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Case Studies

Lean Office - Southern Trust Case Studies

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Scheduling of Clinical Supervision in the Mandeville Unit

The Mandeville Unit is one of four Cancer Units opened in December 2001. The facility accommodates the delivery of chemotherapy to Oncology and haematology patients along with review appointments and supportive care procedures. Currently we have staff working within the unit along with Clinical Nurse Specialists connected to the Unit.

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The NPSA(14) Right Patient, Right Blood’ initiative is a mandatory and essential programme for post registration nurses and midwives and requires that all staff involved in the blood transfusion process must receive theoretical training every 18 months and competency assessment every 3 years. Sustainability of these quality standards requires to be monitored regularly and difficulties have arisen due to staff booking places for the scheduled sessions and then being unable to attend. This is due to competing training priorities within the Trust and the difficulties in releasing staff from the clinical areas.

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Annie Treanor and Eimer McGeown are Breast Care Nurse Specialists working in the breast care service within the Southern Health and Social Care Trust. Annie and Eimer had completed their Breast Care Nurse Advanced Practitioner course in Cambridge and were keen to utilise their new knowledge and skills in a practice setting. Their project was based around the introduction of their advanced practice at the Family History Clinic (FHC).

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Improving Patient Flow through the Glenanne Unit

Our Breast care unit within the Glenanne unit treats 6,548 patients a year, attending screening, symptomatic and family history clinics. We as Breast Care Nurse Specialists are the key workers for all patients newly diagnosed with breast cancer (in which there were 191 in the last year.) We also treat patients for benign breast disease. We review all our patients at results and prosthesis clinics.

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This project was undertaken by the Trust’s Oncology Nurse Specialist who has responsibility, along with other staff, for the management and treatment of patients who present with Neutropenic Sepsis following cancer treatment. The Oncology Nurse Specialist was concerned that staff in the Mandeville Unit and Emergency Department were not fully aware of the treatment pathway for these patients and that the door to needle time of 60 minutes was not being met. The plan was to embark on a journey of staff awareness programmes with the aim of developing a standardised pathway for staff to adhere to as well as attempting to secure medical cover in the Mandeville Unit to assist with the timely management of patients.

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The Trusts Haematology Nurse Specialist is a position with specialist duties, roles and responsibilities including having the most up to date information available in the right place at the right time and providing a coordination function to other staff. Frequent interruptions for information and a disorganised computerised and manual filing system was leading to a great deal of time wasted for this staff member. The project plan was to streamline the filing systems and create a central and standardised information hub that staff could readily access without the need to consult with the Haematology Nurse Specialist in all instances.

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We are a team of two specialist nurses who independently manage a caseload of people with complex bowel and bladder problems. This is a highly committed, dynamic and innovative service, which is constantly striving to provide high quality, patient centred care with a Trust wide responsibility. The service is provided for the 2 acute sites (Craigavon and Daisy Hill) and rehabilitation sites (Lurgan and South Tyrone) as well as home visits, nurse led outpatient clinics, patient support groups and education regarding colorectal and stoma care nursing throughout the Trust.

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Improving Communication and Education, through staff engagement.

We are a small team of 2 research nurses with a wide remit. Currently based in Craigavon we targeted 11 wards with over 10 studies open to recruitment. Patients can become unwell on a trial and may need to be admitted. We need to ensure they can be cared for safely; according to each specific research protocol. We also want to raise our profile so that others involved in Cancer research know we are available. This project concentrated on link nurses on 11 wards/departments. The outcomes of this project are transferrable and we hope to disseminate our findings and roll out the project across other sites/depts. and disciplines in the trust.

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Support for Upper GI Cancer Patients

The purpose of this project was to improve patient experience by increasing referrals to the Cancer Nurse Specialists and developing a follow-up service for patients receiving bad news.

