Performance Improvement Lessons on Lean Internationally

1
Performance Improvement Lessons on Lean
Internationally
ACHSE National Congress 2008

• Kate Silvester BSc MBA FRCOphth
• NHS Heart of England Foundation Trust, England
• (via video conference)

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The Issue for UK National Health Service

• Waiting lists and waiting times
• UK Government targets
• lt 4 hrs in Accident and Emergency
• lt 18/52 from GP referral to 1st definitive
  treatment
• lt 62 days for suspected cancers

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How does this fit with Lean?

• Waiting lists are inventory
• Inventory is a cardinal sign of waste
• MUDA
• Overburden of people or machines
• MURI
• Un-evenness of work
• MURA

4
Agenda

• The clinical process
• Why do we have waiting lists?
• The problem
• What we need to do instead

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The elective process
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What is the performance ?
Days from Addition to Waiting List to Operation
primary hip replacement
Special Cause Flag
700
600
500
400
Individual Value
300
200
100
0
1
6
11
16
21
26
31
36
41
46
51
56
61
66
71
76
81
86
91
Upper process limit for IP wait needs to be here!
Consecutive patients from 01/04/06 to 31/07/06
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What is the Waiting list for operations?
8
What are the charts telling us?

• Process time is not going up
• Backlog is not going up
• (hidden waiters?)
• (patients diverted elsewhere?)
• So why have we got a waiting list ?

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Demand and capacity definitions
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Demand Capacity no variation
Demand 10
No queue, No empty slots
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Average demand gt average capacity
Waiting list grows by 1 patients each week
Demand 11 Capacity 10
Ever increasing queue
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Average demand average capacityBut variation
Demand varies 5 to 15 Average 10
Persistent queue beyond any target
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Capacity varies too
Persistent queue more unstable
14
If av. Demand av. Capacity, variation mismatch
queue
Cant pass unused capacity forward to next week
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Summary the problem

• Plans based on averages guarantee queues and
  waiting lists beyond any target

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Demand capacity for breast clinic
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Planning capacity to prevent the queue
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Erlangs Rule
Rule of Thumb In the presence of a varying
demand, it is impossible to run a fixed capacity
beyond 85 utilisation (occupancy) without a
queue.
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What we need to do

• Understand demand
• Plan capacity to meet demand
• No waiting
• Deal with backlog
• Temporary short term increase in capacity
• Reduce variation in capacity
• 5. Reduce variation in demand

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More information

• www.steyn.org.uk