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Following a review of demand (GP and Consultant referrals) and capacity (appointment slots) it was decided by our change agents (David McClay, Ali Grove and Jenny Dando) that the two specialties that should be scoped further were; Cardiology and Trauma and Orthopaedics (specifically the Shoulder Pathway).

Project Objectives:

  1. To map the current process from GP referral to discharge for these specialities to identify waste in the process e.g. duplication, queues, workarounds.
  2. To produce a future state map that addresses the issues identified in reviewing the current state.
  3. Create an action plan to implement the changes.

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Lean Event Focus and Participants


The end to end Cardiology pathway was mapped out during the Patient Flow Elective Lean Event held on the 14th and 17th December. This information is stored on the Patient Flow – Elective page so click here to see the outputs for Cardiology

T&O Shoulder Pathway

A mini lean event mapping the current state process, was held for T&O on the 4th October 2012, in attendance were;

  • Mr Simon Greg Smith (Orthopaedic Surgeon)
  • Jenny Dando (Lead T&O Secretary)
  • Maggie Depledge (Head of therapies)
  • Irene Richards (Ward Manager Philip Yeoman)
  • Helen McCabe (Outpatient's Booking Manager)
  • Lynne Presley (Inpatient Booking Manager)
  • Leigh Ingham (Pre Op Assessment Nurse Practitioner)
  • David McClay (Business Development Manager)

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Outputs from the Lean Event

Current State Mapping

The group split into two and mapped the current state from GP referral to listing for surgery and the second group mapped the inpatient process. The current state map is attached.

Orthopaedic Shoulder Pathway - Current State (Oct 2012)

Following the event a meeting was held with community physio teams to see how the referral process could be standardised. An agreement was reached by both parties just by getting the right people in the room to make a decision, thanks to Maggie Depledge for organising this.

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What Does Good Looks Like?

The group are planning another event at the beginning of February to identify what does good look like for Shoulder pathway patients. A patient has also been identified that we will be invited to this event. For more information about this subject area then please contact Jenny Dando at Jenny.Dando@nhs.net

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