In this slideshow, David Hamer, Professional Lead for Laboratory Medicine, Bolton NHS Foundation Trust and National Clinical Lead for Service Improvement (Blood Sciences) at NHS Improvement (Diagnostics), outlines his approach to improving the efficiency and effectiveness of hospital services, with a focus on Lean methodology. David Hamer presented at How can hospitals do more with less? in October 2012.

1. David Hamer
Professional Lead for Laboratory Medicine
Bolton NHS Foundation Trust
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National Clinical Lead for Blood Sciences
NHS Improvement (Diagnostics)
IMPLEMENTING BEST PRACTICE
FOR EFFICIENCY
© David Hamer 2012. All rights reserved.
LONDON, 17TH OCTOBER 2012

2. © David Hamer 2012. All rights reserved.
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Royal Bolton Hospital

3. Some Recent Bolton Awards
Laboratory
Respiratory Nurse
Medicine Ed Hinchcliffe Bolton NHS FT Dr Ian Dufton Fiona Murphy Specialist Team
HSJ Efficiency Award Service Innovation of 2012 Europe Process Clinical Leader of the Year Nursing Standard’s National Process Excellence
2012 the Year 2012 Excellence Award Winner British Medical Journal 2011 Nurse of the Year 2011 awards 2011
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Noreen Ryan, Lesley Carney
Theatre Team CAMHS Team and Cath Ashworth Outpatients Team District Nurse Team Margaret Meadows
Excellence in ADHD Award Health Service Journal's Health Service Journal's Healthcare Caterer of the Year
Patient Safety Awards 2011 Champion for ADHD 2011
2011 Efficiency Awards 2011 Efficiency Awards 2011 2010
Bolton Stroke
David Fillingham Nicky Ingham Suzanne Lomax Orthopaedic Team BICS Academy
Services
NHS Quality Champion of the Human Resources Director of NHS North West Leadership Social Care Award Regional Diamond Care Award Winners Diamond Care Award Winners
Year 2010 the Year 2010 Academy Award 2010 Finalists 2009 2009 2009
© David Hamer 2012. All rights reserved.
Patient Experience Bolton Improving
Andy Minett
Team Care System
Diamond Care Award Winners National Health and Social Care TrusTECH's North West NHS
2009 Awards 2008 Innovation Awards 2008

4. © David Hamer 2012. All rights reserved.
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American humourist
Evan Esar 1899-1995

5. Bolton NHS Foundation Trust
Integrated Care Organisation since July 2011
General hospital with 750 Acute beds
Community based services delivered at more than 20 sites
Serves the population of Bolton and surrounding catchment (around 350,000)
Employs approximately 6,000 staff
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‘Supercentre’ for maternity and children's services for Greater Manchester
Accident & Emergency attendances around 110,000/year
Circa 1,000,000 patient contacts/year
© David Hamer 2012. All rights reserved.
Turnover £270M

6. Department of Laboratory Medicine
Blood Sciences comprising Clinical Chemistry; Haematology; Blood Transfusion ; Immunology;
Serology; Regional Downs Screening Lab; Specimen Reception & Phlebotomy
Cellular Pathology comprising Histopathology, Cytology and Mortuary Services;
Microbiology comprising Bacteriology, Virology, Mycology and Infection Control.
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Admin & Support Services (Secretarial; Admin; Logistics; Patient facing)
Quality & Service Improvement Team
Combined services employ approximately 170 staff - Biomedical Scientists / Clinical Scientists / Laboratory
© David Hamer 2012. All rights reserved.
Assistants / Medical staff / Nursing staff / Secretarial, clerical & other support
Process approximately 4 million Blood Sciences tests per year

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Laboratory Medicine

8. Challenges to Gtr Manchester
Pathology Services (20:20 vision)
 Need to reduce costs to GPs by 20%
 £600,000 by August 2012 at Bolton
 Need to improve quality by 20%
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© David Hamer 2012. All rights reserved.

9. © David Hamer 2012. All rights reserved.
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Lean Enterprise Academy
Professor Daniel Jones
a good crisis”
“Never waste

10. © David Hamer 2012. All rights reserved.
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Holistic approach
processes
the whole service
It’s about improving the
not just some elements &
efficiency & effectiveness of

11. © David Hamer 2012. All rights reserved.
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Lesley Doherty
Bolton NHS Foundation Trust
Chief Executive
“It’s the way
we do things
around here”

12. Lean basics
Eliminating Focussing on Respecting Our
Waste the Patient Staff
• Capacity  • Value • Enabled
• Quality  • Deliver value • Enhanced roles
• Defects  • Pathways • Innovate 
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• Cost  • Reduce TAT • Ideas 
• Productivity • Improvements 
© David Hamer 2012. All rights reserved.
Provides capacity
Understanding customer
& quality
value drives further
improvement

