Process improvement in the National Health Service

Those of you who have seen Michael Moore's film "Sicko" will, no doubt, have a rather rose-tinted view of the UK's National Health Service (NHS)

Yes. It's true, when you have a baby the government pays you to have it in a hospital. And yes it's true that you can walk in off the street without any form of health insurance and be admitted. And yes it's true that no matter what medication they put you on your prescription cost is limited to about £8 ($16).

But there is a downside to that, and I noticed it at a recent trip to 'The Blood Bank'

Following Mr Sean Bean in his UK adverts I decided to "Do something amazing. Give Blood" (Actually, full disclosure here: I decided to accompany a friend who was doing something amazing. I was the designated driver). It gave me an excellent opportunity to check out some of the process issue the NHS have (For more thoughts - of a non-process nature - around the NHS check out The Musing Cafe)

For those of you who have never given blood before here is the proposed workflow

  • Arrive and show documentation
  • Complete a separate questionnaire and take a processing number
  • Have form reviewed and answer ancillary questions
  • Give blood
  • Have Tea and Biscuits
  • Leave.

So far so good, right?

Well, lets' go through the reality of that process and see if we can identify a few failings - either in the process itself or tin the implementation of the process.

As a scene setter let me say that the blood donation centre was a hall in a local community building with a single entrance and exit. The room was nominally divided into a waiting area, a processing area, an area with 10 beds to get the blood and a place for your tea and biscuits. (For those of you outside the US, Google "Hancock" + "Blood donor" for classic comedy about this very situation)

Arrive and show documentation. Ideally this should be a quick and easy step. You show the documentation, there is a review of the content to identify if you are in the right place at the right time. If so, proceed. If not, exception process. However the people dealing with this were on the same side of the desk as the people coming in through the door, thus creating a bottleneck. In addition the administrators were also the same ones updating the computers (As a separate step...) and retrieving the completed questionnaire forms. Result: Slow processing and queues

Complete a separate questionnaire and take a processing number: To be fair the completion of the questionnaire was well handled. They had enough pens and everyone got a clipboard with some advice about the questions. Filling it in was easy enough (Tick either 'yes' or 'no' in the boxes) but then you had to go back to the same queue as before to hand the forms in. The same guy was now dealing with new arrivals and completed forms whilst standing on the same side of the table as everyone else causing a blockage at the door. Once dealt with, you received a processing number which was added to you form. The form was then dropped into a processing pile.

Have form reviewed and answer ancillary questions: There were three 'booths' in the corner where the forms were processed. In each booth was a uniformed nurse who came out, took a document from the pile, called the number and took you in for 'processing'. This consisted of checking blood type with a pin-prick sample and asking any clarifying questions about answers on the form (My friend, for example had answered 'No' to the question 'Have you taken any medication in the last 7 days', forgetting totally about the fact that she's asthmatic and is on an inhaler. This part of the process worked really well, with the exception that the forms (while apparently being taken from the form in a numerical sequence) were actually taken somewhat randomly causing my friend to miss her turn. Obviously a process flaw in the organisation of the filing system,

Give Blood: This, in theory, should have been the easiest part. Lie down, get a needle stuck in your arm. Wait for 10 minutes. In fact it did work almost that slickly. We had a venepuncturist called Leslie who was very adept and very experienced. There was minimal fuss and everything went smoothly. However, once the blood had been collected there was a call for 'Bag Check' where a third party had to come from some other part of the room and check that everything was alright with the plasma. Again this should work quite well, but with 10 beds in use and only 1 or 2 qualified checkers, it didn't quite go as slickly as required.

Have Tea and Biscuits: The far corner of the room was set out with a small table and some chairs where an old lady served steaming hot tea from a boiler and you helped yourself to biscuits. Very civilised. However once you had finished you had to pick your way back through the beds, the waiting area and the processing desk to get out. Good process, bad execution.

Lessons learned: Overall the process was reasonably slick. There were one or two small gaps (such as the filing system for forms waiting to be processed), but the main issue was with the layout of the room. Having reviewed the layout while waiting (I was in there 1 hour and 15 minutes) I believe that a few simple changes would have sped things up.

  • Have the form processes seated behind the desk to allow more folks into the room at once
  • Have two people dealing with forms - one for initial review and another for completed questionnaires
  • Either invite fewer people to give blood at a time OR add an extra person to the processing (75 minutes for a 10 minute blood giving session as too much)
  • Create a processing channel around the room that kept the people and the documents flowing in a single direction - Reception -> processing -> blood giving -> tea and biscuits -> Exit

I would be interested in thoughts and feedback from other folks who've been through this process. If they use those special mobile blood gathering units is the process any better?

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