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Highland Quality Approach
Quality in Action
Gavin Hookway
Senior Quality Improvement Practitioner (Lean)
NHS Highland
Putting quality first to deliver Better health, Better care and Better value
Captures the spirit of how NHS Highland is working to improve care and outcomes for people…and describes the way we want to
“do things here in NHS Highland”
The Highland Quality Approach
OUR Strategic Framework
Quality & Efficiency Framework
Eliminate WASTE
Manage VARIATION
Eliminate HARM
Person Centered
QUALITY
We relentlessly pursue the highest quality outcomes of care
Method Focus Culture
Virginia Mason Production System (VMPS)
Patient is always first
Focus on highest quality & safety
Engage all employees
Strive for highest satisfaction levels
Maintain a successful economic enterprise
Based on Toyota Production System (TPS) methodologies (Lean)
Method Focus Culture
Cancer
Patient Flow
Patient Management System
Method Focus Culture
LEAN, SPSP, Productive series
Tool kit, evidence based
Remove waste + add value for all our patients
Apply training with rigor & consistency
Define
Sustain
Improve
Analyse
Measure
SPSP
LEAN
Not addressed
Qu
alit
y Im
pro
vem
en
t
Create bundles
through
observation and
rigour
Run charts
PDSA
Kaizen RPIW PDSA
Productive Series
PDSA
Standardised
tools & solutions.
Some bundles set
Bundles
set and given
Not addressed
LEAN allows practitioners to spend more of their time caring for
people and improves the quality of care these people receive
15 RPIW’s completed
50 RPIW’s planned for 2014-2015
9 Certified Lean Leaders - Qualified
20 Certified Lean Leaders in training
6 Certified Lean Leader Coaches in training
Over 1200 staff trained to Basic Awareness Level
Quality in Action
Mid Argyll
Community Mental Health
RPIW – 5th August 2013
RPIW Project Form
Event Name: Mid Argyll & Bute Community Mental Health Date: 5th August 2013
Sponsor: Deborah Jones Board Strategic Goals (linked to this process)
Provide quality care all times Support people and communities to maximize their own health Develop precision driven services so that when people need our care they experience; timely,
focused, effective services, that minimize the duration and frequency of contact; Ensure that every health pound spent delivers maximum health gain Specifically to develop a mental health service which aspires amongst many core principles to
deliver care predominantly provided in the individuals community or own home and where hospital admission will be for the few.
Current Situation:
Small team comprising a core of 5 members supported by other specialists looking after clients from the geographic area of Mid Argyll.
There is variation of referrals into the service There is variation in the methods used to process referrals once received in to the service Case load triage on referral through single point – 1
st and 2
nd stage triage are manual process
Patients allocated in accordance with need, priority, specialty and available capacity (gender preference also a consideration).
Total case load across 5 core members, as at 12 June 2013, 131, of which 109 active and 23 on waiting list. There is variation in capacity of specialist team members to accommodate MA referrals.
Patients placed on waiting list are not offered an appointment until relevant team member’s discharge from existing case load if at capacity. There is variation in waiting time for first appointment.
Workshop Leader: Gavin Hookway / Derek Leslie
Team Leader: Derek Leslie / Gavin Hookway
Process Owner: Douglas Philand
Team Members Advisory Group
Ros Box Nicola Gillespie Geraldine Hannan John Lawson Amanda Adams-McGilp Valda Parnaby Fiona McClean Moira Harrison Tina Jordan (tbc) Social Worker (tbc) Fiona Margach Sheena Clark Kristin Gillies
John Dreghorn David Logue Fiona Coffield Fiona Broderick Consultant Psychiatrist (tba) Cameron Stark Linda Kirkland GP (tba) Glen Heritage (AVA)
Production Requirements/Takt Time Calculation 782 minutes
Process Flow: RPIW Theme/Overview
Community Mental Health Service – Mid Argyll. Effective triage and case lists management to minimise number of clients waiting for first appointment and to ensure any related waiting time targets are met.
RPIW Targets/Boundaries
Start point on receipt of referral to department.
End point is patient discharge or onward referral.
