Earlier Diagnosis of Cancer Dean Harmse Carole Stoddard Madeleine Stephens

The Innovation  Based on Lean Principles  Green Stream, Yellow Stream, Red Stream  Established flow, reduced carve out and moved towards FIFO  Scheduling of tasks throughout the process  Collection of meaningful data and presentation of data in a useful format.

The Context of the Challenge  Backlog of > 500 unreported cases in the laboratory  Turnaround Times of more than 10 weeks  Delays in diagnosis of Cancer  Critical Incidents due to delayed cancer diagnosis

Patient M.E. -Male 64 yrs  Lesion on finger removed 12 Jan. 06  Reported 14 Mar. 06  Dx: MALIGNANT MELANOMA with infiltration of bone  9 WEEK DELAY IN DIAGNOSIS OF POTENTIALLY FATAL NEOPLASIA

Previous Strategies  Internal Reviews (including my own)  External Reviews  Focused on demand & capacity  Need for more staff  Never explored change in working practice.  Need to do More with Less

National Base Lines  RCPath. Key Performance Indicators % of cases reported within 7 days and 10 days  NHS Improvement % of cases reported in 3 days, 7 days and 10 days

Comparison to Standards TATNational Standard Local Baseline 3 Day50%15% 7 Day80% (biopsies) 38% 10 Day80% (all cases) 48%

The Change ‘The Hard Side’ - What we did - Maddie ‘The Soft Side’ – Team Engagement - Carole

The Hard Side The way things were……..  Historic prioritisation of consultant cut up in the laboratory (carve out)  Inefficient work output  ↑ Laboratory staff time spent on ↓ numbers of cases  Delay of many diagnostic biopsies and the aim of the Innovation

The Hard Side What we did………. Red Stream Very complex biopsies and large resections requiring a vast amount of technical work  Large numbers of blocks  Range of complex staining techniques

The Hard Side What we did………. Yellow Stream Small biopsies and excision specimens requiring a moderate amount of technical work  More than one block and/or levels

The Hard Side What we did………. Green Stream Small biopsies and excision specimens requiring little technical work  One block  One H&E slide This includes Basal Cell Carcinomas & Squamous Cell Carcinomas

The Hard Side What we did…… Cut up Green Streams highlighted and segregated Design of in-house digital template system to facilitate voice recognition reporting

The Hard Side What we did……….. Main Laboratory Green stream cases scheduled with designated members of laboratory and consultant staff nominated to deal with them  Technical target 9.15  Consultant target 12.00

The Hard Side Control Systems…… Visual control system for target day of reporting to achieve 7 day turnaround time First In First Out New Quality Control Procedure

Change Leaders taking the ‘soft’ side Working together to overcome the perception that it was counterintuitive to change what we had done for the last years

Change Leaders taking the ‘soft’ side Out performed to show that the target was achievable Whole Departmental Team participation in the change was instrumental in making the difference Maintained Open communication for feedback and fine tuning Encouraged Ownership rather than just Buy In

Communicating the Change

Communicating the Innovation

Change Leaders monitoring the change Technical Dashboards Set time targets Traffic light colour scheme Good for positive sense of achievement and increased work satisfaction

Change Leaders monitoring the change Weekly publishing of TATs to all staff & posted on Departmental Notice Board Good for morale and ownership of the effort

6 months on

The Results

Influence on 18 Week Wait Suspected Cancer Diagnosis

18 Week Cancer Breaches

Basal Cell Carcinoma

Delayed Diagnosis and Treatment

Improved BCC Reporting

Impact on Cost  Changes were cost neutral Human Resource : No additional staff employed Consumables : No additional use of consumables  The change was achieved despite: Cost saving measures in Trust (£1.54 M saving target for directorate) Loss of Staff: 1 x WTE Consultant Pathologist 2 x Biomedical Scientists 2 x Assistant Technical Officers 23% overall reduction in staffing level in terms of posts filled  We are doing More with Less

Potential for Spread  Moderately easy  Identification of work streams  Scheduling of work  Collection of meaningful data  Convincing people that the ‘traditional way’ of working is not always the best

Summary  Established flow through the laboratory by using Lean principles  Resulted in overall improvement of TAT  Dramatic improvement of TAT for patients on the 18WW Cancer pathway  The key to success was involvement of the whole departmental team at every level

The Team That Made It Happen!