Karen McCleod, Sandwell and West Birmingham Hospitals NHS Trust

Richard Johnson, Pan Birmingham Cancer Network

Cervical ScreeningBackground

‘The cervical screening programme will ensure that all women receive the results of their screening tests within two weeks by 2010’

Cancer Reform Strategy, DH, Dec2007

‘Seize (or create) a crisis to motivate action across your firm’

Womack & Jones. (2003) ‘Lean Thinking’

Baseline

Up to 7 week turnaround time (approx)

Delays throughout the process5 days to send the

letter? Days to receive

the sample in Lab

0

100

200

300

400

500

600

700

0 1 2 3 4 5 6 7 9 10 14 15 18 19 21

Sam

ples

Days

Days between sample taken and arrival at Lab (Sept 09)

HowValue stream mapping

Helps you to see the flowHighlights ‘waste’Forms basis of an implementation plan

Data – highlights where issues are!

14 day turnaround1

2 3 4 5Sample taken

6 87

9 10 11 12 13 1514

16 17 18 19Results received

20 2221

23 24 25

M T W T F S S

26 27 28 29

30

Taking of

sample(Primary

Care)

Screening

(Lab)

Send results(Call & Recall)

‘value add’ - <4 hours

•Meetings held at the Cancer Network

(Neutral ground)•Doodle.com

Practicalities

Karen McCleod, Sandwell and West Birmingham Hospitals NHS Trust

CommunicationWith PCT’sWith other labsWith primary care/smear takersWith Pan B’ham Cancer Network Service

Improvement Team

Hub and SpokeCytology labs converted to Liquid Based

Cytology following NICE evaluationProcessing machine - large volumeHospitals grouped together in ‘Hub’ and

‘Spoke’ arrangement

Improvements in LabSending samples to ‘Hub’ every day instead

of every other dayChanging workflow in lab – batch sizes Involving different groups within the LabNon acceptance policy – working with PCT’s/

QA Reference CentreDiscarding of out of scope samples – working

with PCT’s/ QA Reference CentreSmear taker PIN’s - working with PCT’s/ QA

Reference Centre

Improvements in LabSending results via electronic link to Shared

Services and PCT – changed timeFHSA sender codes – some belonged to GP’s

no longer practicingCame up as Test after sender ended at PCT

– causes delaysChanged these codes on laboratory system –

saw improvement straight away

Primary CareElectronic HMR101 request formInvolved in training sessions organised by

PCT’sInput from Pan B’ham Cancer Network

Service Improvement teamFrom Shared Services/PCTFrom Laboratory

Primary CareGive deadlines for starting to use electronic

formsBUT – even with deadlines some people still

don’t use themOne to one sessions – even this doesn’t work

with some practices

TechnologyPre-printed HMR101 form –takes all the

patient demographics form the National Exeter system

Staff in the lab don’t have to rely on reading handwriting!

Worked with other labs and the QA centre to get the District of Residence onto the HMR101 forms

Means the result can go directly to the correct PCT

Future?Set up electronic links with other PCT’s for

few out of area resultsGet all smear takers to use pre-populated

HMR101 formsContinue to work closely with PCT’s and

other labs