1. Process Improvement across an NHS Acute Care Trust Simon Dodds Consultant Surgeon Clinical Director for Outpatients Clinical Lead for the Lean Academy simon.dodds@heartofengland.nhs.uk Applying Lean in Healthcare An Irish & International Perspective Thursday June 2nd 2011

2. Personal Journey 2000Started improving my outpatient clinic 2004NHS Service Improvement Award 2005Wrote the story... 2006Heard about "Lean Thinking" 2007Lean Academy born at HEFT

3. Does Lean Deliver? 1. Safety and Quality 2. On Time Delivery 3. Financial Viability

4. #Neck of Femur

6. Waiting Time for Operation

7. Outpatient Clinic - before

8. Outpatient Clinic - after

9. Mr H: Youve performed a miracle. With this number of patients wed normally be seeing patients until 2pm Ms S: Today has been so much more bearable, Ive had time dictate letters and do the admin work which I would normally have to do after clinic. Registrar: Ive actually enjoyed clinic today. I havent felt as if I need to rush What the Docs said...

10. What Finance asked... Have you saved more than you have cost us?

11. A&E Performance

12. A&E Arrivals

13. Emergency Admissions

14. What are the traps? Biting off too much. Transformation teams. Do once then roll out. Under estimate the learning time.

15. What are the traps? Discounting the relationship stuff. Assume the cash will just follow. Impatience. Operations Management blindness.

16. What are the gaps? Tools for Finance. Tools to predict the QTC benefits. Blue Sky goals are Aspirations. Management of Variation.

17. What are the gaps? "Catch-22" effect. Limited strategic capability. Peer reviewed publications. Operations Management blindness.

18. partly

19. and next time I would also... Adopt a more Systemic approach. Actively develop Trust Relationships. Get Operations Management skills. Use all of Improvement Science.