title: The use of Lean Thinking techniques in implementing the Department of Health, UK, 18-week waiting time directive for cochlear implantation.
abstract: In October 2007, Primary Care Trusts throughout the East of England agreed to fund assessment and implantation for all patients referred to Cambridge University Hospitals' Cochlear Implant Unit ('the Unit') providing they met locally agreed criteria.  Subsequently, the Unit has employed  Lean Thinking techniques to maximize departmental efficiency in order to comply with the Department of Health's 18-week guideline. Analysis of the patient's pathway, from referral to implantation surgery, highlighted areas of 'waste' that were causing delays in downstream processes. Through  a number of streamlining measures a large waiting list of long-waiting patients (n = 141) has been cleared. Of those patients not receiving a preliminary hearing aid trial, 89% were implanted within 18 weeks (31/35 patients). Of those receiving the hearing aid trial 100% were assessed and  commenced on the trial within 18 weeks, and 47% received implantation within the allotted time frame (7/15 patients).  The Unit is continuing to monitor these processes to ensure these change s are continuing to maintain shorter waiting times. Equally, patients must feel that they have  received optimal care and received sufficient information throughout the entire patient pathway.
authors: Cambridge University Hospitals’ Foundation NHS Trust, Addenbrooke's Hospital, Cambridge, UK.
authors: Peter
authors: P
authors: Kullar
authors: Frances
authors: F
authors: Harris
authors: Simon Kw
authors: SK
authors: Lloyd
authors: John
authors: J
authors: Briggs
authors: Zebunnisa H
authors: ZH
authors: Vanat
authors: John
authors: J
authors: Willis
authors: Patrick R
authors: PR
authors: Axon
mesh_terms: D000328:Adult; D001071:Appointments and Schedules; D002648:Child; D019929:Cochlear Implantation / Q000706:statistics & numerical data*; D019091:Critical Pathways / Q000458:organization & administration / Q000592:standards / Q000706:statistics & numerical data; D017598:Efficiency, Organizational; D004739:England / Q000453:epidemiology; D019983:Guideline Adherence / Q000458:organization & administration / Q000592:standards / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000458:organization & administration / Q000592:standards / Q000706:statistics & numerical data; D034381:Hearing Loss / Q000453:epidemiology / Q000601:surgery*; D006779:Hospitals, Public / Q000458:organization & administration / Q000592:standards / Q000706:statistics & numerical data; D006785:Hospitals, University / Q000458:organization & administration / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D017146:Models, Organizational; D015397:Program Evaluation; D012017:Referral and Consultation / Q000458:organization & administration / Q000592:standards / Q000706:statistics & numerical data; D014850:Waiting Lists