ws chaired by james p womack - lei – glhs – 25.06.07shown at the 1st Global Healthcare Summit on 25th June 2007

1. First Global Lean Healthcare Summit 25-26 June 2007
Managing a Lean Hospital: Only a
part of the Patient Journey!!!
Martin Turner, Chief Executive,
Gwent Healthcare NHS Trust

2. First Global Lean Healthcare Summit 25-26 June 2007
Our Customers: 600,000 Resident Population
Caerphilly 177,000 29.5%
Blaenau Gwent 76,400 12.7%
Torfaen 93,600 15.6%
Newport 140,400 23.4%
Monmouthshire 89,200 14.9%
Others 23,400 3.9%

3. First Global Lean Healthcare Summit 25-26 June 2007
We are a Large Healthcare Provider
• 3 hospitals providing
acute services
• comprehensive mental
health services
• 15 other hospitals
41 health centres and
clinics
Over 13,000 staff
6,000 nurses
1750 allied health workers
Over 1000 doctors
Including 260 Consultants

4. First Global Lean Healthcare Summit 25-26 June 2007
Emergency admissions
Non-emergency admissions
Day cases
New outpatients
Follow-up outpatients
Obstetric admissions
Accident & Emergency
68,300
15,017
49,350
115,000
277,113
9,200
158,670
692,650
187
41
134
316
759
25
434
1,896
Average
weekday
Demand for Services

5. First Global Lean Healthcare Summit 25-26 June 2007
Our Challenges
• Service provision model unsustainable
– Unsafe (21st Century)
– 75% of our estate is > 60 years old
– Not EWTD compliant
– In the wrong place
• We believed we were inefficient
• Senior Doctors did not.
• Not enough money (£35MM revenue)
• Government Targets
– Waiting Lists
– efficiency

6. First Global Lean Healthcare Summit 25-26 June 2007
So What?
• Clinical Futures Program
• Efficiency Plan (£35- 50MM revenue)
• Organisational Development
– Lean
– Clinical Leadership

7. First Global Lean Healthcare Summit 25-26 June 2007
Our Lean Journey
• Started 2003
– Used an Event approach (86)
• Executive Review of Progress 2005
– Why is performance what it is?
• Deep Cause Analysis
– Mental models of staff : Why we do things this way….
• Blind spot to standardisation
• Informal approaches
• Part time resources
• Changes in Priority
• Lack of Operational management
• New/Current Approach
– Select an Exemplar
– Strategic/Process/Operational focus

8. First Global Lean Healthcare Summit 25-26 June 2007
What is an Exemplar
– By exemplar we mean a Future state where best
practise experiments are conducted and standardised
without the influences of the Deep causes of the
current organisational approaches.
– A laboratory where we carry out experiments in
process and organisation re-design. These can then
be deployed into the rest of the organisation in a
controlled manner.
– End 2 End Lean Patient Value Streams

9. First Global Lean Healthcare Summit 25-26 June 2007
Focus on the End to End
Exemplar: Our Laboratory
• 1 hospital providing acute
services
• 4 other hospitals
13 health centres and
clinics
• Serving 180,000 local
residents (30% of
Demand)

10. Clinical Consummables Goods
Annual Cost
0
50000
100000
150000
200000
Before After
£s
30%
reduction
CT Scan Lead Time Improvement
0
1
2
3
4
5
6
7
Before After
Delay for off site scan
Days
Patient 'Right First Time on Time'
Diagnostics & Treatment
0
20
40
60
80
100
120
Apr-07 May-07 Jun-07
%
JI Programme No. of Staff Trained
0
20
40
60
80
100
Apr-07 May-07 Jun-07
Productivity Improvement General Medicine
CDMH
0
20
40
60
80
100
May 06 -
Sep 06
Oct 06 -
Mar 07
Apr 07 on
Beds
patients per bed
per week
300%
improvement
Up 24.5%
Up 19%
Up 47%
>90% trained
on time

11. First Global Lean Healthcare Summit 25-26 June 2007
Lessons Learned
• Not as complicated as we are told.
• People get motivated by this approach
– Bloody obvious when they don’t……….
– But you have to deal with them (says more about you)
• Not for free….
– Speed is limited by the number of skilled people you have working
towards the Future State
• Patient Journey 11,000 minutes, 94 minutes hands on
– You must keep coming back to this..
• We believe it is Win/win/win for Patient/Clinician/Manager
– But nobody believes it to begin with.
• Created a ‘Pull’ within the organisation

12. First Global Lean Healthcare Summit 25-26 June 2007
So where next for us?
• Next 12 Months:
• Develop the Model:
– Roll out through ‘Learn by doing’
– Increased Capacity (Additional 30 People)
– Develop & Deploy Organisational strategy & plans
• 2 to 5 Years:
– Lean Clinical Futures Model