Lean Implementation – Streamlining Oncology

• Reduced Turnaround time by 10% (42 minutes saving for patient) to an average of 382 minutes. 
• Reduction in Pathology turnaround time by approximately 45% through introduction of prioritisation of Chemotherapy Day Care patients in Pathology, eliminating queue jumping and improved monitoring. 
• Reduction of Medication production process lead time by around 25% due to quicker order receipt using faxes. 
• Reduction in Oncology Pharmacist Prescription check process lead time by 71% by moving Outpatients Clinical Check process from Pharmacy to Outpatients area and better integration of CHARM system. 
• Reduction in Outpatient Pharmacist intervention time by 80% through better and immediate communication with doctors at clinics. 
• Introduction of blood appointment times for patients 90 minutes prior to clinic resulting in reduction in delays to clinics as bloods available prior to clinic.

With limited availability of resources such as Day Care patient chairs, nursing staff and time, it became necessary for the Oncology department to review all its processes in order to identify and resolve the source of delays. Resolution of these issues would lead to an increase in capability and capacity – thus more patients could be treated using the equivalent amount of resource. Importantly, by improving processes, staff frustrations and problems could also be addressed resulting in increased staff satisfaction and more staff to patient contact time. After completing an initial diagnostic DC were requested to support the Oncology department in implementing the key recommendations through mentoring and coaching with a view to improving the Chemotherapy patient journey through Day Care.

Initial Observations:

• Batch processing of Chemotherapy patients.
• All Chemo patients scheduled in at start of clinics creating significant imbalance of work load and delays.
• Huge peaks and troughs of work load creating long waiting times, and frustrations.
• Patient Turnaround time of 428 minutes.
• 64% of patient turnaround time was non value added (waste) due to waiting.
• Day Care Chair utilisation was only 61%.
• Value Added Chair (patient sitting in chair receiving treatment) utilisation was only 53%.
• Clinic utilisation was 62%.
• Poor data capture processes and visualisation in place making it difficult to monitor key metrics and improve.
• Patients arriving just before clinic appointment time not allowing enough time to for blood results to be ready creating huge delays in appointments.
• Blood lead-time is 119 minutes of patient journey Steering.
• Lead time for pre-meds preparation was 78% non value added at 185 minutes.
• Large use of paper copies due to sub optimal use of CHARM system

• Optimisation of patient journey.
• Streamline processes to reduce waste and improve flow.
• Reduction in Turnaround time for chemotherapy Day Care patients.
• An improvement to the integration of CHARM with the process.
• Improved understanding of the link between Oncology Pharmacy and Production.
• An improvement to the scheduling and progression through the patient pathway.
• An improvement in the communication between all departments

• Initial Lean overview training for all staff.
• Walk through all work streams and map process.
• Develop a Current State Value Stream Map and lead-time. Complete waste walks to identify areas of waste in process. Collect and analyse base data such as Turnaround time, cycle times, volumes, rework, capacity, resources.
• Undertake a Blue Sky activity with all staff and stakeholders to brainstorm all current problems/ frustrations.
• Complete staff flow analysis using Spaghetti diagrams.
• Identify opportunities for improvement.
• Develop Future State Value Stream Map and new lead time ladder target.
  Establish key recommendations for improvement in 5 key areas.
• Establish clear Master Schedules for improvement activities.
• Create 5 key project teams with team leader for each key improvement area – Pathology, Outpatients, Pharmacy production, Day Care and CHARM.
• Set up a Project control room for activity progress monitor and project management.
• Provide coaching and mentoring support to Project teams in implementation of key improvement activities including creating new outpatient pharmacist role, introducing patient mix theory and standard scheduling trials, improving Chemotherapy patient scheduling, improved integration of CHARM to eliminate paper trail, creating appointments for bloods.
• Provide lean training where required.