Lord Darzi's report calling for a 'world class NHS that is fair, personal, effective and safe' will come as a welcome relief to most in the NHS, as the patient becomes the central factor in decision making once more. Patient care and patient safety are of paramount importance as they journey through the NHS. In a difficult environment, with parties split over the effectiveness of targets in the NHS to drive productivity, cleanliness and time to care, there is an ever greater need for Lean to support staff in treating patients according to Lord Darzi's vision and achieving significant targets along the way.

Case Study 1
NHS Pathology Lab Layout

A pathology lab, recognising their need to improve efficiency turned to the Lean approach to build stability in current operations. LMR was requested to review current automation proposals which would significantly change the layout and potential throughput. LMR, using a Value Stream Map, was able to propose the necessary changes with qualified improvements. The scope of the work was to cover both urgent and non-urgent blood samples from 2 locations within the Hospital. These were to include Accident and Emergency and one Ward.

LMR’s approach was to create a cross functional team including Lab staff, a Ward Sister, an A&E Sister, Phlebotomists and Trust Porters to understand their problems, their role in the operation and the restrictions placed upon them by other departments and systems. LMR, having gained an insight into operations decided the best approach to address the client’s current position would be to make a high level Value Stream Map, a detailed level process flow diagram and at the same time analyse the concerns through a concern resolution process.

Visual Workplace ( Information Centre)
The client was also able to identify/quantify a mismatch in the profile of samples received by time and current working hours. This is now being used by the client to investigate manually controlling that profile to fall in line with working hours.

Problem Resolution
A3 sheets designed to capture problems, allocate responsibility and effectively drive countermeasures were introduced into each department of the Lab. Clarity of roles in problem solving has led to better teamwork among the staff and a clearance of recurring problems affecting flow.

Process layout and Flow
A new layout was designed and proposed to improve the flow of the samples and create standardised processes.

The introduction of a new labelling process reduced the inconsistency in the blood sampling process with a reduction in the number of re-sampling required of patients.

Process layout and flow changes would reduce the total throughput time for samples from an average of 69 minutes to 32 minutes. £1m cost avoidance in capital expenditure. TPM and Quality would contribute to a reduction of handwritten forms by 75%. This would be supported by an introduction of standardised work and systematic training throughout the hospital. ROI on LMR resource 100:1.


Case Study 2 – Pharmaceutical

Our client is a major healthcare company with over 26,000 employees and is a world leader in the development of insulin to combat diabetes.

A recent innovative insulin product had been approved for market and was experiencing steep increases in volume sales. LMR was asked to diagnose methods in which the production line could be enhanced to meet the increased demand.

LMR began the project with a rigorous analysis of the whole value chain using a Value Stream Map. A further analysis of the capacity of each automated station led to the application of OEE (Overall Equipment Effectiveness) on the bottleneck process.

Initial data collection demonstrated that the bottleneck could shift between three automated stations on the production line depending on the variants.

In order to protect the customer at all costs – defects in the field of healthcare can have repercussions beyond those in other industries – LMR built a customised deployment of Lean which prioritised the principles of Jidoka (no defects forward).

Building on the foundational work of OEE and TPM (Total Productive Maintenance) to drive capacity and stabilise production volume, LMR embarked on the application of error proofing, escalation processes and Information Centres to capture problems and investigate the root cause.

After 20 weeks the project was deemed by the customer to have been a success with all KPIs having been met in accordance with the initial scoping of the project.

Capacity improvement of 42% on the overall production line.

ROI on LMR resource 18:1.