using lean for continuous improvement
TRANSCRIPT
Created by D Carr – BICS Team – December 2011 © Bolton NHS Foundation Trust 2011. All rights reserved. Not to be reproduced in whole or in part without the permission of the copyright owner
On 14th December 2011, approximately 50 leaders from the integrated Trust (including clinicians, Directors, staff-side, Divisional and Departmental Managers) came together to plan the strategic objectives for the integrated trust in 2012/13, taking stock of the changes to the organisation’s operating environment, the day was framed by the Trust’s five-year strategic vision, and led to discussions (catch-ball) as to what could be the breakthrough goals and improvement priorities for the Trust in 2012/13
Five-Year Breakthrough Goals – approved by Trust Board • 7 day services • Regulators’ top 10% • Exceeding all national patient access targets • Highest Care Quality Commission standards • Achieving top measures on assurance of quality • Sunday Time Top 100 employers • Achieve Shingo (Operational Excellence Standard) • In top ratings on measures of financial health (Monitor’s risk* rating of at least 4)
The attendees discussed and translated what the annual objectives for 2012/13 would be for strategic progress (moving towards goal) and came up with the following suggestions:
Draft Annual Objectives – for further discussion: • Same high quality care regardless of day for acute and clinically high risk patients and
services across all divisions. (Matching delivery and support to demand) • Improve outcomes for patients and population including sustained achievement of all
defined quality and safety standards. • Achieve all national and local access targets • Increase employee engagement score – close gap by 50% • Establish model pathway capable of winning Shingo Bronze – reference pathway for
organisational learning • Improve Monitor rating by closing gap, moving from 3 to 3.2
The group also discussed what would be the Improvement Priorities (how) the Trust would focus its energies into achieving these annual objectives. A “Dragons Den” will be held on 21st December with Lesley Doherty to feedback the discussions.
Next steps: Proposed annual objectives and improvement priorities will be
circulated wider for discussion, with the first draft of the L1 to be circulated in early January 2012, prompting Clinical Divisions to
start to translate corporate priorities to Divisional Objectives and so on.
Catch-ball—Please get involved and be part of the priority setting conversation and dialogue for your area.
The BICS Team are happy to assist teams with the development of their Level 2s and Level 3s etc, we are also
holding Policy Deployment awareness sessions (please see the BICS Academy section for more information)
For more information about the annual planning day and to see presentations from the day, take a look at the Strategy
Deployment section of the BICS intranet site
Issue: December 2011 BICS Newsletter
Using Lean for
Continuous Improvement
Special points of interest:
• Improvement News
• BICS Academy
• Sharing the Learning
• Forthcoming events
INSIDE THIS ISSUE:
Annual Planning Day 1
Planning Our Workload
2
Cancer Engagement 2
Bolton One 2
Early Supported Discharge
3
Micro Biology 3
Emergency Dept 6S 3
MSK Clinical Pathways 4
Safety Express—Falls 4
Intermediate Care 4
Policy Deployment 5
BICS Bronze 5
BICs Green 5
Handy Hints 6
IG Training 6
Annual Planning Day 2012/13
Joy Furnival
Associate Director of
Transformation
Created by D Carr – BICS Team – December 2011 © Bolton NHS Foundation Trust 2011. All rights reserved. Not to be reproduced in whole or in part without the permission of the copyright owner
Improvement News ………. Page 2
Bolton One is a new LIFT building procured by NHS Bolton, Bolton Council and the University of Bolton, the building has three components: • University sports science department • Local Authority swimming pool and hydrotherapy pool, • Health service provision.
In terms of the health component the services to be delivered from the building were selected by the PCT, prior to the introduction of the clinical commissioning group and have been the subject of public consultation. The building is due to be commissioned ready for occupation by February 2012 the building will remain in the ‘ownership’ of the PCT.
There are a number of workstreams linked to the safe and sustainable transfer of services into Bolton One and Carol Bernstein will provide project management support, in keeping with BICS principles and with focus in particular around the huge logistics issues required to bring the commissioned building into operational use. If you would like any further information please contact [email protected]
Bolton One Update
The Community Stroke and Falls and Community Therapy Teams are continuing their improvement journey, focussing on Planning our Workload (POW) (called Heijunka in BICS). An initial checklist identified that:
• The amount of time the teams spend with patients is not quantified • There are no clearly defined standards on the amount of time that needs to be
spent with patients each week. • Work is not distributed systematically, between team members • Work allocation within the team did not support geographical working for band 3
therapy instructors
Data collection has provided a baseline for the teams on how much time is spent patient facing whilst a visual planning board is supporting the new processes around allocation of planned and unplanned work referred into
the team Benefits—Community Stroke Team:
• Staff consistently reporting a manageable workload as evidenced by their planning sheets • Workload distributed equally across the team • Patient facing time quantified and the team target achieved at 90 days audit
Benefits—Falls & Community Therapy Team: • Band 3 staff to be achieving 50% patient facing time at 90 days audit • Band 3 staff to be allocated work in their geographical area with greater consistency in
maintaining these areas at 90 days
The teams will be continuing their hard work as they monitor the impact of these changes over the next 3 months and seek to invest the time saved into patient care. Well done to everyone involved. For further information, please contact [email protected] (Falls and community Therapy ) and [email protected] (Community Stroke)
PLANNING OUR WORKLOAD
An engagement event was held to look at how we can meet the Cancer 62 day target across all Cancer pathways in the Trust. As a Trust we need to see, diagnose and treat 85% of our patients within 62 days. This event was the prep for ongoing improvement work. The aim was to identify from teams the current challenges, share good practice and decide the next steps such as further events. We held 3 engagement events, which were attended by Consultants, Specialist Nurses and MDT Co-ordinators to understand what the issues and frustrations are across the 11 tumour pathways. The information collected from staff working in the Cancer pathways has been fed into an action plan, so work can be taken forward, such as: • Piloting a visual management for tracking patients on tumour pathways • An event for Cancer MDT Co-ordinators to understand processes, design visual management and create
standard work For further information contact [email protected]
Cancer Engagement Event
Created by D Carr – BICS Team – December 2011 © Bolton NHS Foundation Trust 2011. All rights reserved. Not to be reproduced in whole or in part without the permission of the copyright owner
Improvement News ………. Page 3
An engagement session was held on the 6th December at Winifred Kettle to update staff on what has been happening with the Alderbank Early Supported Discharge Rapid Experiment. The experiment
involves pulling work from the Intermediate Care Unit into Intermediate Care at Home to complete rehabilitation goals. This new way of working commenced on the 12th December at Winifred Kettle. Other changes at Winifred Kettle include revising the MDT meetings and board rounds.
