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IMPLEMENTING BEST PRACTICE FOR EFFICIENCY LONDON, 17TH OCTOBER 2012

David Hamer Professional Lead for Laboratory Medicine Bolton NHS Foundation Trust National Clinical Lead for Blood Sciences NHS Improvement (Diagnostics)

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Royal Bolton Hospital

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Some Recent Bolton Awards

HSJ Efficiency Award 2012

Laboratory Medicine

Service Innovation of the Year 2012

Ed Hinchcliffe 2012 Europe Process

Excellence Award Winner

Bolton NHS FT Clinical Leader of the Year

British Medical Journal 2011

Dr Ian Dufton Nursing Standard’s

Nurse of the Year 2011

Fiona Murphy National Process Excellence awards 2011

Respiratory Nurse Specialist Team

Patient Safety Awards 2011

Theatre Team Excellence in ADHD Award

2011

CAMHS Team

Champion for ADHD 2011

Noreen Ryan, Lesley Carney and Cath Ashworth

Health Service Journal's Efficiency Awards 2011

Outpatients Team Health Service Journal's Efficiency Awards 2011

District Nurse Team Healthcare Caterer of the Year

2010

Margaret Meadows

NHS Quality Champion of the Year 2010

David Fillingham Human Resources Director of

the Year 2010

Nicky Ingham NHS North West Leadership

Academy Award 2010

Suzanne Lomax Social Care Award Regional

Finalists 2009

Orthopaedic Team Diamond Care Award Winners

2009

Bolton Stroke Services

Diamond Care Award Winners 2009

BICS Academy

Diamond Care Award Winners 2009

Patient Experience Team

National Health and Social Care Awards 2008

Bolton Improving Care System

TrusTECH's North West NHS Innovation Awards 2008

Andy Minett

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Evan Esar 1899-1995 American humourist

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Bolton NHS Foundation Trust Integrated Care Organisation since July 2011

General hospital with 750 Acute beds

Community based services delivered at more than 20 sites

Serves the population of Bolton and surrounding catchment (around 350,000)

Employs approximately 6,000 staff

‘Supercentre’ for maternity and children's services for Greater Manchester

Accident & Emergency attendances around 110,000/year

Circa 1,000,000 patient contacts/year

Turnover £270M

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Department of Laboratory Medicine

Cellular Pathology comprising Histopathology, Cytology and Mortuary Services;

Microbiology comprising Bacteriology, Virology, Mycology and Infection Control.

Blood Sciences comprising Clinical Chemistry; Haematology; Blood Transfusion ; Immunology; Serology; Regional Downs Screening Lab; Specimen Reception & Phlebotomy

Admin & Support Services (Secretarial; Admin; Logistics; Patient facing)

Quality & Service Improvement Team

Combined services employ approximately 170 staff - Biomedical Scientists / Clinical Scientists / Laboratory Assistants / Medical staff / Nursing staff / Secretarial, clerical & other support

Process approximately 4 million Blood Sciences tests per year

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Laboratory Medicine

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Challenges to Gtr Manchester Pathology Services (20:20 vision)

Need to reduce costs to GPs by 20% £600,000 by August 2012 at Bolton

Need to improve quality by 20%

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a good crisis”

Professor Daniel Jones Lean Enterprise Academy

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Holistic approach

It’s about improving the efficiency & effectiveness of

the whole service not just some elements &

processes

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Lesley Doherty Chief Executive Bolton NHS Foundation Trust

“It’s the way we do things around here”

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Lean basics

Eliminating Waste

• Capacity • Quality • Defects • Cost • Productivity

Focussing on the Patient

• Value • Deliver value • Pathways • Reduce TAT

Respecting Our Staff

• Enabled • Enhanced roles • Innovate • Ideas • Improvements

Understanding customer value drives further

improvement

Provides capacity & quality

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Objectives

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The Bolton Approach Lean methodology

Staff engagement

Value Stream Mapping

Visual management of progress

Governance

Customer value Multidisciplinary Team

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Number Work Stream Lead Work Stream Name

