Abstract

Hothi S. Load Levelling with Heijunka in Histopathology . Journal of Improvement Science 2023: 97; 1-26.

Histopathology reporting is a critical component of cancer pathways enabling diagnosis. Minimising delays in reporting aids timely treatment planning for cancer patients. An improvement by design project deployed a bundle of changes to reduce reporting delays.

As a result of these changes, the number of cases that could not be discussed at the weekly Breast Cancer Multi-Disciplinary Team Meeting (MDTM) due to missing histopathology reports fell by 59%, from an average of 13.5 cases per week in the baseline period to an average of 5.5 cases per week in the intervention period. This allowed eight additional patients per week to not suffer from unnecessary anxiety awaiting their histopathology results. The only financial investment required was a whiteboard and whiteboard markers to create a visual scheduling tool.

Mapping and measuring revealed that a lack of reporting time capacity was not likely to be the primary cause of reporting delays. Inadequate scheduling was a more likely diagnosis as the incoming workload had been segmented into multiple categories with consultant capacity carved out to serve different categories via a rota. The rota system resulted in consultants experiencing feelings of overburdening and stress. Rapid prototyping was used to develop an alternative scheduling solution which required pooling the workload, implementing Required Delivery Time Order queuing and using the Heijunka load levelling technique. This was explored with the consultant group during an interactive workshop.

A test of change period was agreed for two months with a reflective workshop held at the end to discuss the objective data and subjective feedback. In addition to the reduction in MDTM delays, a 12% improvement in cases reported within two working days was also realised. The subjective feedback from most of the consultant group was that they preferred this new way of working, and they agreed to continue with the new scheduling system. The improvements have been sustained for five months at the time of writing.

Cancer; Cellular Pathology; Health Care Systems Engineering (HCSE); Healthcare; Heijunka; Histopathology; Load; Load Levelling; Multi-Discplinary Team Meeting (MDTM); Required Delivery Time Order (RDTO); Scheduling; Urgent Suspected Cancer (USC); Variation