Lean Enterprise Academy > Healthcare > Questions and Answers
Typically over 85% of Medical Patient’s LoS consists of Waiting Time. Time spent waiting for diagnostics, treatment and therapies etc. It is during these waiting times where it both becomes un-safe for the patient and the money is pouring out of the system. Mapping the Patient’s Journey in your hospital (end to end from the patients perspective) will enable you, for the first time, to see where these waits reside, enabling you to get to the root causes of these waits thereby enabling their systematic elimination.
In today’s economic environment there is now, more than ever, pressure to reduce costs through ward closures. However it is both un-safe for the patient & stressful for your staff, to consider closing wards until you have significantly reduced the average medical LoS. Once you have achieved a reduction in LoS by more than half you can then make safe & informed decisions about ward closures.
A combination of the current ‘Off Duty’ practices and lack of forward planning results in un-balanced working patterns which in turn results in excessive, last minute, Bank and Agency usage. Employing simple, visual, planning processes will enable you to all but eliminate this expensive practice.
It is a common practice for organisations to seek to discharge patients earlier in the day to create empty beds for incoming demand. However, how often does this happen in reality. There is usually a large surge in discharges, later in the day that puts the entire system (and staff) under immense pressure. Most organisations know the demand for patients trying to get in to their hospital, but how many actually know their patient demand to get out. By adopting sound, visual, operational management, you will be able to both see patient demand to get out of your hospital and to actually schedule discharges throughout the day.
When the pressure is on to admit medical patients, often the only available option is to either place them in the wrong medical specialty beds (off template) or worst still outlie them onto Surgical wards. This practice is know to extend LoS, it dismays Clinician who then have to perform ‘safari ward rounds’ and causes cancellations of elective procedures. By adopting sound, visual, operational management processes to both reduce LoS and effect safe timely discharges/transfers the number of outliers, present at any given time, can be reduced to zero.
There are normally two major causes for patients breaching the 4 hour target. One being the fact that there are no spaces available further down stream for a patient requiring admission. This can be remedied by LoS reduction and scheduling of safe discharge/transfer of Medically Fit patients. Even doing this however does not guarantee that patients will not breach, due to the other major cause namely the A&E process itself. Through a combination of re-designing working practices and sound, visual, operational management this major cause can also be eliminated.
Organisations are struggling to meet the national 18 week target. The causes for this are many but mainly include multiple handoffs (and journeys to and from the hospital) exacerbated by elective scheduling processes (distorting natural demand beyond recognition). By eliminating, combining and simplifying process steps in the right sequence it is possible to reduce the RTT time to a point where it is limited only by patient choice.
Clinicians use scientific, evidence based approaches when diagnosing and treating patients. They frequently (and often quite rightly) are both bemused and dismayed by management approaches and decisions. However once you can demonstrate to clinicians that you too, are adopting a scientific approach, employing evidence based management to diagnose and treat broken processes then any perceived hostility or lack of co-operation from clinicians is normally transformed into mutual trust and respect.
It is common for a patients LoS to be extended due to the delivery performance of support services – Pathology, Radiology etc. It is quite normal, for example, for the Turnaround Time for an inpatients TTOs (from writing a Scrip to delivery to the ward) to take many hours. By truly understanding demand for TTOs and re-designing the working practices in the Lab it is possible to reduce this time to less than 30 minutes. The same approach can be adopted for all support services.
The cost of Clinical Consumable Goods on a ward can be hugely excessive – too much stock. Sometimes passing it’s expiry date on the shelf without ever being used. Worst still you can go from ‘feast to famine’ whereby wards run out of vital goods – compromising patient safety and leading to the practice of borrowing from other wards, that will in turn run out prematurely. Through visual stock control on the ward, combined with regular, appropriate, delivery frequencies to the wards, savings in the region of £1,000 per ward per month are easily achievable without ever compromising patient safety.
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