Making an impact in an organisation of the complexity of the NHS is about as easy as trying to gain control of a small country. Yet a team from Atos Consulting figured out a way of helping NHS South Central meet a government target early, while also making a sustainable improvement to the quality of care.
NHS South Central is one of 10 strategic health authorities in England and serves 4 million people. It's made up of nine primary care trusts, nine acute trusts, three mental health trusts, one learning disability trust, one specialist trust and an ambulance trust.
In 2004, the Government decided that no-one should wait longer than 18 weeks from GP referral to hospital treatment. Without additional funding to make this happen, NHS South Central realised it would have to transform the way it delivered patient services if it was to meet this target. Using 'lean' principles, it redesigned patient 'pathways' - the journey from first seeing a doctor, through diagnosis and on to recovery.
But to put these principles into practice, NHS South Central asked Atos Consulting to work with its nine primary care trusts to deliver not one but 27 redesigned patient pathways - three for each area with high waiting times or particular challenges. It also wanted an NHS South Central Academy that would act as a repository of tools and techniques, NHS staff to be trained to deliver improvements over time, and a network of experts who would help with making the changes sustainable.
As an early adopter of the Government's target, NHS South Central had to demonstrate significant progress by March 2008. But although patient pathways had been discussed for several years, they were still a relatively new concept, and applying lean principles to patient care on such a large scale had never been tried before.
Redefining just one pathway meant asking up to 30 busy managers and clinicians to co-operate and collaborate. Many were sceptical about whether a technique that has its roots in industry could work in a clinical environment. Organisational structures within the NHS also made it difficult to establish ownership of a single pathway from start to finish. Atos consultants had to resist the pressure to 'go native' and bend to the immediate needs and concerns of patients and clinicians in a particular healthcare setting. And, of course, this initiative was not the only one under way within NHS South Central - staff and managers were concerned about yet more change and extra work for their already-stretched teams.
Atos designed its own project pathway - an eight-step process to implement lean principles across each pathway. These eight steps would take 20 weeks. Steps 1 to 5 covered redesign; steps 6 to 8 focused on implementing and sustaining the changes.
Lean experts from Unipart Expert Practices were brought in and integrated into the project teams. Joint teams of clinicians and consultants worked closely together and, over the 20 weeks, successfully gained credibility with frontline staff and helped them to embed innovative new practices. Waiting times have since reduced by an average of 14 weeks - and in some cases, by 25 weeks. At the time of writing, waiting times have reduced across 24 different pathways. At one A&E department, 98% of patients are now treated within four hours; and in one GP practice, all patients now expect to consult with their doctor the same or next day.
Having redesigned patient treatment 'pathways', NHS South Central turned to Atos for help in putting them into effect. The consultancy brought in 'lean' experts from Unipart and worked alongside clinicians to change practices among front-line staff. The result: drastic cuts in waiting times for patients
- Resist the pressure to 'go native' - stay focused on the big picture;
- Work to gain credibility and to build consensus among key participants;
- Build a strong evidence base to convince sceptics of the value of the project.