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Success Stories Showcase: Productive work flows

Productive work flows: Reorganising the working environment

Time. It’s a luxury most practice managers just don’t have. In fact, according to the recent Practice Index Pay Survey, the majority of practice managers put in plenty of overtime, many working nearly an extra day a week.

It’s an issue that’s clearly not lost on the NHS, which is one of the reasons why it’s investing heavily in the General Practice Forward View and, more specifically, the 10 high impact actions (HIAs) designed to free up practice time.

One of those 10 HIAs is focused on productive workflows and how some relatively simple tasks can streamline activities. This is a wide-ranging topic covering everything from correspondence handling to automated paper workflows, practice nurse utilisation and management of appointments. Further information on the ideas that can be rolled out can be found on the NHS Networks site.

Reorganise and refocus

One success story from a practice focuses on reorganising the working environment. Trafford Health Centre in Manchester, which has three GPs and 4,300 registered patients, decided to improve the physical working environment of the practice, leading to over 40 hours of the practice team’s time being released.

An improvement team comprising of the practice manager, reception and admin staff, practice nurse and health care assistant was formed to work through the task. This commenced with a walk-through of the practice, where the team identified potential areas where valuable staff time is wasted. This helped to identify the following issues that were having an impact on how efficiently the practice team worked:

• Areas were overcrowded and cluttered e.g. reception, practice manager’s office, business manager’s office and the stock room.
• Overstocking was taking up scarce space e.g. dressings, nappies, oxygen masks, as well as paperwork which needed reviewing and/or archiving.
• Clinicians were struggling to locate items in stock cupboards and even their own clinical rooms.
• Admin staff were reporting multiple interruptions daily (up to eight hours of staff time) to help clinicians find things.

The team used the findings of the walk-through to identify the administrative and clinical areas that could be reorganised.

The 5S model

The team used the 5S model which helps introduce the concept of standardisation in a practice. Initially the administrative and management areas underwent 5S, resulting in a highly impactful decluttering and reorganisation operation.

5S represents Japanese words that describe the steps of a workplace organisation process:

1. Seiri (Sort)
2. Seiton (Straighten, Set)
3. Seiso (Shine, Sweep)
4. Seiketsu (Standardise)
5. Shitsuke (Sustain)
In simple terms, the five S methodology helps a workplace remove items that are no longer needed, organise the items to optimise efficiency and flow, clean the area in order to more easily identify problems, implement colour coding and labels to stay consistent with other areas and develop behaviours that keep the workplace organised over the long term.

Interestingly, and appropriately for GP practices, the model is often extended to include another ‘S’ – safety.

Following suit

Coming back to the Trafford Health Centre, once the impact of the physical changes set out by the improvement team was highlighted, other staff saw the benefits and followed suit, undertaking 5S in their own working areas e.g. reception, scanning room, store cupboards and waiting room.

After meeting with the nursing team, minimum levels of clinical stock were agreed and the practice team is now more robust with ordering. The ordering process itself has been streamlined with ordering now only taking place on a specific day of the week. A practice wide database is also in development which will enable stock levels to be tracked and help identify areas that require review.

The impact of the changes include:

• Stock rooms and clinical rooms have been decluttered, reorganised and fully labelled. The impact of this has been significant as clinicians no longer need to waste time searching for items and/or interrupt admin staff for help. Collectively this has released over 40 hours* a week of the practice team’s time.
• As a result of the time saved, GPs are now able to have a dedicated desk space where they can do their admin work, as well as being able to hold weekly briefings with one another. The admin team feel more empowered to suggest or trial a change within their working environment and have less call for sourcing stock for clinicians meaning the admin work i.e. tasks and Docman have more time spent on them.
• The practice feels calmer and more organised with no last-minute panic to find items or equipment.
• Patient feedback has been positive. The waiting room has vastly improved and patients now find it much easier to find information.
• The team has learned how to apply the 5S technique, helping them to maintain the improvements.

* Time based on a total of 7.5 hours released for 3 GPs and 35 hours per week for 22of the admin team including managers, secretaries and receptionists.

Commenting on the initiative, Natalie Sheldon, Practice Manager at the Trafford Health Centre said: “Productive General Practice Quick Start has changed our mind set – we won’t put up with a disorganised mess anymore! We have a tidier and more organised environment which is helping us work more efficiently as a team.”

When it comes to implementing a similar initiative, the practice suggests that it’s worth making staff aware that this is not a reflection on their personal tidiness; it is about encouraging an efficient and more comfortable working environment, which is everyone’s responsibility. Also, remember that a new ‘home’ for something is not always set in stone, some changes may not work so there may be some items/equipment you may need to move back.

The above example does show how relatively simple, cost-effective changes can make a big difference to a practice – without too many headaches in the process.

Have you implemented any similar initiatives to the above? Have you used the 5S model? What advice can you share with other practices? Let us know by joining the conversation.

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