The NHS Blood and Transplant has to ensure a reliable supply of blood and blood products to hospitals around the United Kingdom. Joy Furnival, Head of Service Improvement, Debbie Carmouche, Head of Operational Improvement, and Vaughan Sydenham, Assistant Director of Finance, explain how lean is helping NHSBT.
NHSBT is a Special Health Authority, dedicated to saving and improving lives through the range of services we provide to the NHS. Our challenge is to offer a safe and reliable supply of blood components, diagnostic services and stem cell services to hospitals in England and North Wales and tissues and solid organs to hospitals across the UK.
We also provide diagnostic and therapeutic services outside the UK. We collect donations from voluntary donors, prepare them for use, dispatch them to hospitals and match them to patients who desperately need them.
Over the last few years the blood service has focused on streamlining its processing and testing productivity. We have successfully removed excess capacity and improved efficiency and productivity delivering more than £30 million of annual savings to the NHS by reducing the price of blood to hospitals.
This included implementing lean principles across our 15 blood centres and multiple blood donation sites since 2009. In doing this the organisation wanted to engage its staff in creating a culture of continuous improvement that aligned with its mission to save and improve lives.
NHSBT has had to really understand and listen to the voice of the customer at both ends of the blood supply chain. Upstream it relies on the generosity and time that is freely given by 1.3 million volunteer donors and downstream it has to meet the needs and expectations of about 300 hospitals and 1.9 million units of blood.
Through a programme of focused activities, such as the introduction of cellular manufacturing and visual management techniques, NHSBT has been able to achieve some truly spectacular results.
These include a significant contribution to a productivity improvement of between 70% and 90% in blood component manufacturing and testing (between 2008 and 2013), which places NHSBT well into the upper quartile of blood services across Europe.
This equates to recurring savings of about £5.7 million annually from a relatively modest OIP investment.
Work has been particularly intense at the Filton manufacturing site near Bristol, where productivity has moved from 5,200 units/WTE/year in 2007-2008, when the data was baselined, to over 10,000 units/WTE in March 2013.
Other examples of improvements include the introduction of new platelet quality processes and improvements in donor waiting times by more than 24%. The introduction of lean into the organisation via the operational improvement programme (OIP) led to NHSBT being awarded a prestigious Health Service Journal Award for Quality and Productivity last year.
In-house capability for developing productivity and quality improvements via lean has gradually been developed firstly using an external specialist consultancy and now increasingly through in house resource or in collaboration with other NHS partners.
This has led to over 800 staff now having been trained in lean principles, many of whom have taken part in rapid improvement event activity or kaizen work. Improvement objectives and aims are increasingly being built into staff objectives as well as being linked into values of caring, expert and quality across the blood supply chain.
A primary objective has always been to develop a continuous improvement culture and capability in such a way that this becomes regarded as “business as usual”.
As evidence of its growing confidence and maturity in the lean field, NHSBT has been able to successfully deploy its experience in the application of lean principles by helping to support and develop best practice in other European Blood Services who are facing similar challenges.
Improvement activity has been strongly governed with a focus on selecting the highest priority problems for the business. There has been an emphasis on strong performance management and coaching in order to expedite improvement actions when there have been problems or blockages with the activity.
Lean gains have been used not only to deliver existing activities more efficiently but also to introduce new ones with minimal cost as demonstrated by the effective implementation of a major £3 million and fairly labour intensive blood safety initiative (bacterial screening of platelets) without the requirement for any additional staff.
Here’s what Michelle Ashford, associate director of manufacturing development, who has led the lean activity from the beginning, thinks the biggest learning has been so far: “As we began to encourage our staff to examine what they do every day and think about removing waste, removing batches and really focus on value, the ideas that our teams have been able to generate have been astounding. I am so proud. And to think, too, that all these fantastic improvements help make working lives better and at the same time help us deliver better services and better value to help the front line NHS.”
NHSBT is now planning to further extend the reach of lean and its principles across the business, notably in the diagnostic and therapeutic services and organ donation and transplantation divisions.
There is a strong link with organisational workforce development programmes to further embed and reinforce the lean culture across the organisation. Senior management actively participate in lean initiatives and can often be seen participating in gemba walks and sponsoring rapid improvement events and value stream analyses.
Immediate plans include further embedding local production cells and introducing daily problem solving and visual management into all manufacturing centres. We also intend to examine the adaptation and use of single minute exchange of die (SMED) techniques within donation units, which will reduce set up and set down times, increase opportunities to donate, limit waiting times, and boost productivity.
Feedback from donors indicates that one of their biggest issues relates to waiting times, so any improvement in this area will have a positive impact on donor retention and satisfaction, both of which are critical to meeting the demand for life -saving blood products.
In conclusion, NHSBT’s lean experience has clearly proved that the methodology will be critical to the organisation’s ability to respond appropriately to the demanding environment in which it operates. Continued success will depend on being able to embed a culture of continuous improvement across all staff with visible and unambiguous support from senior management.