New Clinical associates
We are pleased to announce the addition of Steven Allder (Clinical Director for the Stroke Service Line at Plymouth Hospitals Trust) and Paul Jarvis (Consultant in Emergency Medicine at Calderdale and Huddersfield NHS Foundation Trust) to the Lean Healthcare team.
Dr Steven Allder
Steven is a consultant neurologist and Clinical Director for the Stroke Service Line at Plymouth hospitals trust. His sub-specialist interest is acute stroke. He did a period of research at Nottingham University using multi modal MRI to investigate acute stroke and carotid atheroma as a cause of stroke. He also did an acute stroke fellowship in Sydney, Australia.
He has been interested in management, leadership and clinical system improvements since becoming consultant in 2003. He’s had experience as a sub-specialist lead, a clinical director of neuroscience and ophthalmology, a clinical director of a cross-community stroke service line and most recently as assistant medical director of Plymouth hospital trust.
He’s had development via a programme for young consultants and managers run by the Royal College of Physicians in association with the national institute for innovation. He did a two-year training course in clinical system improvement called the OSPREY course with Kate Silvester. He completed a six-month course on social movement acknowledgy in association with the national institute for innovation and improvement, and more recently has been a clinical lead in a programming collaboration with the Health Foundation called safe clinical systems.
As part of these roles Steven has set up a stroke unit within Plymouth Hospital Trust, changed service configurations in neurology and stroke demonstrating quite significant improvements in quality and reductions in cost. In his trust-wide roles he has produced a high level synthesis of how the flows of work operate into moving in and out of hospital and has written a synthesis of how cost and quality can be viewed from a systems perspective within NHS economy.
Steven has written many fascinating articles and papers some of which will be posted here in the very near future.
Anne-Marie Brogan
Anne-Marie qualified as a nurse in 1992 she has a BSC (hons) in Nursing and a PgC in Clinical governance. She spent four years as a ward sister, also spending some time as a specialist nurse caring for head and neck cancer patients after this she spent a further two years as a clinical site manager, managing demand and capacity for a busy acute hospital, prior to her present role as lean facilitator at Portsmouth Hospitals Trust.
She says “I began working on the discharge end of the value stream. Prior to this I had no knowledge of lean principles but now I can fully appreciate how lean has provided us not only with a means to uncovering and solving our process problems but has also provided us with the tools to take clinical governance to its maximum potential”
Anne-Marie whilst working on the discharge loop of the value stream, has been working closely with teams from the many internal functions that have a direct influence on discharge as well as all relevant external agencies. As such she has become a very rare source of knowledge with regard to de-mystifying the complexities involved in the discharge process.
Anne-Marie is currently in the process of writing a exciting article on the Discharge Process and it’s effect on Length of Stay. More details of the will be posted shortly.
Dr Paul Buss
Paul is a Consultant Paediatrician and Director for Quality for Aneurin Bevan Local Health Board (formerly Gwent NHS Trust)
Paul has helped review NHS trusts for the Commission for Health Improvement and has also undertaken work for the Healthcare Commission. Paul chaired the All Wales Medicines Strategy Group and has also held the position of Executive Medical Director to a Primary care health board and hence the whole health system. Paul first met Ian and Marc whilst Deputy Director of an acute Trust in Gwent.
Paul says “Pressure on the acute system in unscheduled care (in particular within one of our large local general hospitals and especially in it’s A&E department) became sufficient to explore the possibilities of the application of lean thinking – connecting frontline staff with change to processes based on definition, measurement, analysis, improvement and control. Lean provided the obvious practical solution. I saw that lean, as an active process, had to be done by staff to be understood.
Within weeks I, and my senior colleagues, witnessed (and heard) the effect that lean had on the system, staff morale and efficiency. It was impressive and as an active clinician involved on the management team won me over.
The full potential for lean applications to health systems has, I believe, yet to be fully realised through its application to systemising health care processes - enabling quality to be enhanced with better decision making within clinical pathways and reduce process and clinical variance. During this economic downturn lean offers the NHS much more than traditional approaches. Next stop the health and social care interface”.
Paul Jarvis
Paul is a consultant in Emergency Medicine at Calderdale and Huddersfield NHS Foundation Trust. He is the co-founder of the Emergency Department Quality Improvement Forum within the NHS Trust where he works.
Paul first encountered ‘Lean Thinking’ working in Clinical Decisions Units in Emergency Departments in West Yorkshire. He has built upon this, working alongside Marc Baker and Ian Taylor by implementing the principles contained within ‘Making Hospitals Work’.
Paul is currently leading on a project improving the clinical effectiveness of two Emergency Departments. He has shown how lean methodology can reduce patient journey time in the Emergency Department whilst improving the quality of care that is delivered.
Paul has recently completed a Postgraduate Diploma in Medical Education and hopes to use these skills to raise awareness of Lean methodology and the positive effects it can have on healthcare delivery.
