Making it count

Andrew CottomFourth Lean Healthcare Forum

9 October 2007

Content

• Context• Reflection – has it

helped / is it helping• But what about

savings?• Future – some

thoughts

Visitors from Wales

BlaenauGwent76400

Monmouthshire89200

Newport140500

Torfaen93600

Caerphilly177000

Local Authorities / Health Boards In Gwent

The Gwent Healthcare NHS Trust

• 3 hospitals providing acute services

• 3 hospitals providing acute services

• 2 main hospitals providing mental health services

• 15 other hospitals

• 3 hospitals providing acute services

• 2 main hospitals providing mental health services

• 3 hospitals providing acute services

• 2 main hospitals providing mental health services

• 15 other hospitals

• 41 health centres and clinics

• 3 hospitals providing acute services

• 2 main hospitals providing mental health services

• 15 other hospitals

• 41 health centres and clinics

• serving a population of around 600,000

• 3 hospitals providing acute services

• 2 main hospitals providing mental health services

• 15 other hospitals

• 41 health centres and clinics

• serving a population of around 600,000

• Turnover £0.5bn

Last year we treated

Emergency admissionsNon-emergency admissionsDay casesNew outpatientsFollow-up outpatientsObstetric admissionsAccident & Emergency /Minor Cas.

65,80016,20048,400

113,000287,000

9,700172,000

712,100

18065

194451

1,14827

471

2,536

Average weekday

During the year

Financial Position - context

• Deficit

Diverging Income & Costs - 2003 to 2009

-10-505

101520

2003

/04

2004

/05

2005

/06

2006

/07

2007/0820

08/09(est)

Cost Pressures Inflation(inc pay)Service Pressures Income Loss

£17m£12m£21m

£16m

£8m

Gwent NHST - I&E Position 1999/00 to 2011/12

-8

-6

-4

-2

0

2

4

6

8

99/ 00 00/ 01 01/ 02 02/ 03 03/ 04 04/ 05 05/ 06 06/ 07 07/ 08

£5m

Emergency Pressures

3500

4500

5500

6500

7500

2000/01 2001/02 2002/03 2003/04 2004/05 2005/06 2006/07

How could/has “Lean” helped

Lean (simply put)Some early expectations (2003)

• Cooks out the fat (waste)

• More consistently done• A better taste• Better for you (Safer)• Visible performance

Some early lessons - (May 2003)

• Our processes complex - years of “adding solutions”

• Lean = OD • Techniques in Lean offer genuine

sustainable improvement• Lean = new skills for management• Focus of Lean is Quality product• Lean projects generate spin offs to

continuous improvement

Implementing Lean ThinkingSept’04

• 7 tactics – Innocuous pilot– Get an expert– Lean Network– 5S/CANDO– Clinical project– Management Development– Whole “Production” System

Clinical Consummables Goods Annual Cost

0

50000

100000

150000

200000

Before After

£s

30% reduction

CT Scan Lead Time Improvement

01234567

Before After

Delay for off site scan

Days

Patient 'Right First Time on Time' Diagnostics & Treatment

020406080

100120

Apr-07 May-07 Jun-07

%

JI Programme No. of Staff Trained

0

20

40

60

80

100

Apr-07 May-07 Jun-07

Productivity Improvement General Medicine CDMH

020406080

100

May 06 -Sep 06

Oct 06 -Mar 07

Apr 07 on

Beds

patients per bedper week

300%

improvement

Up 24.5%

Up 19%

Up 47%

>90% trained on time

Productivity ImprovementGeneral Medicine CDMH

0

10

2030

40

50

6070

80

90

May 06 -Sep 06 Sep 06 - Mar 07 Apr 07 0n0

0.2

0.4

0.6

0.8

1

1.2

BedsPatients per bed per weekUp

19%

Up 47%

But what about the savings……?

Counting the cost – traditional method

• Estimate of savings (Caerphilly)– CT Scans (patient days saved) £42k– Outliers (patient days) £98k– Delayed Transfers £88k– Agency (actual cost reduction) £500k– Stock (est. costs) £50k

• Issues– “Notional”– Hitting budget?– Other programmes

But what about the savings……?

a hypothesis

Theory – Congestion Costs

“On the basis of available data, it is estimated that the total direct costs of congestion are around £825m per annum, which comprises around £430m incurred by business users and £395m incurred by other users.” (Economic Costs of Congestion in the East Midlands –ATKINS – May 2007)

Current State VSM for Patient Journey: Shortness of Breath

Lead Time = 11,055 minsProcess Time = 94 mins

NHS Congestion Costs• Short term / unplanned

– Agency / locum– Unplanned capacity– Outliers & lost surgical activity (income)

• Long term / planned– Administrative systems (inc Medical Records)– Consumables – drugs; medical supplies;

catering; paper– Management capacity

Counting the cost – futures

• Pathway focus• Patient level focus• Lesson from private sector

– “…taken aback by the level of precision, not just in the engineering process but also in the approach to costing. …impressed with the desire of production people to look at every opportunity to reduce costs…” (HealthcareFinance – Oct’07)

Counting the cost – futures

• Patient Level Costing & Lean @ Caerphilly– Patient focus– Pathway / Value stream based– Engagement with front-line– Detail, detail – “…the devil is in the detail but

– so is the answer….”– Charge-out from service departments– Reconciliation to budgets

Current State VSM for Patient Journey: Shortness of Breath

Lead Time = 11,055 minsProcess Time = 94 mins

Cost Cost Cost

Cost

Cost

Counting the cost – future savings programmes

Counting the cost – future savings programmes

Ward X

Roster Project Skillmix Review

Procurement / Stock Control Admin Duties

Lean/Ops Management

Plan for Every patientEvery day

In conclusion….

4th Lean Healthcare Forum 2007