By Jonathan Clarke, Ear, Nose and Throat Consultant, Clinical Lead at Improvement Cymru, and Assistant Medical Director for QI at Aneurin Bevan University Health Board.
It means that seven cancer teams across Wales are looking at their cancer pathway to reduce the time taken between suspicion and diagnosis of cancer. They are being supported by Improvement Cymru and Toyota Production System for this. But why Toyota, don’t they make cars? I hear you ask.
In Wales most of us improvers have heard the acronym ‘PDSA’ which means Plan-Do-Study-Act. It is part of the Quality Improvement method called Model for Improvement. However, there are other improvement methodologies and ‘Lean’ is one of those. Much of the development of Lean thinking has been led by Toyota through the Toyota Production System (TPS). Lean methods help to improve flow and eliminate waste, ideal for a patient pathway to improve the quality of the service provided.
Toyota’s Taiichi Ohno describes what Lean is in the quote:
“All we are doing is looking at a timeline from the moment the customer gives us an order to the point when we collect the cash. And we are reducing that timeline by removing the non-value-added wastes.”
We can see from that quote that this is like our Suspected Cancer Pathway. Instead of the customer giving us an order we receive a referral and by the end of the 28 days we hope to have the diagnosis, not cash. By using the Lean methods, we hope that the cancer teams will be able to find ways to reduce the timeline from suspicion of cancer to diagnosis or improve the number of patients receiving the diagnosis within 28 days.
And applying that Lean approach is already showing great potential for delivering on that aim. The Colorectal multidisciplinary team in Aneurin Bevan University Health Board have shortened the time from point of suspicion to decision to treat by 21 days so far and sustained that change. They continue to make improvements and it is exciting to see how much they will achieve using the Lean principles.
In Hywel Dda University Health Board they have designed a new one-stop diagnostic clinic for patients. This will enable patients to undergo endoscopy and radiology procedures at the same clinic appointment.
This gives great promise for the new cohort, who are attending Toyota’s Lean Management Centre in Deeside for intensive training in the lean approach as part of the programme.
If you are part of a cancer team and have interest in this work, we will be sharing learning from each of the participating MDTs throughout the programme. If you’d like any more information, don’t hesitate to get in touch with Improvement Cymru.