Peter Gray and Dave Slater of Royal Bolton Hospital shown at the 2nd Lean Healthcare Forum on 6th June 2006 ran by the Lean Enterprise Academy www.leanuk.org

1. Royal Bolton Hospital
Blood Sciences Lean project
Peter Gray
Dave Slater

2. Bolton Hospitals NHS Trust
Covers a population of 265,000
Employs 3100 staff
Emergency admissions of >38000
Total beds = 779
Pathology total workload >1.4 m
requests 2004/5
Blood Sciences = 50% of above

3. Pathology lab history
Pathology is split in 2 buildings across the
hospital main corridor
Due to increasing workload, we believed that
the size of the building and staffing needed to
expand (business case showed spend of
£650,000 was required)
The laboratory is CPA accredited

4. Value Stream analysis
Team of various grades from pathology,
pathology users and external staff
worked on value stream analysis over 4
days

5. Mean of all deliveries
MEAN of all deliveries all routes for all Pathology departments
0
50
100
150
200
250
300
350
400
GPvan Air tube Reception
GP
vans
GP
vans
phlebotomy

6. Current state

7. Unnecessary movement
Urgents (Biochemistry)
Sample 75 steps approx 40x daily =3,000
Information 135 steps once a day
GP van (all labs)
Samples 4924 steps per day
Information 135 steps x2 daily
Routine (Microbiology)
Sample 309 steps x7 daily
Information 362 steps x 7 daily
This is the minimum, it could be higher

8. Future State

9. Value statement
The delivery of a correct result for a blood
sample, for the correct patient to the
correct clinical team within 1 hour of
receipt unless precluded by current
technology

10. Staff Communication
After the week, feedback sessions were
held with staff.
One per day for 5 days
Staff were asked for comments to be
written on feedback sheet in Staffroom
Analysis of comments showed 2
categories of concern:
Staff roles
New laboratory design

11. Week two - 3P planning event
Revisited first Blood Sciences laboratory
design
Reviewed staff comments
Re-calculated waste(s)
Used a lean project management tool to
produce a 1-decision implementation plan
4 phases
Individual task definition and detail

12. Redesigned the Lean laboratory

14. Benefits from New Design
Achieves process flow
Reduced Steps
Urgent Blood Samples - reduced from 75 steps to
a maximum of 57 steps
Routine Blood Samples – reduced from 309 steps
to a maximum of 57 steps
GP vans maximum of 57 steps from 2462 steps for
1 run
Strategic grouping of analysers – better
utilisation , require reduced numbers of
analysers

15. Predicted benefits from new design
New laboratory design accepted by all
staff
Reduced number of staff required
Reduction of floor space (40%)
Reduction of travel distance (80%)
Opportunities to utilise skill mix of staff in
new ways

16. Current progress
Understand the type of equipment required for
flow processes
Reduction of sample processing time from an
average of 5 hours to approximately 60
minutes. (Routine)
Reduced the turnaround time for some tests
e.g. HbA1c from 30 hours to 3 hours
The design of the lean laboratories will have
flexible benching and analysers will be on
trolleys.
Reduced re-work

17. Additional benefits for Blood Transfusion

18. Value stream mapping for Blood Transfusion
Cross Matching
Broken into 28 stages
323 steps
Touch time – 176 secs
Flow time – between 25min – 2hrs 51min
Group & Save
14 Stages
90 – 111 steps
Touch time – 210 sec
Flow time – 70 min
Hand offs – 2 or 3 dependent on staffing levels

19. Lean Blood Transfusion Lab
Runners
Repeaters
Strangers

20. Benefits from New Design
Improved flow
Reduced waste
Stocking Blood bank – reduced steps from 160 to 50 steps
(70%)
XM – reduced from 323 to 69 steps (79%)
G&S – reduced from 95 to 7 steps (91%)
Abnormal antibodies – reduced from 111 to 30 steps (73%)
Less re-work
Reduced number of hand offs
Designed area for flow stoppers
Dedicated pod station

21. 6S for Flow
Sort (get rid of what’s not needed)
Straighten (A place for everything..)
Shine (clean and wash)
Safety (checking for hazards and
defects)
Standardise (build into acceptable routines)
Sustain (maintain the standards set by
the 6S event)

22. 6S event for Specimen Reception

23. Current state

24. After 6S

26. Benefits of 6S in Specimen Reception
6S score has improved from 24% on Monday to 87% on Thursday
Staff involvement
As the week progressed staff became more involved and enthusiastic
Visual Management introduced
Labelling
Cupboard fronts removed
Clear boxes introduced
Colour coding
6S board introduced
Working Environment
Cleaner
Brighter
Better organised
“Waste” removed

27. Is Lean Easy ?

28. Issues
Extremely complex project
Reconfiguration of services
Project delays due to external suppliers issues
Scanning software for request forms not ready
(external supplier)
Continuing to provide a service 24/365 whilst under
going major change
Plenty of strangers due to configuration issues
IT issues e.g. analyser interfaces

29. Issues cont’d
Changing the way staff work
Integration of previously discrete departments
HR issues (many to be addressed)
Getting ALL staff to understand lean
Staff on shifts, part time staff, staff using batch techniques
for many years
Some staff are very receptive
Others are less receptive and see it as a means of
reducing staffing levels (particularly in the current NHS
climate)

30. General lessons
Huge changes in very short time scales have
had (are having) a profound effect on all the
staff.
Some have adapted very quickly, some not at
all yet.
The magnitude of the task of managing the
human issues cannot be over emphasised.
It is a credit to the staff & their managers that
we have progressed so far so quickly.

31. General lessons
It has been (is still) a roller coaster ride
of emotions & stress & tension usually all
within the same day.
Mutual support especially within the
senior management team has played a
vital role.

32. Lessons learnt
Don’t leave the staff as they will revert back to
their customary working practices
Must have a team leader responsible for each
area who wears a “lean hat”
Don’t expect the new “flow” to work to the
reduced waste calculated – it will take time
Document the new working practices –
standard work

33. Is lean easy ?
NO
Changing mindsets
Changing a 24/365 service
But this project has been achieved in 8 months
Previously it would have taken years!!
Pathology and this Trust are at the beginning
of a journey