Making our hospitals work

Tania KingService Improvement ManagerLean Summit 2nd November 2010

• 2  hospital  sites  5  miles  apart

• Provide  healthcare  for  over  435,000  people

• Approx  400  beds  on  each  site

• A&E  on  each  site

• Medicine/elderly  beds  on  both  sites

• Calderdale  Royal  has  only  elecCve  surgery/orthopaedic  beds

• In  2007/08  there  were:     110,000  inpaCents,     380,000  out  paCent  aLendances

Our  hospitals

• FoundaCon  Trust  since  2006

• Financially  sound

• History  of  meeCng  all  targets

• Care  Quality  Commission  raCng  of  “good”   BUT….

• A  feeling  of  constant  fire  fighCng  to  manage  daily  admissions  and  achieve  4  hour  target  in  A&E.

Our  hospitals

So  what  have  we  done?

• OperaConal  management  of  paCent  flow  hour  by  hour.

• Demand  for  beds,  and  capacity  are  visual  and  clear.• Immediate  acCon  can  be  taken  to  fill  empty  beds  thus  leaving  assessment  areas  with  capacity.

• We  can  see  at  a  glance  if  paCents  are  off  template  or  outliers  and  repatriate  if  appropriate  and  possible.

• Delayed  discharges  can  be  invesCgated  and  acCon  taken  to  move  things  along  (helps  ward  staff  who  don’t  always  have  Cme  for  this).

What  is  Visual  Hospital?

Update  (17/10)  -­‐  Analysis  of  Medical  PaEent  LoS  Prior  to  ‘Visual  Hospital’  ImplementaEon  (08/06)  V’s  Post  ImplementaEon

Copyright Lean Enterprise Academy 2010

Lean Enterprise Academy

Bottom Line Results:

Mean Medical LoS has reduced by 2 days (24%) from 8.5 days to 6.4 days .

The Median Medical LoS has reduced by 1 day (20%) from 5 days to 4 days

P-value = 0.000 which means statistically there is a difference

Update  (17/10)  -­‐  Analysis  of  Orthopaedic  PaEent  LoS  Prior  to  ‘Visual  Hospital’  ImplementaEon  (02/08)  V’s  Post  ImplementaEon

Copyright Lean Enterprise Academy 2010

Lean Enterprise Academy

Bottom Line:

Mean Emergency Ortho LoS has reduced by 4.2 days (50%) from 8.4 days to 4.2 days.

P-value = 0.000 which means statistically there is a difference

• Maintaining  the  gains  whilst  spreading  quickly

• Reducing  bed  base

• Keeping  staff  on  board

• Resource  to  keep  all  this  going  and  move  on  to  the  next  level

• Working  with  Social  Services  to  reduce  delays  (parCcularly  packages  of  care)  especially  in  current  financial  climate

Challenges