Cut in waiting times sees summit invite

A Swansea Bay cardiologist who has helped transform his service into a smooth, well-oiled machine has delivered a keynote speech to an organisation that originated within the car industry.

Professor David Smith, a senior cardiologist consultant in Morriston Hospital, addressed the UK Lean Summit in Liverpool earlier this month after cutting waiting times for his patients.

The summit was hosted by the Lean Enterprise Academy, a worldwide organisation which started off by looking at improving productivity within car making in the early 1980s. It then spread across the globe and beyond the industry, to sectors such as construction, healthcare, and local government.

Professor Smith (left), who specialises in replacing heart valves through keyhole surgery, said: “They look at a range of different industries and companies and try to see where improvements can be made in productivity and efficiency.

“I contacted them at the start of 2019. At that time we recognised that we had long waits, people were coming to hospital on multiple different occasions and their pathway of care was too long. That was something we wanted to change.

“I sat down with one of the Lean coaches and we mapped out the pathway that existed for patients. In other words, how many visits, where were they going to, how long were they waiting, and where were the roadblocks in their care?

“We then looked at redesigning not just the procedure but the overall pathway of care. We asked questions such as, when they first come to see us how many tests do they need? How long did they wait between tests? 

“We redesigned the pathway to make it much shorter with the aim of making it better for patient outcome.

“I look back now and think why didn’t we do this sooner?”

Crucial to the changes brought in was reducing the number of hospital visits a patient was asked to make.

Professor Smith said: “We made the patients come to hospital less frequently for review by developing a joint clinic where they meet their cardiologist, which is what I do, and the cardiac surgeon who offers the alternative treatment, which is open-heart surgery. Instead of having two separate appointments, they now have just the one.

“We have also streamlined the number of tests people need before they have a new heart valve, reducing them to those that are absolutely essential.”

Like several other services within Swansea Bay, the pandemic inadvertently provided Professor Smith and his team with the opportunity to restructure their whole approach.

He said: “I think Covid probably enabled all of us – whether professionally or socially – to look more critically at ourselves and the things we were doing. When you are busy you don’t tend to get that time to reflect upon what you are doing and how successful it is.

“During the pandemic we had to minimise patient visits to hospital and patient contact in hospital, and also their duration of stay in hospital when they needed to be there. 

“In that regard Covid has been an ally. It has helped us look very quickly and critically at what is essential, what’s not, and how we can streamline pathways even further.”

The scale of the team’s success came to the attention of the Lean Enterprise Academy and Professor Smith was asked to address the summit on 17th April.

He said: “I’ve been asked to go because we have demonstrated a significant improvement in our timeliness of treatment to the point where last year our waiting times were just a shade over eight weeks from referral to treatment.

“This is amongst the best in the UK. Previously, at the start of 2019, our patients had been waiting up to a year.

“At the same time, we have been able to double our volume, which in business terms, to double your output and halve the time to create your end product, is quite impressive. That’s why I’ve been invited to talk.”

Professor Smith has also accepted an invite to share the secret of his success with fellow cardiologists.

He said: “I’ve also been ask to share what we have done at the National Cardiac Benchmarking Collaborative meeting, which is a UK-wide cardiac conference on healthcare delivery, in London this month.”

Despite the growing recognition, Professor Smith is keen to emphasise he has not achieved such wonderful results through working alone.

He said: “This is a team effort. The whole team I work with, which is comprised of doctors, nurses, allied healthcare professionals, our management team within the directorate – everyone has come together to produce what is a team output.”