The main project objectives were –

  • Increase consultant and self-referrals to the team.
  • Increase Team visibility throughout the Trust by use of posters, information leaflets etc.
  • Secure dedicated locations in which to break bad news to patients
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Change in mind Project - Southern Health and Social Care Trust

Review of Mental Health Services

The Southern Health & Social Care Trust was established with the amalgamation of 4 legacy Trusts. This prompted a need to review the Mental Health Service with the aim to provide a uniform service across the Southern Board area. The Trust’s delivery plan, outlined how they would meet the targets for improving and delivering a coherent and consistent Mental Health Service. The plan included a 13 week maximum waiting time for access to psychological therapies, increasing the choice of therapies for patients with mild to moderate conditions and empowering and increasing the workforce.

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Colo-Rectal Cancer - Airedale NHS Trust

Fast Track Pathway Review

The Colo-Rectal Cancer department at Airedale NHS Hospital provides a vital service to patients suspected of having cancer. After a GP has made a fast track referral, the patient enters a convoluted road through diagnosis, treatment and aftercare. The aim of the review was to find and remove wasted effort from the system and ultimately speed up the process.

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Continuous Improvement in the Radiology Department - SHSCT

Enthusiastic with New Year resolutions to improve their department, the Radiology Team held a meeting to find out more about the Lean Healthcare Academy Lean E-Learning Programme being offered by the Trust. The team were keen to make improvements particularly in relation to sharing information across the team in an easily understood and timely way.

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Diabetic Foot Clinic - Airedale NHS Trust

Diabetic Foot Clinic Review

Airedale NHS Trust requested help from the Lean Healthcare Academy to review and improve their Diabetic Foot Clinic. Foot ulceration, foot infection, foot and limb amputation and some forms of deformity are major forms of disability arising from types 1 and 2 diabetes. In the UK every year 5,000 people with diabetes have an amputation, meaning people with diabetes are 15% more likely to have an amputation than those without. Airedale runs a twice weekly foot clinic serving the local community.

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Endoscopy Airedale NHS Trust

Capacity & Demand Review

The Endoscopy department at Airedale NHS Hospital was experiencing a backlog of over 100 patients due to have, mostly, surveillance colonoscopies. They needed to investigate and remedy the reasons behind the backlog.

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Occupational Therapy - Bradford Metropolitan District Council

Occupational Therapy Review

The Occupational Therapy department consists of a large diverse team covering many disciplines. On average, the 65 strong department has to deal with some 150 adult referrals a week - around 6,000 annually – the majority by direct contact from an individual service user, supplemented by others from hospitals, GPs, physiotherapists, carers, social workers and users’ families. The Bradford Metropolitan District Council chose to work with the Lean Healthcare Academy to streamline working practices and improve across-the-board service delivery.

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Southern Health and Social Care Trust - Orthopaedic ICATS

Orthopaedic Integrated Clinical Assessment and Treatment Services Pathway

Within the workplan of the Directorate of Older People and Primary Care a number of patient pathways were identified as requiring development.  The Orthopaedic ICATS pathway was the first pathway to be taken forward, with assistance from the Reform Team using the principles of Lean to remover non-value added activities.  Key issues that were identified prior to the process mapping session included a lack of clarity around the referral pathway and referrers’ responsibilities.  

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University Hospital of North Staffordshire - Productive Ward

Productive Ward Project Review

The overall project aims are to engage and empower staff in the redesign of their ward environments and processes in order to release more time for direct care, and also to improve the patient experience and the safety of patients through continuous cycles of improvement. The project is supported by a facilitation team who use a ‘bottom up’ approach to empower staff to explore and realise their ideas adopting lean methodologies.


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Yorkshire Cancer Network - Sustainable Lung Cancer Pathway

Sustainable Lung Cancer Pathway

Lean Healthcare Academy worked with the Yorkshire Cancer Network to help them to improve the patient experience and ultimately save lives by shortening and simplifying the Lung Cancer pathways across the network. A key driver was that Trusts across the network were failing to hit and sustain the government standard of a 62 day limit between referral and first definitive treatment (FDT) for life saving surgery. This was greatly increasing the risk of patients dying as a result of late diagnosis and treatment.  

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Nicola Hayes

Refurbishment of Main Theatres & Recovery at Craigavon Area Hospital

Theatre accommodation at Craigavon Area Hospital is over 40 years old and has become out-dated and in need of much modernisation. The refurbishment began at the end of 2010. Working in a live environment meant implementing a phased approach as continuity of services was central to the project. 

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