Workforce Implications of LEAN Principles in action: Front End Laboratory Re-Design Christine Morrell Dr Wynne Williams AberTawe BroMorgannwg University NHS Trust

Improvement Project  Six Sigma Uses statistical tools to uncover root causes and reduce variation  LEAN Seeks to improve flow and eliminate waste

Speculation  “There is a lot of speculation and I guess there is going to continue to be a lot of speculation until the speculation ends” George W. Bush

Eliminate Waste- SWIMTOOT  Scrap (It just doesn’t meet expectations)  Waiting (Things just don’t happen when they should)  Inventory (Keeping stuff on-hand when it isn’t required)  Motion (Excess movement -person/material -within a process)  Transport (Shipping stuff to different locations)  Over Production (Doing more than you need to -output of a process)  Over Processing (Doing more than you need to -within a process)  Talent (Using skilled people to do unskilled jobs)

Sample Reception - Lab Redesign Phase 1

Consultation Process  Independently staffed and managed  At Front of House

Design a laboratory

Ideas  “ We have nothing against ideas. We’re against people spreading them.” Augusto Pinochet. (former military leader of Chile, accused of fraud and human right abuses)

Pathology Support Worker

Options  Phlebotomist  Pathology Support Worker  Pathology Support Worker excluding Phlebotomy

Multifunctional Workers  Must be well trained  Insulation against absenteeism and vacations  Creating a Continuous Improvement Mindset

Band 3 & 4 staff  Band 3 Phlebotomy Training/MLA Senior Phlebotomist/MLA  Band 4 Office Manager

Specimen Reception Manager  Key Competences H.R. Management Training Quality

Skills Analysis

Training and Competences  Training Logs  Competence Assessments  Evidence of Continuous development e.g. Attendance at CPD sessions Lean Team Presentation Involvement in preparation of Laboratory Instructions

The Lean Workforce  Flexible  Motivated  Aligned to Demand  Appropriate Competences

Access to Appropriate Training

Putting People First Improve employee morale through  Using Lean to solve “every day”problems  Improved lab performance and patient care  Staff empowerment via Lean methods

Flexible working - A4C (37.5h)  Introduction of Flexible working Early starts and finishes Shortened Lunch Breaks Late starts and finishes

Visual Clues: Staffing Levels

Work Force Implications  Managing Expectations  Structure on to which hang Competences  Appropriate Extended Roles

Healthcare Scientist Career Framework  “To those of you who have received honours, awards and distinctions, I say well done. And to the ‘C’ students, I say, you too can be President of the United States George W. Bush (US President)

Challenges  Pathology: towards a competence based workforce  A report of the Pathology Profiling Project. May 2008

Improvement in TAT

TAT: “U&Es - Cold 2005/ / / /092.1

Troponin T

Thankless Tasks  “It’s not so much a thankless task. It’s more a job with no thanks.” Colin Baker. Dr Who.

The Lean Workplace Delivery of a Quality Service in the most cost effective manner