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"Phlebotomy Phiasco - a customer-oriented process?"

About: King's College Hospital (Denmark Hill) / General medicine King's College Hospital (Dulwich) King's College Hospital NHS Foundation Trust

(as the patient),

It was real vintage Blitz memories stuff complete with stoic South Londoners joking about arriving the night before and camping out to be sure of being seen quickly. Cheery instructions for the new arrivals to how to use the system - take a ticket. It was like being inside a display at the Imperial War Museum minus only the sound track of air raid sirens and the whistle of falling bombs. Right on cue, the guy next to me removed his artificial leg. At least he had a seat - courtesy of his fellow citizens. A Quality Service? This was a queue outside the Blood Tests and X Ray department of the East Dulwich Community Hospital at 0700h - a service run by KingsPath whose strapline runs 'high quality, clinically excellent, cost effective pathology' . Let them add if they dare 'well worth waiting for?' Queuing to Join the Queue I discovered I was in what turned out to be a pre-queue since the department door was locked shut. A roll of numbered paper tickets lay on a counter which experienced users knew to take. In the best traditions of user-administered service process, first time users were instructed in the system by the veterans. About 30 people were there already - 50 by opening time at 7.30. Why were so many people there so early in the morning? Well I can only guess that they knew that turn up any later and you can say goodbye to most of your day . The day before when I arrived at the Phlebotomy unit at 11am, I found a queue which stretched back from a full waiting room down the hall and round the corner - I did not stay but would estimate the queue was around 3 plus hours long. People out in the corridor - they had yet to reach the waiting room- had already been there for two hours. Try Again So that was two tries and there was one more option - switch the venue and head for the twice-weekly Blood Test clinic at the main Kings College Hospital using 'the early bird gets worm' strategy. There were plenty of even earlier birds queuing at 7am but the bright and modern room was open and and there were enough seats at least for the earliest arrivals. The electronic number screen was showing 178 - presumably last nights tally. I got ticket 200 having been kindly directed to the ticket roll on the sideboard - getting the hang of the system now. The banter was about how early you had to arrive to be first in the queue? The consensus was that you better arrive the night before. If you had not brought something to read and did not fancy the news cycles of breakfast TV, you could always read the notice on the wall reminding you that the staff at Kings were working hard for us and deserved our respect. No violence and abuse please - only carefully calibrated and preferably wholly internalised displays of mild forms of irritation will be permitted further defused by the jokes and banter. Good People - Poor System In East Dulwich I was too far away from the entry point to see a receptionist. At Kings the receptionist opened promptly at 7.30am and then proceeded to play a blinder administering two systems at once - logging in the people who were already there when she arrived and then simultaneously the long queue of people who arrived after opening time. She did not use a computer at all but administered a double ticket system - you kept yours and she attached one from a duplicate roll on your paperwork and then hopefully both those numbers tallied with the electronic number on the wall. Classic stuff where the very highly developed skills of a human - good motor skills deployed simultaneously with excellent people management attributes - are holding a poor low productivity system together that begs to be automated. The temptation to draw a wider conclusion about the whole NHS is hard to resist. 5 minutes and out I was seen at 9am and out five minutes later. In total I waited about 4 hours counting the time spent on previous visits before I decided to try again another day. I had wondered whether I would have to abandon the third wait since I had another hospital appointment at 09.30. I managed to get there on time but need not have worried since that appointment system was running 45 minutes late. A notice on the wall of the dermatology clinic said that there might be delays of up to 30 minutes caused by 'attendance upon emergencies' - some teenage crisis with an emergency acne attack no doubt. By this time my reaction to all these homilies and reassuring messages on the walls was getting rather sour. Better process not more people Now what is the solution? There is a huge demand which is creating a bottle neck at the relatively limited central facilities which you have to use if this is not a facility offered by your GP either at all or at mine, once a week. So what are the major service design issues - devolve the drawing of samples to GPs and spend money on a temperature controlled collection system? Or increase the resources available centrally with longer opening hours, more people. That costs money - try better process. I handed in a form that the GP had filled in by hand to the receptionist who logged its receipt and my presence by hand while attaching my raffle ticket label with a paper clip; after the blood test, labels were stuck on to three different samples tubes and filled in again by hand. Talk about the customer journey - 90% of the time was spent immobile in the waiting room ruminating on the notion of mutuality and respect and the rest watching a 19th century clerical system in action (and in East Dulwich, premises to match). All that was missing was the hydraulic air pressure tubes to whisk away the paper work and/ or the samples- perhaps it is time to bring this great Victorian leap forward in retail productivity. Plenty of room for productivity What of the future - spending cuts etc? Less staff, less time open - how much worse can this service get before someone who has not had anything to eat since supper the night before and who cannot arrive before 10am does not get seen that day and gets sent home to do it all again another day? But the potential for raising productivity is enormous. This is a largely standardised process that can be organised and automated and made paper free - how do I know that this is possible? Answer - they had done it all for the BioBank research testing procedure. Meantime at least it is light in the mornings by 6am and if you have to wait for the bus, they say it will get warmer soon. Originally posted here
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