13. © David Hamer 2012. All rights reserved.
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Objectives

14. The Bolton Approach Lean methodology
Value Stream Mapping
Multidisciplinary Team Customer value
Staff engagement
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Visual management of progress
© David Hamer 2012. All rights reserved.
Governance

15. Number Work Stream Lead Work Stream Name
1 Quality & Improvement Lead Next Level of LEAN
2 HR Business Manager Workforce Planning
3 Clinical Chemistry Manager Sendaways, Value for Money, Repatriation
4 Lab Med Professional Lead Customer Service, Marketing & Advice
Specimen Reception / Phlebotomy
5 Laboratory Medicine in the Value Stream
Manager
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6 Cell & Infection Science Service Manager Transport
7 Haematology Manager Information Technology
8 Transfusion Lead Demand control, Pathways, Order sets
© David Hamer 2012. All rights reserved.
9 Lab Med Clinical Lead New Business, Innovations
Finance, Managed Service Contracts,
10 Management Accountant
Procurement

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Quality / Timeliness / Delivery
BEST CARE FOR BETTER HEALTH

17. Secure high quality GP
services
Initiatives
Support GPs in Triple Aim
Big Bolton Health check
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Provide GP CPD sessions to educate & influence pathways & testing protocols
Provide GP newsletter
Collect GP practice views & analyse using Kano tool
Improved sample collection system/courier service in consultation
© David Hamer 2012. All rights reserved.
with users
Expanded GP domiciliary phlebotomy services

18. Continuously improve Quality
Action Improvement
Number of agreed clinical requesting pathways 78%
Repatriated sample turnaround time 86-90%
Number of sendaways (sent to reference lab) 10% reduction
Needle to Notes for A&E 74%
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U&E 40% reduction
Number of tests in GP test profiles
Bone profile 25% reduction
Increased electronic reporting of tests >95%
Meet or exceed RCPath Blood Sciences TAT KPIs 100%
© David Hamer 2012. All rights reserved.

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Cost / Value for Money
USING RESOURCES RESPONSIBLY

20. Efficiency savings of 20%
Forecast - identified £803K recurrently
£517K posted in Year
• Reprofiling – skill mix / reorganisation
• Procurement – Re-negotiation of contracts (suppliers; referred work;
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Managed Service Contracts)
• Streamlining efficiencies (better stock management; demand control;
removing waste; eliminating defects; repatriation of work)
• Income generation (new business with same resource; new services)
© David Hamer 2012. All rights reserved.

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Productivity
<<< 62% >>>
Last 6 months
Productivity rose by 9.5%

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Morale / Human Dimension
VALUED, RESPECTED & PROUD

23. Improve patient/staff
experience post in Haematology / Transfusion under
Initiative
We have secured Scientist Training
Modernising Scientific Careers
All staff have attended BICS Academy Green training; all senior staff have
attended Bronze; all Lab Managers have attended Silver & some are also now on
Gold.
All senior/supervisory staff have now attended the Engaging Manager programme
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& completed LMSQ
Formed a cross discipline/cross grade Lab Med Team to support 100 voices
(monthly in-patient interviews)
Assigning BMS staff to named wards to support Transfusion safety & education
© David Hamer 2012. All rights reserved.
Job satisfaction and morale have increased, sickness absence continues to run
Willingness to
below the Trust target of 3.75%. Staff feel empowered to deliver the services they
adapt
have developed

24. Innovation in practice
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© David Hamer 2012. All rights reserved.
Unique & Innovative Quality Assurance Scheme provided for high
street point of care testing services throughout the UK.
(GPs, Pharmacies, Health Centres, Supermarkets)

25. Reflections/Insights (Lab Med)
 Went well
 Team approach
 Staff engagement
 The work has improved quality and protected jobs
 Insights
Leadership
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
 Voice of the Customer
 Break out of your silo
 Focus on the Quality
 Daily (continuous) Improvements
© David Hamer 2012. All rights reserved.
 It’s tough

26. Reflections (Trust)
It’s too compelling to ignore:
 It has to be a cultural change
 Board and lean team leading by modelling behaviours
 It has to be values and behaviourally led built on
engagement
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 It requires leaps of faith
 It requires leadership courage
 It saves lives….and money
© David Hamer 2012. All rights reserved.
 Lean is all about people and all about quality

27. Insights (Trust)
Leadership We already
changes have the We don’t
experts really know
80% people what’s
happening
20% method Narrow and out there
Deep v. Other
Broad and people have
Get good been down It’s not a
Shallow – project
advice; the the path
build balancing before us
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knowledge act
and skill
It feels Patients
Leadership good (even know what
Sustainment from the though it’s value is
is hard top is tough)
essential
© David Hamer 2012. All rights reserved.

28. © David Hamer 2012. All rights reserved.
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do things
around here”
“It’s the way we

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Questions