“Efficiency is doing things right; effectiveness is doing the right things”Peter F. Drucker

My interest in QI really began as a registrar in a large inner city ED in the Midlands, which underwent a yearlong government funded “Change” programme. All staff were invited to contribute, and I was quickly drawn in by the opportunity to improve care for much larger numbers of patients using system changes, than I could individually help as a clinician. We were taught Lean processes by staff from Toyota, and I became so hooked on Lean Thinking that I even changed my own cup of tea process to be to reduce wasted time.

Since those early days I’ve learned a lot more about understanding and improving systems in healthcare and common problems that crop up when people ask for advice about QI projects. One of the most important things is to always make the effort to understand the problem before trying to change something to fix it. A good example of this was trying to untangle problems with delayed blood results.

My staff regularly complained that delays to get blood results were due to lab processing or portering delays. I wanted to know what was really happening, so we followed and recorded every step of a few sets of blood samples from patient to laboratory processor over 24 hours. We found that the root problem was that the air chute system was only switched on for part of each 24 hour period, and when it was off, our staff inadvertently did things like walk around with the samples in their pockets for 20-30 minutes, forget to phone a porter, or put them in the wrong place for collection – nothing at all to do with portering or lab services. So we arranged for the air tube transport system to be switched on all the time, and helped changed lab processes slightly to accommodate this change. We designed out the delays we had previously observed and hey presto! - our time from venepuncture to blood results improved by over half an hour.

Sometimes small changes can have big impacts, like this one, which helps every ED patients that has bloods taken get to their discharge, diagnosis or treatment faster. So don’t be afraid to do the small stuff as it can have wide ranging positive effects for huge numbers of people - but always be effective as well as efficient, and target your energies in the right place.”

Dr Leesa Parkinson , ED Ysbyty Gwynedd

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