Rhiannon Jones (RN, DipN, PGDip, MSc)
Rhainnon is currently the Assistant Director of Nursing responsible for Quality, Safety & Patient Experience in Aneurin Bevan Health Board, Gwent, South Wales. She has held a range of nursing management and leadership positions spanning acute and community care since 1989, when she first Registered as a Nurse. She has published in professional journals in addition to securing travel scholarships to support international study in Canada (Florence Nightingale Scholarship) and Boston (South Glamorgan Nursing Scholarship).
Rhiannon was first exposed to Lean concepts in 2006 when she first met Marc Baker and Ian Taylor when she was a Chief Nurse for the Royal Gwent Hospital and Manager for Acute Adult Services for South Gwent.
Rhiannon began working closely with Marc and Ian when they were deployed in late 2007 to assist the Emergency Care Directorate Team to achieve compliance with the A&E 4 hour transit time standard. Adopting Lean approaches saw compliance to the standard improve from mid 80’s to full compliance by March 2008.
Reflections on the Lean journey saw Rhiannon invited to the Lean Symposium in Florence (November 2009) to share her experience of introducing Lean in the Accident & Emergency Department.
Rhiannon also collaborated with Ian and Marc to review the role of the Ward Sisters, which saw a pilot study of Supplementary Status for Ward Sisters in Medicine, Royal Gwent Hospital introduced from January 2009. A paper outlining the test is available on the LEA website, for further information.
Peter Lewis
Peter is a vascular surgeon who trained in Wales, the Southwest region and St Mary’s Hospital in London. After a period as a consultant in Torquay, he moved back to South Wales where he holds the position of Divisional Director for Scheduled Services in the Aneurin Bevan Health Board (formerly Gwent NHS Trust).
Peter was introduced to lean methodology by Marc and Ian other members of their based in Caerphilly Miners Hospital and the Royal Gwent Hospital. This collaboration resulted in Peter conducting successful experiments in the vascular outpatient department using lean methodology which resulted in significant reduction in RTT waiting times. Peter’s work is featured in the Elective Chapter in the book ‘Making Hospitals Work’ where the main character David Morton is actually based on Peter.
Peter has recently completed a Masters in Medical Management at Carnegie Mellon University in which lean applications in medicine were taught in a module on health care quality.
See Peter’s presentation at the Lean Healthcare Transformation Summit in 2009.
Dr Khalid Abdulnoor Saifeldeen
Khalid is currently working as a consultant and lead clinician in Emergency Medicine in Hamad General Hospital (HGH) at Hamad Medical Corporation (HMC) in the state of Qatar. HMC is the country’s main health care provider and the largest in the Middle East. The Emergency Department at HGH sees an average of 1500 patient presenting a day. Khalid obtained his primary medical degree from the RCSI, in Dublin. He is a fellow of College of Emergency Medicine (FCEM), UK. Khalid relocated, with his family, to his home country, Qatar in January 2009 and is actively leading major initiatives and service redesign to improve the current state and by developing a world class future state of for emergency care.
It is actually Khalid’s work that is featured in the ED section of chapter four (Developing Countermeasures: Designing the Future State) in the book ‘Making Hospitals Work’
Khalid first met Marc and Ian in late 2007 at the Royal Gwent hospital in South Wales. Khalid joined the emergency department as a consultant to help the Emergency Care Directorate Team achieve compliance with the A&E 4 hour transit time standard. Khalid led the design and implementation of the Gwent Rapid Assessment, Treatment and Streaming (GRATS) of patients presenting to the majors side of the ED (a senior decision maker greeting the patient at the front door). GRTAS did not require additional resources. Working closely with Ian and Marc the compliance to the standard improved from mid 80’s to full compliance by March 2008.
Khalid describes the lean thinking as “a common sense approach” to achieving high quality patient centred healthcare. Khalid again used his approach in leading the design and implementation of the “Perfect Week” trial whilst working as a consultant in Emergency Medicine in Prince Charles hospital, Merthyr Tydfil, Wales where compliance with the transit time was among the worst in Wales. The trail incorporated ED, MAU, bed management (visual hospital board) and discharge lounge. The trial, again, did not require any additional resources. The trial was an immediate success resulting in 100% transit time compliance for the entire week.
More recently, Khalid has (employing lean thinking) designed and implemented a see and treat service for the, up to, 1000 patients a day presenting at the HGH ED with minor injuries and illnesses. The new service proved to be an instant success. It has reduced the patient journey time from an average of five hours to less than one hour and significantly decongested the previously over crowded department.
Khalid’s latest challenge is designing the Senior Led front door Rapid Initial Assessment, Management & Streaming (RIAMS) for the, up to, 500 patients a day presenting at the HGH ED majors department.
How to do it
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