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NHS
NHS Improvement
case studyPathologyImprovement
University Hospital of North Staffordshire NHS Trust
Re-designing specimen transport to smoothworkflow and improve
productivity
The University Hospital of NorthStaffordshire NHS Trust has
1200beds and provides a wide range of
services to a population of morethan 700,000 people across
NorthStaffordshire.
The Pathology Directorate, incollaboration with the
NationalPathology Service ImprovementTeam, started its Lean journey
witha Rapid Improvement Event inMicrobiology, which resulted in
a90% reduction in turnaround timesfor MRSA samples. This
initial
project identified a number ofissues, including specimen
transportand the impact of delivering largenumbers of samples to
the lab atthe end of the day leading toincreased pressure on staff
resourcesand a reduction in efficiency andproductivity.
Having realised the significantbenefits of Lean methodology,
thePathology Directorate decided totransfer their learning and
apply
these principles to redesign theirtransport service.
Understanding the userA short questionnaire was sent tothe users
(GP’s, community hospitalsand clinics) to:
• gain their views of the currentservice
• identify their future requirements• establish data
about demand• confirm opening times and
preferred collect times• identify users no longer
requiring
printed paper copies.
Users who did not respond werecalled directly.
The 100% responserate immediately highlightedusers wanted
the service to change.
Visual Management tounderstand the Current StateAn ordinance map
was used todemonstrate:
• user location and percentage ofsamples generated
• the driver’s routes• district nurse drop off points
and
phlebotomy clinics.
This immediately highlighted:
• inefficient routes• the location of large clusters
of
users• high and small volume users.
Go and see for yourselfAs with all Lean methodology
theimportance of ‘walking (or driving)
the pathway’ was crucial tounderstanding the real process.
Accompanying the drivers on their journey highlighted:
• the reality of the drivers dailyexperience
• items taken out and collectedfrom the users
• the numerous other jobsperformed e.g.• collecting
mail and other items
from one practice to another• delivering and collecting
surgical kits• the occasional pharmacy run.
Drivers time was wasted having to:
• wait in the patient queue• wait for security guard
to open
doors• wait for staff to find keys tounlock a fridge.
www.improvement.nhs.uk/diagnostics
January 2010
Ordinance map of drivers routes
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“The samples are now delivered more regularly meaning
we do not have staff waiting for work. Before we couldhave staff
waiting for work for 20 mins and then all fivevans would arrive
together meaning we had in excess of
1,000 samples to process.
Antony Durose - Central Reception Supervisor
NHS
NHS Improvementcase studyPathologyImprovement
Once identified some of these
practices were changed immediatelythrough good communication
withpractice staff and drivers.
By accompanying the drivers it wasclear that:
• routes had evolved over time• new GPs surgeries and
clinics had
opened• others had moved into new
buildings• the driver with the lowest
workload took extra collections• the whole process was
extremely
inefficient.
Workload levellingTo keep a flow of work through thelaboratory
the followingadjustments were required:
• small batches of samples fromspecimen reception
• vans passing close to the labneeded to drop off what ever
they
had.
Implementing these changes hasdelivered:
• 500 samples 1hr hour earlier• 200 samples 1hr 30mins
earlier
Smoothing the workload for labstaff and reducing turnaround
timesfor patients.
New ways of working
Drivers typically started work at 9ambut did not begin the
specimencollection run until 9.30 -10.00am.
Following negotiations with thedrivers, key changes could
beimplemented including:
• re-organising routes• reducing unnecessary
activities• clusters of surgeries received 2-3
pick-ups per day• to eliminate large batches
impacting the laboratory flow• to reduce volume of samples
atthe end of the day
• establishing an early morningsweep for users taking
earlymorning samples.
This enabled a more efficient, logical
and timely service which hasimproved driver morale.
Respect for peopleAfter initial apprehension, the driverswere
receptive and generally happyto support the changes to theirroutes.
Effective communicationwas key to ensure:
• the drivers knew the changeswere not personal
• the redesign of routes provided
greater efficient for lab staff• the patient was at the
heart of
the redesign.
Eliminating the minor problems thedrivers had with GP surgeries
helpedthem become committed to thechanges.
QUOTES
”
Benefits of Visual Management
Implementing a visual managementsystem in the form of a ‘kanban’
cardplaced in the window of a low userpractice prevented the need
for thedriver to stop when there were nosamples for collection.
A ’pager’ service may be used for lowuse rural surgeries.
A visual management system has alsobeen implemented in
specimenreception to indicate the status of the
delivery rounds.
Contact details
Antony DuroseCentral Reception
SupervisorEmail: [email protected]
“There are smaller deliveries now meaning we cancomplete one
batch before another is delivered which
has reduced the pressure on the staff.
Sue Pierpoint - MLA ”
“I wouldn't want to return to the old system as thereis usually
much less work left for the night staff to
process.
Chris Williams - MLA”
David FrodshamActing Laboratory ManagerEmail:
[email protected]
