Introduction Lean in radiology
Radiology For many radiology departments the pain of trying to get waiting times down Radiology is process-intensive. Traditionally, it has been associated with long
to meet the December 2008, 18-week general practitioner (GP) referral to waiting times, particularly for outpatient services. Waiting is a form of waste, and
is process- treatment target, is beginning to ease. However, the problems of sustaining this therefore suggests that the use of Lean could be beneficial. The Royal Bolton
acceptable waiting times in the face of a continuing escalation in demand Hospital Radiology Department has been using Lean for almost four years as part
intensive are becoming apparent. In many cases, waiting times have been reduced to of a trust-wide application of Lean, known locally as the Bolton Improving Care
meet the target by additional out of hours work, often in an expensive ad hoc System (BICS). A group of trained facilitators enable individuals to come together,
manner. Clearly, a more systematic approach is needed, and this article will work through a problem in a systematic way and implement a solution using
explore some of the possibilities. These are based largely on the principles of Lean tools. Three case studies from the radiology department are given later in
Lean. this article but, before those, some more general ideas about improving radiology
services are discussed.
What is Lean?
Lean thinking, or simply Lean, is based on a set of ideas which was developed Be ambitious
by the Japanese car manufacturer Toyota in the 1950s and was known as the To provide the timeliest service for patients and to allow for occasional slippage in
Toyota Production System (TPS). As a result of the use of TPS, Toyota began to turnaround times when things aren’t going quite to plan, services should aim to
increase its profits and market share while the North American car companies, perform and report examinations within two weeks of receipt of the request. There
which had previously enjoyed domination of the market, began to see a are plenty of opportunities to provide a same day imaging service. The prime
downturn. The Japanese demonstrated that they could produce more cars in example of this is in breast clinics. In many trusts mammography, ultrasound and
less time, with less stock, in a smaller space, and with fewer defects than their needle biopsy at the first outpatient visit is well established. This ‘one stop’ model
competitors, whilst having minimal absenteeism. This was achieved by focusing can be extended to other imaging-intensive specialties such as urology (renal
closely on the manufacturing processes, concentrating on improving quality and ultrasound, intravenous urography and computed tomography [CT]) and ear, nose
eliminating waste. and throat (sinus CT, and neck lump ultrasound and biopsy). Not only does this
provide an excellent service for the patient, it also eliminates the work associated
Over the last half-century, Lean thinking has been applied successfully by with booking appointments. Short Lean ‘2P‘ (Process Planning) events are useful to
many other manufacturers, and more recently has been embraced by suppliers plan these changes.
of services such as postal carriers, insurance companies and healthcare
organisations, and also retailers such as Tesco. It can be applied in any Change the culture
organisation that utilises complex processes. In essence, it consists of the Major changes to the way imaging departments provide their services cannot be
following: achieved without a major change in staff attitude. Instead of paying lip-service
Identify the ‘value stream’ – the parts of the process that really add value to to the notion of a patient-centred service, staff should consider how they would
the final product or service (the ‘value-added’ steps). wish the service to be provided were they patients themselves. The large amount
Eliminate waste (the ‘non-value-added’ steps) from the process. Waste is of public money that has been sunk into the National Health Service (NHS)
everywhere – overstocking, waiting, transport, duplication, overproduction, etc. really does give patients the right to expect a good service, something which is
Pursue perfection by constantly improving the process and quality of the sometimes forgotten. Involvement of front-line staff in Lean service improvement
product or service. events is essential so they develop a sense of ownership of and pride in their
service. It is important to involve medical staff where appropriate, as they are
Benefits that can be gained in healthcare include: often the most resistant to change. Making full use of the skills of existing staff
A truly patient-centred service, designed around patients’ needs. with the appropriate use of skillmix not only makes sense financially, but also
Decreased waiting times, increases staff ownership of the service.
Increased throughput,
Improved environment, Leadership
Decrease in resources required, Major changes cannot be wrought without strong clinical and managerial
Increased quality. leadership. An effective departmental management structure is needed, and there
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