title: Health service improvement through diagnostic waiting list management.
abstract: OBJECTIVE
  The purpose of this research is to focus on a hospital Division of Diagnostics and Clinical Support (150 medical, 1975 non-medical staff) and how systems were enhanced through lean principles application to facilitate quality and performance improvement.
  
  
  METHODS
  An action research methodology was adopted. The research involved: review of available performance and quality improvement literature; identification of the systems that required improvement; adoption and implementation of new working methods.
  
  
  RESULTS
  The results were recognised as being beneficial to all parties, especially the patients! Staff recognised the need for change; the process transformation was actually welcomed. Patient waiting times reduced from 26 to 13 weeks. Fast-track/"query cancer" service for out-patients now within ten days; the majority of in-patients receive imaging within 72 hours. Ultimately, patients are diagnosed faster and treatment commences earlier. Departmental managers can effectively manage capacity to meet demand because they now understand the waiting "profile". RESEARCH LIMITATIONS\
  
  
  CONCLUSIONS
  The methodology applied was appropriate, generating data to facilitate discussion and from which to draw conclusions. A perceived limitation is the single case approach; however, Remenyi et al. argue that this can be enough to add to the body of knowledge.
  
  
  CONCLUSIONS
  Guidelines indicating "What went well?" and "What could have gone better?" were produced. These centred on the practical application aspects. The implementation methodology developed is being used elsewhere within the same hospital group.
  
  
  CONCLUSIONS
  The paper demonstrates that the application of improvement techniques, such as "Lean", can focus efforts to improve performance. This is of value to those working in the UK healthcare and wider public sector.
authors.affiliation: Pennine Acute Hospitals NHS Trust, Fairfield General Hospital, Bury, UK.
authors.forename: Amy
authors.initials: A
authors.lastname: Lodge
authors.forename: David
authors.initials: D
authors.lastname: Bamford
mesh_terms: D003954:Diagnostic Services; D017598:Efficiency, Organizational; D006779:Hospitals, Public / Q000458:organization & administration; D006801:Humans; D013222:State Medicine; D006113:United Kingdom; D014850:Waiting Lists