Impact of workload management on team capacity. RPIW Measures Reduce numbers on the waiting list – reduce from 23 to 0 (zero) Reduce waiting time for patient from referral to first appointment – max 12 week wait
Ensure demand is in balance with available capacity. Improve quality of care given to all patients.
Revision: Version 3 – 24/07/2013
Receipt of Referral
1st Stage
Triage
2nd
Stage Triage referral
Outcome of 2
nd Stage
Triage
1st
AppointmentBooked
1st
AppointmentAttended
Patient Discharged from Service
Target Progress Report
Team Name: Community Mental Health Team Date: 24 July 2013
Department: Mid Argyll TAKT Time: (include calculation)112500mins /144 patients = 782 minutes
Product/Process Summary: From Receipt of Referral to point that Patient is given first appointment
Team Leader: Derek Leslie Sub-Team Leader:
Workshop Leader:Gavin Hookway Process Owner: Douglas Philand
KPO Coach (if applicable): Keith Appleby
Metric (units of measurement) Baseline Target
Day 2 Day 3 Day 4 Final 30 days mm/dd/yy
60 days mm/dd/yy
90 days mm/dd/yy
12 months mm/dd/yy
% Change
Space (square feet)
Inventory (£s)
Staff Walking Distance (feet) Travel
Parts Travel Distance (Minutes) 14 (>= 50%)
Lead Time (Weeks) 52 (>= 50%)
Work in Process (WIP) (units observed in the
process) 132
Standard Work In Process (SWIP) (lead
time/takt time); target SWIP should be target lead time/takt time
149 72
Quality (defects)(%) Referrals via SCI 97% 100%
Productivity Gain (FTEs – see target metric
definitions for formula to calculate baseline)
Environmental, Health & Safety (5S) (levels 1
thru 5) – specify for physical space or virtual space 1 Level 4
Set-up Reduction (minutes)
Remarks:
128,526 (53 Weeks)
40,961 (17 Weeks)
34
Standard Process Description: NAME referral receipt to offer of appointment
Quality Check Safety Precaution Standard WIP
Notes:- Add notes about related policies or any acceptable exceptions in sequence of steps
Who Must Adopt This Process: team leader or deputy and administration
Takt Time:
GOAL: List key quality and lean targets
STEP Add
Quality, Safety or
WIP symbols
as needed
OPERATOR List role
responsible for each task
TASK DESCRIPTION
TOOLS/SUPPLIES REQUIRED
Fill in as needed to explain use of a specific tool or
supply Add photos if valuable to provide clear instructions
CYCLE TIME Amt of
processing time to
complete each step
1. Admin
Retrieve twice daily log into SCI using login process checking the referral received
Computer with access to both SCI and Helix
2.
Admin
Copy the SCI referral into helix “this will need to be confirmed by information” this will result in the referral being activated on Helix Copy and email referral to team manager or deputy
As above and outlook access for email to manager or deputy
3.
Team manager
Team manager will need to open referral received from administrator using the 1-2 triage 3-4 triage tools complete the referral triage process Email confirmation of completed triage back to team administration for 2-3-4 And to Fiona Margach for level 1
Computer and outlook Triage tools level 1-2 Triage tools level 3-4 “need laminated copies of the triage tool for staff completing action remotely”
4.
Admin
Access team outlook diaries and for 3-4 client check available assessment appointments
Computer Clinician diary appointments
5. admin Completion of referral letter re client appointment:-
Level 2 letter is an opt in letter completed
Template letters 2-3-4
Standard Process Description
NAME referral receipt to offer of appointment
Standard Process Description:
Diary Management
Quality Check Safety Precaution Standard WIP
Notes:
Who Must Adopt This Process: All team members
Takt Time:
GOAL: List key quality and lean targets STEP
OPER-ATOR
TASK DESCRIPTION
TOOLS/SUPPLIES REQUIRED
CYCLE TIME
1. All Each team member should give full access to their diary to other members of the team by:-
In Outlook Calendar click on share my calendar
In dialogue box click add, select the team member from the drop down list, change the permission level to editor, check that create items, read items, edit items All and delete items All are ticked
Continue until all members of the team have been selected
2. All Any appointment that has personal identifiable information should be marked as ‘Private’ to conform to Information Governance requirements, any appointment marked as private can only be read, opened or changed by the owner. To mark an appointment as private, select the appointment, right click with the mouse and select private, a picture of a key will be displayed in the diary entry.