1 Quality & Improvement Lead Next Level of LEAN

2 HR Business Manager Workforce Planning

3 Clinical Chemistry Manager Sendaways, Value for Money, Repatriation

4 Lab Med Professional Lead Customer Service, Marketing & Advice

5 Specimen Reception / Phlebotomy

Manager Laboratory Medicine in the Value Stream

6 Cell & Infection Science Service Manager Transport

7 Haematology Manager Information Technology

8 Transfusion Lead Demand control, Pathways, Order sets

9 Lab Med Clinical Lead New Business, Innovations

10 Management Accountant Finance, Managed Service Contracts,

Procurement

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BEST CARE FOR BETTER HEALTH Quality / Timeliness / Delivery

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Secure high quality GP services Initiatives

Support GPs in Triple Aim

Big Bolton Health check

Provide GP CPD sessions to educate & influence pathways & testing protocols

Provide GP newsletter

Collect GP practice views & analyse using Kano tool

Improved sample collection system/courier service in consultation with users

Expanded GP domiciliary phlebotomy services

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Continuously improve Quality

Action Improvement

Number of agreed clinical requesting pathways 78%

Repatriated sample turnaround time 86-90%

Number of sendaways (sent to reference lab) 10% reduction

Needle to Notes for A&E 74%

Number of tests in GP test profiles U&E 40% reduction

Bone profile 25% reduction

Increased electronic reporting of tests >95%

Meet or exceed RCPath Blood Sciences TAT KPIs 100%

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USING RESOURCES RESPONSIBLY Cost / Value for Money

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Efficiency savings of 20% Forecast - identified £803K recurrently

£517K posted in Year

• Reprofiling – skill mix / reorganisation • Procurement – Re-negotiation of contracts (suppliers; referred work; Managed Service Contracts) • Streamlining efficiencies (better stock management; demand control; removing waste; eliminating defects; repatriation of work) • Income generation (new business with same resource; new services)

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Productivity

<<< 62% >>>

Last 6 months Productivity rose by 9.5%

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VALUED, RESPECTED & PROUD Morale / Human Dimension

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Improve patient/staff experience Initiative

We have secured Scientist Training post in Haematology / Transfusion under Modernising Scientific Careers

All staff have attended BICS Academy Green training; all senior staff have attended Bronze; all Lab Managers have attended Silver & some are also now on Gold.

All senior/supervisory staff have now attended the Engaging Manager programme & completed LMSQ

Formed a cross discipline/cross grade Lab Med Team to support 100 voices (monthly in-patient interviews)

Assigning BMS staff to named wards to support Transfusion safety & education

Job satisfaction and morale have increased, sickness absence continues to run below the Trust target of 3.75%. Staff feel empowered to deliver the services they have developed

Willingness to adapt

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Innovation in practice

Unique & Innovative Quality Assurance Scheme provided for high street point of care testing services throughout the UK.

(GPs, Pharmacies, Health Centres, Supermarkets)

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Reflections/Insights (Lab Med)

Went well Team approach Staff engagement The work has improved quality and protected jobs

Insights Leadership Voice of the Customer Break out of your silo Focus on the Quality Daily (continuous) Improvements It’s tough

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Reflections (Trust)

It’s too compelling to ignore:

It has to be a cultural change Board and lean team leading by modelling behaviours

It has to be values and behaviourally led built on engagement

It requires leaps of faith

It requires leadership courage

It saves lives….and money

Lean is all about people and all about quality

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Insights (Trust)

80% people

20% method

Leadership changes

We already have the experts

We don’t really know

what’s happening out there

Get good advice;

build knowledge

and skill

Narrow and Deep v.

Broad and Shallow –

the balancing

act

Other people have been down

the path before us

It’s not a project

Sustainment is hard

Leadership from the

top is essential

It feels good (even though it’s

tough)

Patients know what

value is

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“It’s the way we do things

around here”

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Questions