Since initiating an operational management system in 2008, these hospitals in the north of England have managed to close 100 beds yet safely service the same number of patients.
In a bid to cut bureaucracy and improve efficiency, in 2006 these two hospitals adopted Lean into three strategic areas: radiology, phlebotomy and children and women’s divisional offices.
Having achieved a 43 percent reduction in end-to-end patient turnaround times, leadership set itself the even tougher task of sustaining these gains and spreading them further around the organization.
Eager to move away from a project mentality and integrate Lean into mainstream management processes, the hospital’s staff have been working to ensure that all steps in the various clinical processes contribute to improved flow, through standard work.
Central to this progress is the concept of the ‘visual hospital,’ with a plan for every patient and a clear picture of overall patient flow hour-by-hour. Through this, the team can view where a patient is at any moment, the demand for and availability of beds, turnaround times within each part of the system and any delayed discharges.
A weekly ‘value stream map’ provides an immediate situation report, while daily meetings give managers and the staff the opportunity to voice any issues or improvement ideas. Any variation from the standard is considered an opportunity to improve and is immediately highlighted and addressed, using root cause analysis to determine the reason. By communicating regularly with service users the patient is now at the heart of the service, which gives greater certainty for users and patients, and enables repeat appointments to be booked sooner.
The Trust’s senior clinicians and managers demonstrated strong leadership and maintained regular communication, with staff fully engaged and empowered to understand Lean and come up with their own solutions. Team members have been given sufficient time and a safe environment for growing and testing ideas, and all hospital staff can now study for a UK National Vocational Qualification in Lean.
The hospital has not only sustained its improvements but also exceeded them, helping embed a Lean culture of continuous improvement. The average length of stay for medical patients and emergency surgical patients has been reduced significantly, while over US$3 million a year has been saved by closing over 100 medical beds across the Trust – with no negative impact on patients.
By redeploying staff, the hospitals have also cut around US$1 million in annual payments to nursing and other agencies.
Consequently the UK Health Service Journal awarded the Trust ‘Acute hospital of the year’ in 2011, commenting that it was: “an extremely impressive and rounded organization where care has been improved by focusing not just on safety but also on individual patient outcomes.”