18 Weeks Whole Health Community Workshop

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18 Weeks Whole Health Community Workshop Tuesday
4th December Avonmouth House - London
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Who are we?
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We are a training organisation
We train people in best practice manufacturing
and healthcare lean principles.
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Exploring the opportunity to apply lean across
healthcare boundaries
Current Projects
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The 18 Week-ometer Where are you?
No problem
The Too Difficult Box
Government conspiracy
What 18 weeks?
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18 Weeks is it all just too BIG?

• How do you tackle something involving
• 100s of staff
• 10,000s of appointments
• Dozens of specialities
• Dozens of separate home grown processes

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Process flow-typical LHA project
Get a team together- key staff- Prepare in
advance Day 1- First ½ day training, set
objectives then begin mapping Day 2- Second day
continue mapping Day 3- Complete map Day 4-
Redesign begins, complete data gathering Day 5
Formulate action plan the get on with it!
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LHA- Process flow projects
Airedale NHST- Acute Orthopaedics, Elective
Orthopaedics, Colposcopy, Cardiology, Colorectal
Cancer, Paediatrics, IUGR, Elective
sections Scarborough NHST- Complete OP pathway
all specialities Doncaster NHST-
Orthodontics Bradford THNHSFT- ENT and
Ophthalmology Hull- Acute Orthopaedics YorkN.
Yorks PCT- MSK
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Process Flow analysis Identifying the Hidden
Process
Individual Opinions
Fred thinks
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Process Flow
Understand-Validate-Improve
Examine the Current State map.Identify the
value added steps
Build the Future State new process around the
value added steps.
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Value added steps

• Any medical decision
• Any required diagnostic
• Any required consultation/examination
• Any treatments given (including watchful waits)

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ANHST-Colposcopy services
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Doncaster Orthodontics
Pathway excellent, lack of resource causing
constraint
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BRI Head and Neck
39 possible locations for notes 22 subspecialty
clinics
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Scarborough- whole OP pathway
129 Issues to resolve with the re-design
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Elective Orthopaedics
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Common themes

• The value steps account for a matter of hours in
  a 20 Week pathway
• There are easy admin wins to take weeks out of
  the process
• Decisions need to be made as soon as a referral
  hits
• All subsequent decisions need to follow quickly
• Pooled decision making for multiple handed
  specialities
• Order diagnostics concurrently. Simple
  diagnostics same day.
• Under resourcing the process of creating an
  appointment creates delay
• Apply SPC and streaming to the OP process to
  fully understand capacity, demand and variation.
• Follow up to new ratios creating constraint in
  the drive to fulfil 18W
• Lack of clear ownership for pathways, different
  people/departments own bits of the process.

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Time losing Black holes

• Awaiting single consultant decision
• Ill defined Post routes
• Medsec Holidays
• Consultant Holidays/Study Leave
• Waits on Diagnostics
• Local ownership of processes (making own
  appointments, no joined up processes)
• High DNAs- multiple appointment letters
• Re-arranging appointments
• Authorisation to overbook or make similar
  administrative decisions

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Brave solutions

• Consultant triage of referrals on arrival
• The triage meeting becomes the hub of managing
  referrals
• Pooled referrals- consultant triage on rota
• New admin role to support triage/patient
  appointments
• Patient appointments managed in one call-
  Diagnostics, patient transport and OP
  appointment.
• Single route for all referrals- Tertiary, paper
  and CB/directly bookable
• Ownership an accountability
• Consultants taking an active role in managing
  capacity and demand
• No appointment letters sent out until 6 weeks
  before