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January 2010

Pathology
Improvement

NHS
NHS Improvement

case study

www.improvement.nhs.uk/diagnostics

University Hospital of North Staffordshire NHS Trust

Re-designing specimen transport to smooth


workflow and improve productivity
The University Hospital of North
Staffordshire NHS Trust has 1200
beds and provides a wide range of
services to a population of more
than 700,000 people across North
Staffordshire.
The Pathology Directorate, in
collaboration with the National
Pathology Service Improvement
Team, started its Lean journey with
a Rapid Improvement Event in
Microbiology, which resulted in a
90% reduction in turnaround times
for MRSA samples. This initial
project identified a number of
issues, including specimen transport
and the impact of delivering large
numbers of samples to the lab at
the end of the day leading to
increased pressure on staff resources
and a reduction in efficiency and
productivity.
Having realised the significant
benefits of Lean methodology, the
Pathology Directorate decided to
transfer their learning and apply
these principles to redesign their
transport service.
Understanding the user
A short questionnaire was sent to
the users (GPs, community hospitals
and clinics) to:
gain their views of the current
service
identify their future requirements
establish data about demand
confirm opening times and
preferred collect times
identify users no longer requiring
printed paper copies.

Ordinance map of drivers routes

Users who did not respond were


called directly. The 100% response
rate immediately highlighted
users wanted the service to change.

the pathway was crucial to


understanding the real process.

Visual Management to
understand the Current State
An ordinance map was used to
demonstrate:

the reality of the drivers daily


experience
items taken out and collected
from the users
the numerous other jobs
performed e.g.
collecting mail and other items
from one practice to another
delivering and collecting
surgical kits
the occasional pharmacy run.

user location and percentage of


samples generated
the drivers routes
district nurse drop off points and
phlebotomy clinics.
This immediately highlighted:
inefficient routes
the location of large clusters of
users
high and small volume users.
Go and see for yourself
As with all Lean methodology the
importance of walking (or driving)

Accompanying the drivers on their


journey highlighted:

Drivers time was wasted having to:


wait in the patient queue
wait for security guard to open
doors
wait for staff to find keys to
unlock a fridge.

Pathology
Improvement

NHS

case study

Once identified some of these


practices were changed immediately
through good communication with
practice staff and drivers.
By accompanying the drivers it was
clear that:
routes had evolved over time
new GPs surgeries and clinics had
opened
others had moved into new
buildings
the driver with the lowest
workload took extra collections
the whole process was extremely
inefficient.
Workload levelling
To keep a flow of work through the
laboratory the following
adjustments were required:
small batches of samples from
specimen reception
vans passing close to the lab
needed to drop off what ever they
had.
Implementing these changes has
delivered:
500 samples 1hr hour earlier
200 samples 1hr 30mins earlier
Smoothing the workload for lab
staff and reducing turnaround times
for patients.
New ways of working
Drivers typically started work at 9am
but did not begin the specimen
collection run until 9.30 -10.00am.
Following negotiations with the
drivers, key changes could be
implemented including:
re-organising routes
reducing unnecessary activities
clusters of surgeries received 2-3
pick-ups per day
to eliminate large batches
impacting the laboratory flow
to reduce volume of samples at
the end of the day
establishing an early morning
sweep for users taking early
morning samples.

NHS Improvement

This enabled a more efficient, logical


and timely service which has
improved driver morale.
Respect for people
After initial apprehension, the drivers
were receptive and generally happy
to support the changes to their
routes. Effective communication
was key to ensure:

Benefits of Visual Management


Implementing a visual management
system in the form of a kanban card
placed in the window of a low user
practice prevented the need for the
driver to stop when there were no
samples for collection.
A pager service may be used for low
use rural surgeries.
A visual management system has also
been implemented in specimen
reception to indicate the status of the
delivery rounds.

the drivers knew the changes


were not personal
the redesign of routes provided
greater efficient for lab staff
the patient was at the heart of
the redesign.
Eliminating the minor problems the
drivers had with GP surgeries helped
them become committed to the
changes.

QUOTES

The samples are now delivered more regularly meaning


we do not have staff waiting for work. Before we could
have staff waiting for work for 20 mins and then all five
vans would arrive together meaning we had in excess of
1,000 samples to process.

Antony Durose - Central Reception Supervisor

There are smaller deliveries now meaning we can


complete one batch before another is delivered which
has reduced the pressure on the staff.
Sue Pierpoint - MLA

I wouldn't want to return to the old system as there


is usually much less work left for the night staff to
process.
Chris Williams - MLA

Contact details
Antony Durose
Central Reception Supervisor
Email: antony.durose@uhns.nhs.uk

David Frodsham
Acting Laboratory Manager
Email: david.frodsham@uhns.nhs.uk