ARTICLE
same error with the same consequences received in 2009
transposed identification, switch/partial switch of patient identifiers.
After reviewing the pathway, it was clear that the final part of the pathway (from release of slides from the laboratory to receipt of the final report) was where the most impact could be made, without neglecting the other parts of the pathway. Mechanisms for change were identified as: Leadership Empowered staff with daily meetings Visual Management – display of data.
Of course, waste reduction is always the beginning and following are some examples:
Defects Transcription errors reduced by 60%, two hours wait time and 1.5 hours MLA time saved daily at slide labelling (North Tees).
Quality defect rate dropped from 2% to 1% and 360 hours of biomedical scientist time saved by removal of redundant QC step (UCLH).
17% error rate in final report reduced to 2% by introducing standard work in sample reception (Whipps Cross).
Using RCA to reduce defects in the laboratory, from 10 to one per month, at a cost of £21 per defect (Birmingham Women’s).
Automation £60,000 resources saved and three-day TAT increased from 41% to 77% by introducing digital dictation (Birmingham Women’s).
Over-production 50 days of staff time released per year, with cost savings (£1229 consumable savings) by stopping producing spare unstained slides (Leeds).
Skills utilisation 208 km per year (60 hours) of pathologists’ walking saved; illegible writing eliminated, forgotten or duplicate requests reduced (Musgrove Park).
Other principles of CQI that were used in histopathology:
Pooled reporting Skin/lung reduced reporting TAT by over 60% to 8.1 days (Leeds).
Introducing consultant pull systems reduced reporting TATs from 4.5 to 1.8 days (North Middlesex), from six to 1.5 days (Whipps Cross) and from 2.14 to 0.52 days (Derby).
A3 thinking/PDSA methodology/RCA From 5% to 54% of specimens cut-up on day of receipt (UCLH).
Used to develop countermeasures for future state (UCLH).
710 THE BIOMEDICAL SCIENTIST Jul 10 0.74 2.30 1.45 instigated system PULL Jan 10 0.79 3.90 4.01
Collection to receipt Receipt to slides prepared Slides prepared to validated
Sept 10
0.72
3.79
6.35
Apr 10 0
0.89 2
4.25 4 Whipps Cross patient pathway analysis.
The cytology and histopathology case studies can be found on the Quality, Innovation, Productivity and Prevention (QIPP) section of the NHS Evidence website.
EXAMPLES FROM MICROBIOLOGY In 2010/11, following the second phase review of pathology (Carter, December 2008) and the QIPP challenge (improvements in efficiency, quality and safety), eight microbiology sites from EMSHA and two pilot/spread sites were selected to test changes, with an emphasis on the targets for methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile. While it was vital to measure entire end- to-end pathways, this showed numerous difficulties in recording sample collection and receipt dates, which led to a focus on user engagement and ‘voice of the customer’ (VOC), as well as: clinical and managerial leadership developing a Lean culture staff engagement/empowerment communication (internal and external) standard working
visual management (VM) to reduce inappropriate demand.
Of course, you should always concentrate on waste reduction first, but the following are examples of how other CQI principles were used:
VM/Standard work 38.4% MRSA and 31% C. difficile demand absorbed at no additional cost (Whiston).
Flexible working 82% Chlamydia screening reported within 24 hours; 94 extra samples per day tested (Leicester).
Reducing MRSA inappropriate demand saved £10,000 per month (Northampton).
VOC/User engagement 90% blood cultures arrive via air tube as a result of VM and ‘poducation’ (Whiston).
GP engagement and VM for urine collection reduces demand by 21.5% (Whiston).
Visual aid for primary urine containers (Whipps Cross).
Leadership for improvement Introduction of daily ‘huddles’, using PDSA/A3 thinking, training in CQI (Leicester).
Stop to fix, senior leadership intervention, data collection, VM, 5S improves specimen flow in reception (Nottingham).
Creating an environment for improvement – communications centre created, suggestions boards, Lean drop-in sessions, process sequence charts (Nottingham).
Huddles and stop to fix improve laboratory operations and reduce monthly meeting time by a third (PathLinks).
USEFUL WEBSITES
www.changemodel.nhs.uk.
www.nhsiq.nhs.uk/resource-search/ publications/
nhs-imp-cytology.aspx
www.nhsiq.nhs.uk/resource-search/ publications/
nhs-imp-cont-imp-cytology.aspx
www.nhsiq.nhs.uk/resource-search/ publications/
nhs-imp-histopathology-7.aspx
www.evidence.nhs.uk/qipp/case-studies- by-workstream
http://www.nhsiq.nhs.uk/resource-search/ publications/
nhs-imp-microbiology.aspx
Susie Peachey
(
susie.peachey@
nhsiq.nhs.uk) is National Improvement Lead, NHS Improving Quality. All examples quoted can be found in the publications on the NHS Improving Quality
website and links have been included to view or download the documents.
DECEMBER 2013 6 Days
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