred

Patient sent home and Deferred

Patient picks up TTO on ward

Patient picks up TTO on ward

Patient provided with transport

Patient provided with transport

No

No

Processes made Lean

Qualification and quantification of waste

Total waste identified = £1.2 million

Waiting (£124,964)

Motion/Transportation (£186,125)

Over-production (£888,911)

Methodology

Stage 1Map as is processesChallenge waste and current working practicesStaff interviews

Stage 2 Identify new processes Quantify current savings Rapid Improvement Events

Stage 3Map new value streamsQuantify future savings Development & implementation of process register

Through focusing on the patient and ensuring comprehensive

clinical engagement, we have dramatically streamlined the

patient pathway

And the unique element is that this Lean project has led the design of our new £35 million chemotherapy centre which will open in 2010