Waiting times drop thanks to 'Toyota treatment'

Scores of frontline staff, including porters, drivers and nurses, were asked to submit their ideas on improving the way NHS Lothian is run under the new "lean management" scheme.

The system was designed to tackle problems noticed by "shopfloor" staff on a daily basis, which are often overlooked by senior management. Nine months after the trial got under way, waiting times for a routine CT scan - a special X-ray used to detect a wide range of problems including tumours, lung disease or brain damage - have fallen from up to 21 weeks to a maximum of four weeks. A better management of the system allowed for around 20 extra patients a week to be examined.

NHS Lothian said it would have cost more than 1 million to treat these extra patients if they had not made the changes to working practices.

The "Kaizen" problem-solving system, which was developed by Toyota and has already proved popular in North America, will now be extended to other parts of NHS Lothian.

Health chiefs are yet to decide which areas will be next for the "Toyota treatment".

James McCaffery, director of human resources with NHS Lothian, said: "While we are not a business, we need to learn from the private sector and other international healthcare organisations about the best ways to implement lasting positive changes.

"This education process has helped us provide the most efficient and effective healthcare system we can."

Lean management training aims to eliminate activities that increase costs but do not add value. Workers from every rung of the ladder meet to identify problems and suggest solutions, rather than being dictated to by managers.

The most effective innovations they came up with included a better system for allocating space on CT scanners, thereby ensuring machines were not left unused at quieter hospitals.

Administrators have also agreed a new protocol to ensure that, when a patient is referred for a scan by their family doctor, their details are entered on the hospital system the same day. Previously, delays in logging information onto computers had led to delays of up to a month.

At the same time, patients waiting for a routine colonoscopy - used to diagnose colon cancer or inflammatory bowel disease - have seen delays fall from 29 weeks to 18 weeks.

The changes have saved more than 80 hours of staff travel time after introducing a web-based system to manage hospital beds, and have streamlined the number of forms needed for rehabilitation patients from 11 to one.

Mr McCaffery added: "The initiative has delivered long-lasting change in those clinical services involved in pilot work while staff in those areas have been overwhelmingly positive, and the training has provided an excellent platform upon which to develop."

A total of 35 key managers and other staff, from doctors to porters, have been appointed "champions of change" within NHS Lothian as part of the scheme. A further 200 staff members have so far been involved in seminars or workshops.

Libby Tait, head of modernisation with NHS Lothian, said: "The second phase of this work will again focus on critical clinical processes to improve the patient experience in relation to assessment, diagnosis and treatment across a range of conditions."

Dr Elspeth Atkinson, Scotland director of Macmillan Cancer Support, said: "Macmillan Cancer Support would greatly welcome the reduction in waiting times for services in Lothian, such as a CT-scan or colonoscopy.

"The reduction in waiting times for these services could not only make a difference to the outcome of a cancer diagnosis, but also reduce the anxiety and distress associated with a long wait for a diagnosis."

THE FACTS

The idea of 'lean management' was introduced by Toyota even before it began to produce cars.

The firm launched the concept of jidoka - 'stopping work' - to improve production at its spinning and weaving plant. A system of lights allowed workers to alert senior staff if anything had gone wrong on their power looms, and the whole plant was brought to a halt to solve the issue.

This meant things were sorted out quicker and production was more efficient than if problems were allowed to continue unresolved. When the firm moved into the car-making business in the 1920s, it encouraged workers to suggest new ways things could be done.

"Our philosophy is that the person who is doing the job is the expert," said a spokesman.

"They are the ones who know if something could be changed to make their job more efficient."