3.
All All appointments including planning time for events should be booked in the Outlook calendar as soon as they are received using the following colours:-
None Annual leave/flexi assessment
Standard Process Description
Diary Management
Mid Argyll CMHT SBAR/B
S
SITUATION This is ________________________________
Calling from ____________________________
Regarding patient ________________________
I am bringing this person to the meeting because:
B BACKGROUND Is ____ year old Male / Female Referred by _________________ for ___________________________ History of service(s) involvement / Other professionals involved: PHQ9 _________________________________
CORE / Risk Scores _______________________
Their Goals ______________________________
Symptoms (brief) Impact on Life:
A ASSESSMENT Key Issues are:
R RECOMMENDATION My question to the team is:
D Decision (Team) Who: By When:
5S
Standard Process Description: NAME communication cell management
Quality Check Safety Precaution Standard WIP
Notes:- Add notes about related policies or any acceptable exceptions in sequence of steps
Who Must Adopt This Process: team manager and team members
Takt Time: 5 min daily
GOAL: List key quality and lean targets
STEP Add
Quality, Safety or
WIP symbols
as needed
OPERATOR List role
responsible for each task
TASK DESCRIPTION
TOOLS/SUPPLIES REQUIRED
Fill in as needed to explain use of a specific tool or
supply Add photos if valuable to provide clear instructions
CYCLE TIME Amt of
processing time to
complete each step
1. Team manager and team members
Agree the key issues for discussion at the communication cell – daily briefing NB: may want to consider the following:-
Number referrals received previous 24hour period
Number referrals allocated for assessment previous 24 hour period
Case load management white board VCB
Waiting list position treatment
Team Value stream map Target progress sheet
pre 30, 60, 90day PDSA re-measures and target metrics
NB this is the element of how are we doing
Referral information Assessment information Case management Waiting list information Computer Helix information SCY information
2.
Team manager and team admin
Update the referral received previous 24 hours and referrals allocated for assessment (metric update) Check progress against RPIW target metrics Check clinical staff have updated to case load information
Visual control board Project form Future state VSM Target progress report sheet
3.
Team
Walk the wall “brief staff attending the 9am meeting” NB
Speaker phone for staff phoning or webex
Standard Process Description
NAME Communication Cell Management
Target Progress Report
Team Name: Community Mental Health Team Date: 24 July 2013
Department: Mid Argyll TAKT Time: (include calculation)112500mins /144 patients = 782 minutes
Product/Process Summary: From Receipt of Referral to point that Patient is given first appointment
Team Leader: Derek Leslie Sub-Team Leader:
Workshop Leader:Gavin Hookway Process Owner: Douglas Philand
KPO Coach (if applicable): Keith Appleby
Metric (units of measurement) Baseline Target
Day 2 Day 3 Day 4 Final 30 days mm/dd/yy
60 days mm/dd/yy
90 days mm/dd/yy
12 months mm/dd/yy
% Change
Space (square feet)
Inventory (£s)
Staff Walking Distance (feet) Travel
Parts Travel Distance (Minutes) 14 (>= 50%) 14 14 0%
Lead Time (Weeks) Lead Ref to Discharge
Lead Time (Weeks) Ref to Allocation of First Appt
52 34
(>= 50%) 22 11mins
22 9mins
+58% +1102%
Work in Process (WIP) (units observed in the
process) 132 146 146 -9%
Standard Work In Process (SWIP) (lead
time/takt time); target SWIP should be target lead time/takt time
149 72 67 67 +65%
Quality (defects)(%) Referrals via SCI 97% 100%
Productivity Gain (FTEs – see target metric
definitions for formula to calculate baseline)
Environmental, Health & Safety (5S) (levels 1
thru 5) – specify for physical space or virtual space 1 Level 4 1 2 +25%
Set-up Reduction (minutes)
Remarks:
30 Day Report Out
60 Day Report Out
90 Day Report Out
365 Day Report Out
Thankyou Any Questions?