Cpc lean at the christie

Introducing Lean to improve Service Delivery and Patient Experience at the Christie Mike Hughes

The Christie is Europe’s largest single-site cancer centre Registering 12,500 new patients and seeing over 40,000 patients every year

We deliver 50,000 chemotherapy treatments a year in six different locations on our site

The Lean project for chemotherapy provision at the Christie is fundamentally changing the way that chemotherapy is delivered

We have an ambitious, whole system programme which is producing a new improved patient pathway

and a significantly improved patient experience

This pathway eliminates £1.2 million of waste from service provision This pathway eliminates £1.2 million of waste from service provision

It has also given a process base to plan a new £35 million chemotherapy centre

So, how did the Lean project come about at the Christie?

Initial Problems ,[object Object],Disparate ward and support services logistics ,[object Object]

“ I felt nervous enough coming to hospital but waiting all that time, just made me really worried and anxious”

“ and then waiting again, this time for 45 minutes in pharmacy was too much. I just wanted to go home”

Patient admitted to CS for treatment Scheduler records details Scheduler passes on notes to coordinator Has been ‘ go-ahead’ signed? Patient goes home W1 W2 2a No E Coordinator briefs patient on process and timings Yes Is script correct? No Is treatment on hold? Yes No Yes No Treatment arrives. Coordinator records time Does patient return? Is there time for patient to be treated? Nurse checks script and batch number Patient taken to treatment area Is patient new? Yes No Yes Treatment starts Treatment finishes Does patient have TTO’S? Nurse gives ‘new patient’ talk No No Yes Yes No W3 W4 W7 W8 W10 W5 ,[object Object],[object Object],[object Object],W6 ,[object Object],[object Object],[object Object],Does patient have transport No Yes W11 Yes Is patient well enough for treatment? W9 Example of part of the chemotherapy process Patient waits whilst bloods / treatment is checked by coordinator Coord. contacts Day Services / Pharmacy to locate script Coordinator chases up to get completed Patient given pager (if wait is long) Patient paged (if not present) Patient sent home and asked to return next day Coordinator answer queries and contact relevant staff Patient appointment re-scheduled Nurse organises transport Nurse carries out checks Patient goes to pick up TTO’S Treatment comes off hold

W1 W2 Patient waits whilst bloods / treatment is checked by coordinator Coord. contacts Day Services / Pharmacy to locate script Coordinator chases up to get completed Patient given pager (if wait is long) Patient paged (if not present) Patient sent home and asked to return next day Coordinator answer queries and contact relevant staff Patient appointment re-scheduled W3 W4 W7 W8 W10 W5 W6 Nurse organises transport W11 Nurse carries out checks Patient goes to pick up TTO’S W9 All of these boxes were areas of waste

Patient admitted to ward for treatment Scheduler swipes bar code and schedules next appointment Patient goes home 2a E Coordinator briefs patient on process and timings Is treatment on hold? Treatment comes off hold Yes Treatment arrives. Coordinator records time Nurse checks script and batch number Patient taken to treatment area Is patient new? Yes Treatment starts Treatment finishes and patient handed blood form for next visit Nurse gives ‘new patient’ talk No Yes ,[object Object],[object Object],[object Object],Does patient have transport No Yes Is patient well enough for treatment? Co-ordinator checks bloods Are patients on protocol? No Yes Asst Practitioner carries out checks ,[object Object],[object Object],[object Object],Patient sent home and Deferred Patient picks up TTO on ward Patient provided with transport No No Processes made Lean

Qualification and quantification of waste Total waste identified = £1.2 million ,[object Object],[object Object],[object Object]

Methodology ,[object Object],[object Object],[object Object],[object Object], Stage 2 Identify new processes Quantify current savings Rapid Improvement Events ,[object Object],[object Object],[object Object],[object Object]

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

Cpc lean at the christie

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