1. Karen McCleod, Sandwell and West Birmingham Hospitals NHS Trust Richard Johnson, Pan Birmingham Cancer Network

2. Cervical Screening Background ‘The cervical screening programme will ensure that all women receive the results of their screening tests within two weeks by 2010’ Cancer Reform Strategy, DH, Dec2007 ‘Seize (or create) a crisis to motivate action across your firm’ Womack & Jones. (2003) ‘Lean Thinking’

3. Baseline Up to 7 week turnaround time (approx) Delays throughout the process 5 days to send the letter ? Days to receive the sample in Lab

4. How Value stream mapping Helps you to see the flow Highlights ‘waste’ Forms basis of an implementation plan Data – highlights where issues are!

5. 14 day turnaround

6. Taking of sample (Primary Care) Taking of sample (Primary Care) Screening (Lab) Screening (Lab) Send results (Call & Recall) Send results (Call & Recall)

7. ‘value add’ - <4 hours

8. Meetings held at the Cancer Network (Neutral ground) Doodle.com Practicalities

9. Karen McCleod, Sandwell and West Birmingham Hospitals NHS Trust

10. Communication With PCT’s With other labs With primary care/smear takers With Pan B’ham Cancer Network Service Improvement Team

11. Hub and Spoke Cytology labs converted to Liquid Based Cytology following NICE evaluation Processing machine - large volume Hospitals grouped together in ‘Hub’ and ‘Spoke’ arrangement

12. Improvements in Lab Sending samples to ‘Hub’ every day instead of every other day Changing workflow in lab – batch sizes Involving different groups within the Lab Non acceptance policy – working with PCT’s/ QA Reference Centre Discarding of out of scope samples – working with PCT’s/ QA Reference Centre Smear taker PIN’s - working with PCT’s/ QA Reference Centre

13. Improvements in Lab Sending results via electronic link to Shared Services and PCT – changed time FHSA sender codes – some belonged to GP’s no longer practicing Came up as Test after sender ended at PCT – causes delays Changed these codes on laboratory system – saw improvement straight away

14. Primary Care Electronic HMR101 request form Involved in training sessions organised by PCT’s Input from Pan B’ham Cancer Network Service Improvement team From Shared Services/PCT From Laboratory

15. Primary Care Give deadlines for starting to use electronic forms BUT – even with deadlines some people still don’t use them One to one sessions – even this doesn’t work with some practices

16. Technology Pre-printed HMR101 form –takes all the patient demographics form the National Exeter system Staff in the lab don’t have to rely on reading handwriting! Worked with other labs and the QA centre to get the District of Residence onto the HMR101 forms Means the result can go directly to the correct PCT

19. Future? Set up electronic links with other PCT’s for few out of area results Get all smear takers to use pre-populated HMR101 forms Continue to work closely with PCT’s and other labs