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Making it count
Andrew CottomFourth Lean Healthcare Forum
9 October 2007
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Content
• Context• Reflection – has it
helped / is it helping• But what about
savings?• Future – some
thoughts
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Visitors from Wales
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BlaenauGwent76400
Monmouthshire89200
Newport140500
Torfaen93600
Caerphilly177000
Local Authorities / Health Boards In Gwent
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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
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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
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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
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Emergency Pressures
3500
4500
5500
6500
7500
2000/01 2001/02 2002/03 2003/04 2004/05 2005/06 2006/07
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How could/has “Lean” helped
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Lean (simply put)Some early expectations (2003)
• Cooks out the fat (waste)
• More consistently done• A better taste• Better for you (Safer)• Visible performance
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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
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Implementing Lean ThinkingSept’04
• 7 tactics – Innocuous pilot– Get an expert– Lean Network– 5S/CANDO– Clinical project– Management Development– Whole “Production” System
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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
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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%
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But what about the savings……?
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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
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But what about the savings……?
a hypothesis
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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)
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Current State VSM for Patient Journey: Shortness of Breath
Lead Time = 11,055 minsProcess Time = 94 mins
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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
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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)
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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
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Current State VSM for Patient Journey: Shortness of Breath
Lead Time = 11,055 minsProcess Time = 94 mins
Cost Cost Cost
Cost
Cost
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Counting the cost – future savings programmes
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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
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In conclusion….
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4th Lean Healthcare Forum 2007