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that was delivered in 2012. While none of this will be covered here, I am hoping there will be an opportunity to report on these in a subsequent article. It is worth bearing in mind here that none of the sites the diagnostics improvement team worked with had any ‘pump prime’ monies for this work – they all made tangible improvements (through kaizen) that actually avoided costs on unnecessary activities. Another note is that all of the teams made these improvements while doing the ‘day job’ and with minimal dedicated time for CQI training and to actually make the improvements.
The basic principles of CQI redesign used
included: removal of ‘waste’ in processes ‘go and see’ activities improving flow, introducing ‘pull’ and work cells
reducing batching mapping – value stream mapping, process sequence charts, process mapping
introducing visual management adding value from the patient/user perspective
respect for staff and their views A3 thinking – PDSA problem-solving Data-driven changes – SPC root cause analysis (RCA) capacity and demand right first time, defect-free leadership and communication 5S and standard working.
EXAMPLES FROM CYTOPATHOLOGY In 2008/09, 10 cervical screening sites where engaged to make improvements across the entire end-to-end pathway (endorsed by the Carter report), from when the sample was taken to when the women receive their results. This was precipitated by the impending system driver of the ‘Vital Sign’ of 14-day end-to-end turnaround time (Cancer Reform Strategy). This involved working with GPs and recall agencies, as well the laboratories performing the tests, to improve the whole pathway. While reducing turnaround times (TATs) is often used as a measure of success, this is usually a result of removing wasteful activities to allow staff to concentrate on value-added activities, increasing productivity and staff morale. Quality also increases and costs reduce by concentrating on the elimination of defects. They had some impressive results by first
removing wasteful activities, which costs money and adds time, then focusing on: adopting small batch sizes keeping samples moving to improve flow establishing first in first out using a team-based approach.
The following examples show waste reduction in cervical cytology screening.
Transport Collection and delivery of samples reorganised, saving nine days (110 miles) walking a year (NWLH).
DECEMBER 2013
20 18 16 14 12 10 8 6 4 2 0
20 slides per batch 10 slides per batch
Inventory 77.5 hours of screening capacity released weekly and £30,000 a year savings, avoiding overtime (Leeds).
Backlog reduced from 4000 to 655 slides (Norfolk & Norwich [N&N]).
Motion 8.25 days’ capacity released (123 miles) by moving the refrigerators (Leeds).
Automation Adjusting results download time improves the numbers of women receiving their results letters the next day, from 6% to 67% (Ashford & St Peters).
Waiting Changing the timing of the QC procedure reduces TAT by 1–3 days (Addenbrooke’s).
Total waiting days saved (58,800) by introduction of multiple results downloads (Leeds).
‘Stop & fix’ approach to clerical queries reduces waiting time to three minutes per sample (Derby).
Over-processing Removal of extra steps releases time to screen 7500 extra slides per year (N&N).
Removal of slide matching step (repeated by screeners) saves 90 minutes per day (Barts).
Removal of extra step in specimen reception saves 160 hours per year (Sheffield).
Over-production Screening backlog reduced from 21,390 to 11,700 in 91 days – eight months earlier than predicted (Manchester).
Defects Sample defects at reception reduced from 42% to 2% (Heart of England).
90% fall in errors in request details (Musgrove Park).
Defect rate reduced from 15% to 5% to reduce manual matching (Anglia Support Partnership).
Mean time taken:
20 slides per batch = 7.36 days 10 slides per batch = 3.04 days 5 slides per batch = 0.82 days
5 slides per batch Effect of reduced batching of slides on length of time taken from booking in to primary screen.
Achieving ‘right first time’ reduces defects by ~50% across all categories (Coventry).
Skills utilisation Expanding roles in the preparation room improves continuous flow and increases productivity by 15% (Musgrove Park).
The following examples show improvements in cytology using other CQI principles:
A3 thinking Turnaround for samples to reach the laboratory within three days increased from 73% to 97% (Newcastle).
Visual management ‘At a glance’ task completion improves morale and reduces time taken by 127 hours per year (Leeds).
Improved identification of bloodstained samples reduces reprocessing, saving £3200 a year (Barts).
Standard work Errors reduced by 1% per month, saving 120 hours a year, using a VM request form (Hull & East Yorkshire).
Introducing HMR101 forms saves 1798 hours a year (Coventry).
Reduced batching Turnaround time for booking to primary screen reduced from 7.36 to 0.82 days (Northwick Park).
EXAMPLES FROM HISTOPATHOLOGY In 2009/10, nine histopathology sites were selected as pilots to test the hypothesis that 90% of samples could be reported within seven days, and 50% within three days. This was mainly due to the continuing pressures of supporting the 31/62-day cancer pathway targets and the National Patient Safety Agency (NPSA) reports on laboratory errors, such as: wrong patient given radical prostatectomy due to two patients’ slides switched within histopathology laboratory in 2008
second report from a different trust of the THE BIOMEDICAL SCIENTIST 709
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