PowerPoint Presentation Template Blue

1
The Christie is Europes largest single-site
cancer centre
Registering 12,500 new patients and seeing over
40,000 patients every year
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We deliver 50,000 chemotherapy treatments a year
in six different locations on our site
3
The Lean project for chemotherapy provision at
the Christie, is fundamentally changing the way
that chemotherapy is delivered
4
We have an ambitious, whole system programme
which is producing a new improved patient pathway
5
and a significantly improved patient experience
6
This pathway eliminates 1.2 million of waste
from service provision
This pathway eliminates 1.2 million of waste
from service provision
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It has also given a process base to plan a new
35 million chemotherapy centre
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So, how did the Lean project come about at the
Christie?
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Jim Martin Chairman
Dr Juan Valle Consultant, Medical Oncology
Vicki Wren Patient
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Initial Problems
Inefficient use of resources inadequate
systems

• Patient waiting times at all stages within the
  patient pathway (Christie time)

Disparate ward and support services logistics
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I felt nervous enough coming to hospital
but waiting all that time,
just made me really worried and anxious
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and then waiting again, this time for 45 minutes
in pharmacy was too much. I just wanted to go
home
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Judi Tapp Early Clinical Trials Unit Manager
Karen Palmer Research Nurse
Dr Ron Stout Medical Director/ Consultant
Clinical Oncologist
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Example of part of the chemotherapy process
Patient goes home
W4
E
Patient given pager (if wait is long)
Treatment comes off hold
W11
2a
Yes
Yes
Nurse organises transport
Is treatment on hold?
Treatment arrives. Coordinator records time
Does patient have transport
No
Patient admitted to CS for treatment
No
W5
W3
Patient paged (if not present)
W10
Coordinator chases up to get completed
Scheduler records details
Yes
Patient goes to pick up TTOS
Yes
Does patient have TTOS?
Has been go-ahead signed?
Does patient return?
No
No
W6
No
Scheduler passes on notes to coordinator
Patient appointment re-scheduled
Treatment finishes
Yes

• Arrival time on CS
• Nature of treatment
• Arranges next appt and gives to patient

Yes
Is there time for patient to be treated?

• Arrival time on CS
• Nature of treatment
• Arranges next appt and gives to patient

W2
Is script correct?
Treatment starts
Coord. contacts Day Services / Pharmacy to locate
script
No
No
Nurse gives new patient talk
Yes
Is patient new?
Nurse checks script and batch number
W1
Patient waits whilst bloods / treatment is
checked by coordinator
W7
Yes
Patient sent home and asked to return next day
Patient taken to treatment area
Yes
Is patient well enough for treatment?
W8
W9
Coordinator briefs patient on process and timings
Coordinator answer queries and contact relevant
staff
Nurse carries out checks
No
No
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W4
All of these boxes were areas of waste
Patient given pager (if wait is long)
W11
Nurse organises transport
W5
W3
Patient paged (if not present)
W10
Coordinator chases up to get completed
Patient goes to pick up TTOS
W6
Patient appointment re-scheduled
W2
Coord. contacts Day Services / Pharmacy to locate
script
W1
Patient waits whilst bloods / treatment is
checked by coordinator
W7
Patient sent home and asked to return next day
W8
W9
Coordinator answer queries and contact relevant
staff
Nurse carries out checks
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Processes made Lean
Patient goes home
E
Patient provided with transport
2a
Treatment arrives. Coordinator records time
Yes
Does patient have transport
Patient admitted to ward for treatment
No
Nurse checks script and batch number
Scheduler swipes bar code and schedules next
appointment
Treatment comes off hold
Patient picks up TTO on ward
Patient taken to treatment area
Yes
Is treatment on hold?
Treatment finishes and patient handed blood form
for next visit
No
Coordinator briefs patient on process and timings
Treatment starts
Asst Practitioner carries out checks
Yes
Are patients on protocol?
No
Co-ordinator checks bloods
Nurse gives new patient talk
No
Is patient well enough for treatment?
Is patient new?
Yes
Yes

• Arrival time on CS
• Nature of treatment
• Arranges next appt and gives to patient

Patient sent home and Deferred
No

• HCA contacts Chemo department
• new treatment prescribed
• HCA checks script for next appointment

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Qualification and quantification of waste

• Total waste identified 1.2 million

Waiting (124,964)
Motion/Transportation (186,125)
Over-production (888,911)
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Dr Juan Valle Consultant, Medical Oncology
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Methodology
Stage 1 Map as is processes Challenge waste and
current working practices Staff interviews
Stage 2 Identify new processes
Quantify current savings Rapid
Improvement Events

• Stage 3
• Map new value streams
• Quantify future savings
• Development implementation of process register

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Caroline Shaw Chief Executive
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Through focusing on the patient and ensuring
comprehensive clinical engagement, we have
dramatically streamlined the patient pathway
And the unique element is that this Lean project
has led the design of our new 35 million
chemotherapy centre which will open in 2010
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