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September 2019
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Spreading the lean message

The Cardiac and Stroke Network in Lancashire and Cumbria has transformed the efficiency of its own operation using Lean methodologies and is now taking the principles of Lean into the clinical environment to help improve patient services.
By adopting Lean practices, the Network has dramatically reduced time spent on administrative tasks- releasing more time to spend on supporting frontline services and to increase its workload by more than double by assimilating stroke into its work programme for Lancashire and Cumbria.

As a frontline service improvement organisation, the Network was eager to learn more about the Lean methodologies that are driving change across healthcare and commissioned The Manufacturing Institute to help all Network staff improve their knowledge of Lean tools and techniques.

This began with Lean awareness training involving the entire Network team. Staff were introduced to the guiding principles and key tools of Lean during a practical workshop in which they mapped out a typical journey, or ‘value stream’, for a hypothetical patient reporting chest pain. The Manufacturing Institute introduced them to methods of measuring and evaluating the value adding steps in that process and those wasteful steps that added no value for the patient. Next they created a ‘future state map’ detailing an ideal Lean patient journey in which the non-value adding elements were removed.

To reinforce their knowledge and apply the benefits of Lean to their own organisation they then took part in a rapid improvement event to introduce the Lean principles of 5S good housekeeping into the Network. This involved de-cluttering the office in preparation for a move to new premises, involving clearing out 30 bin bags worth of unwanted rubbish. Visual management systems were established, such as a new system for booking of leave, to make useful information accessible to everybody.

The biggest change was introducing an electronic storage system, abandoning a paper-based system and the wasteful practice of keeping multiple documents. A library was electronically catalogued and a standard system of naming and storing all electronic files was achieved. As well as ensuring easier and open access to all documents and reference sources, this has also freed up vital office storage and desk space, with office drawers and filing cabinets a thing of the past.
Each member of staff now uses 25% less space which means that the Network was able to rent less space than would previously have been necessary when relocating its expanded team to new offices. The new Lean and tidy working practices mean that staff require smaller desks.

The functional layout also means that the space can be used more flexibly to accommodate hot desk working and full utilisation of desks when people are out of the office.

According to Sally Chisholm Network Director: -On first impression our office looked reasonably tidy, but we soon uncovered all the hidden waste and we were staggered by the amount of unnecessary historic paperwork we found. Everyone feels the benefit of working in a clutter-free environment and we work more efficiently so that back-office time is minimised and our advisers can be out in the field more- helping to improve patient services.

The Network has been applying its Lean knowledge and best practice whilst working with its member organisations. For example members of the Network Team worked with clinical and social care staff in one area for two days. This examined the patient pathway for stroke patients at a Lancashire Hospital. Working with a cross-functional team and involving executive leaders, the group started by creating a value stream map to highlight all the complex steps in the patient pathway – from admission to discharge. This visual map demonstrated a convoluted path for the patient – flagging up many wasted steps and, therefore, wasted time and cost built into the system.

Next stage was to develop a future state map in which the non-value added elements of the process were designed out to create a smoother, simpler patient pathway – putting patient care at the heart of the process. Network advisers are now supporting Lean champions from the hospital to make these changes.

Sally Chisholm said: -With the Network’s facilitation the group identified a number of simple changes that could be made immediately that would improve the quality of patient care. One of these was to minimise disruption to patients being admitted through A&E by involving expert ward staff in the initial diagnosis, saving some patients an unnecessary journey to the ward and saving both staff and patient time in undertaking a second stage diagnostic. By changing the pathway and focusing on the value added elements, significant improvements in patient care will be made- with the added benefit of delivering efficiencies.

-We are working with all Primary Care Trusts, social care departments and secondary care units across Lancashire and Cumbria and carrying the Lean message. We have led process mapping events at Royal Preston, Chorley, Royal Blackburn and Furness General Hospitals, which are helping to deliver efficiencies and improvements at these sites.

Staff at the Cardiac and Stroke Networks are specialists in service improvement, so they were able to quickly tune in to Lean methodologies. They have made enormous progress in their own lean journey and it is encouraging to see them spreading the message and developing others in using Lean principles to achieve quality and performance improvements.

The Manufacturing Institute has partnered blue-chip enterprises, healthcare and public sector organisations in the UK and Europe over the last 15 years and has helped all these different sectors to understand their individual needs. Their more recent work with more than 15 NHS Trusts is helping to transform the care given by hospitals such as Stockport NHS Foundation Trust; Blackpool Fylde and Wyre NHS Foundation Trust ; Southport and Ormskirk Hospital NHS Trust; West Middlesex University Hospital NHS Trust and Royal Devon and Exeter NHS Foundation Trust. More information about these Lean initiatives and others can be found at:

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