The Carter Report: How laboratories should deal with steep objectives

The 2015 report by Lord Carter of Coles may well be a wake-up call to many laboratories, but there is light at the end of the tunnel.

In a recent report, Lord Carter of Coles highlighted the need for increased efficacy, innovation and cost effectiveness in healthcare (Interim Report of June 2015 on the Review of Operational Productivity in NHS Providers).

he three key areas identified as major focus points for ensuring the continued delivery of high quality healthcare are:

  • demand;
  • efficiency;
  • and funding.

Improvements in any key area drastically affect the others – and efficiency is foremost of the three. The report states that an improvement in workflow and workforce cost containment should save an estimated two billion pounds annually by 2019. In fact, a mere 1% improvement in workforce productivity could save an estimated £400 million.


If workforce management and productivity is not addressed as a matter of urgency, efforts to achieve the goals for pathology in the Carter Report will not be effective

Furthermore, the report concludes that unless workforce management and productivity are addressed, all other areas of opportunity pale into insignificance. With LTS’ extensive experience in the diagnostics industry, we have seen first hand that efficient workflow is critical for the optimal utilization of the workforce, driving peak productivity and sustained quality. The demand-productivity balance is one that is difficult to achieve in a complex system, and specifically when resources and demand for services can vary on a daily basis. In a complex system such as this, a once-off static model of processes lacks the ability to handle a moving target. Meanwhile, initiatives like Lean Six Sigma “typically start off well, generating excitement and great progress, but all too often fail to have a lasting impact” with “nearly 60% of all corporate Six Sigma initiatives failing to yield the desire results” (Wall Street Journal, 2010).


How will you know if your performance improvement initiative will succeed? Worse yet, can you afford to let it fail?

Both the external consultant-driven projects as well as the internal continuous improvement initiatives have too often proved to be incapable of delivering on their initial promises. In our experience, much of this is due to uncertainty around whether the proposed changes will have the desired impact. This uncertainty, in turn, generates a resistance to change which leads to inefficiencies being retained in the system. In order to address this lack of understanding, certainty and insight, LTS has developed PinpointBPS® to accurately identify, quantify and eliminate the interrelated and often complex problems of aligning workflow, capacity and demand. Its evidence-based methodology differentiates PinpointBPS® from traditional tools and methodologies through its use of simulation, which delivers excellent modelling accuracy and reliability. Through engaging with clients, understanding individual needs and providing a detailed assessment of the many aspects of operational performance, PinpointBPS® identifies site-specific factors inhibiting optimal  efficiency.


Rigorous process mapping and simulation allows you to optimize first, then implement.

Using the simulation model to test a wide variety of probable solutions, we are then able to accurately determine the tangible impacts, which a change in workflow and resource application would deliver. The effects of these changes are determined in the model space prior to implementation, thereby avoiding expensive trial and error cycles - an advantage that few (if any) can provide. A notable further benefit of applying the PinpointBPS® Modelling and Analysis Service lies in its standardized modelling approach and ability to set internal performance targets. This allows for accurate benchmarking against peers as well as internal benchmarking of actual vs. target performance. The creation of clear targets allows teams to align and strive towards the achievement of the set target, thereby nurturing a culture of teamwork.


Getting it right takes more than planning. It takes culture.

The Review of Operational Productivity in NHS Providers acknowledges that there isn’t a one-size-fits-all approach for Trusts when it comes to performance improvement. Changing processes to achieve performance improvement requires a cultural change, removal of change barriers (fear of change and uncertainty of results), accurate data, accurate baselines, accurate targets and the ability to measure performance. Lord Carter’s team attempted to bridge some of these issues through the creation of the Adjusted Treatment Index (ATI), which identifies the relative efficiency of each hospital and then determines the efficiency targets for those hospitals. This will address some of the challenges identified, but it will not ensure support for the required changes, bottom-up understanding of the operational constraints, and a long-term sustainable solution. It is not feasible to achieve sustainability in efficiency improvements by applying the same outdated process improvement approaches and methodologies (but with different targets) - and then expecting a different outcome.


PinpointBPS provides you with the necessary tools and solutions to achieve the goals in the Carter Report.

With the considerable challenges facing the healthcare industry across the UK, a more effective solution is required that can provide accuracy in analysis, certainty in results, confidence in decision-making, detailed operational engagement and long-term sustainability. Furthermore, it must deliver these results more quickly, at a cost that is within reach and through a knowledge community that ensures sustainable learning. PinpointBPS® is a service that facilitates the delivery of these objectives by implementing cultural change through these key areas: empowerment of operational staff; allowing for detailed modelling of operations; providing simulation of new processes to assess the impact of change; and creating detailed targets and baselines to monitor progress during implementation.