Nottingham University Hospitals (NUH):Emergency Department Pathway Improvement

• Increase in productivity : 2010/11 demand managed with 2009/10 resource levels cost avoidance saving of 5 FTE = circa £250K & 15000 more patients processed
• No breaches, therefore a reduction in £200,000 of investigations per annum
• Cost per patient now fully understood with the introduction of ED SLR (Service Line Reporting) : Estimate 20% reduction (finance verifying)
• Ability to roll out (internally) to all patient categories for further monetary savings (year on year)
• New standardised operating procedures designed and all staff trained
• Improved visualisation in the form of dashboards that are fed by the EDIS system
• New process for generating, reviewing, prioritising & implementing new ideas • Improvement sheets on display showing individual benefits from ideas implemented
• New capacity / demand model created to calculate ideal staff numbers required hour by hour, day by day
• Minimum skill set defined that is required per shift
• New electronic planning tool being developed to include individual skill set per person to show a visual representation of skill level for each shift (red, amber, green)
• Staff engaged – morale improved
• Start of a ‘Continuous Improvement’ mindset within the Trust.

Working in partnership with NUH we were engaged to look at three areas; ED, Theatres & preparation for a ‘Whole Hospital’ deployment to improve Trust wide practices and performance.

For the ED project we were asked to build on the success of the Productive Ward Programme that had produced cost effective results within other areas of the hospital, whilst improving the patient experience, staff satisfaction and quality of care including reducing patient waiting times.

Phase 1: Diagnostic – Identify opportunities

Key actions, methods and tools used:

• Establish a project team hub to create a different atmosphere within the department and to track all activities and benefits
• Train and develop the internal teams to understand the benefits of Lean and how to implement Lean tools and techniques.
• Workshops were held with internal team members to transfer knowledge, specifically tools that would help with the engagement of staff
• Review all patient categories and processes with the whole ED area and decide on the priorities.
• These were agreed with Clinical Staff and Exec Sponsor.