For further information contact [email protected]
Early Supported Discharge —Intermediate Care Unit
Linked to the Laboratory Medicine Transformation Plan, Microbiology have implemented a number of improvements in their areas. Recent changes in National Institute of Clinical Excellence (NICE) guidelines and the introduction of new technology made urine processing less ineffective and wasteful and with limited flow. In week the team re-located the urine sample analyser and made IT changes, we collected data, calculated Takt & manual cycle time, organised the area for flow, and improved the standard work Benefits:
• Independent working for the Laboratory Assistant with clear Standard Work, • Improved working environment 6S score from 30% to 80%. • The manual cycle time reduced – equating to 90 minutes less processing time each day. • Training requirements and improvements in the training process were highlighted. • Reducing the number of problems and stress on staff. • Next steps: Implement further training and additional visual management, maintain and further improve the
processing area, creating flow in the reporting area.. Create “super-users” for analysers, and a review of the Microbiology reception cell to be carried out mid January. For further information contact [email protected]
Microbiology
The Emergency Department had multiple locations for orthopaedic related stock/equipment, with limited cleaning, stock management and appropriate storage standards - leading to cluttered, unsafe working conditions and time wasted locating items. Using 6S methodology, a team made up of department staff and fresh eyes, including the Chief Executive made a number of improvements:
• Relocated items at point of use where possible and ensuring appropriate storage by locating items frequently used in the most accessible location. For example, co-location of supplies required for Thomas splint (orthopaedic procedure) together and clearly accessible.
• Removed out of date/obsolete stock • Enhance the environment by cleaning, painting and new shelving • Set stock levels, stock rotation systems and put kanbans (stock visual management
system) in place
Benefits: • 6S score 80% (was 18.75%) with Environment score 90% (was 38%) • 100% of staff feel the areas is now clean (was 17%) • Stock reduced by 24% equating to £1,975 • 95% of staff now feel the stock is located in the right place (was 19%) • Reducing the time and number of steps to prepare for procedure e.g. plaster
The team reflected this event was “not just about a room, but the whole process in the department allowing us to do lots more and providing good insight into what else could be achieved using the BICS approach”. Thanks to all those who supported the event, a special thanks to estates team who were definitely part of the team!
For more information contact [email protected]
Stock Management system
Emergency Department –6S Orthopaedic Store
Created by D Carr – BICS Team – December 2011 © Bolton NHS Foundation Trust 2011. All rights reserved. Not to be reproduced in whole or in part without the permission of the copyright owner
Improvement News ………. Page 4
It was identified during the MSK value stream analysis (VSA) in June 2011 that there was a need to standardise the clinical pathways and treatment plans across the two previous teams. We are beginning by redesigning our top 5 conditions: Osteoarthritis of the hip and knee, back pain, Carpal Tunnel Syndrome and Dupuytren’s contracture. Our aim is to have agreed pathways for these 5 groups to ensure standard, equitable treatment which is based on best practice. Multidisciplinary teams, each with a Consultant lead, were set the task of redesigning their clinical pathway; they produced simple, easy to use flow charts that clearly direct
patients down the correct surgical or non-surgical pathway with the option to “cross over” based on clinical need. This was a definite step towards achieving the patients’ value statement for the service of “the right professional at the right time” – the team simplified patient journeys by reducing non-value added steps and unnecessary diagnostics (e.g. in the carpal tunnel pathway) and developed an identity for the spinal service with a clearer referral pathway for patients who present at the acute site. The next steps are to communicate all pathways to the relevant clinical groups, formalise the pathways and place them on the intranet for ease of access, and update patient literature. The spinal service will also be doing more work to plan for taking the service forward in the future.
For further information please contact [email protected] or [email protected]
MSK Clinical Pathways
During 2011 the Trust has been working to reduce harm to patients in four key areas:
• Pressure ulcers, • Reduction of serious harm from falls , • Reduction in Catheter Acquired Urinary Tract Infections and • Reduction in VTE. (blood clot)
The Falls workstream initially identified the potential root causes of falls and then designed a number of rapid experiments aimed at resolving the root causes; these included using visual management on walking aids and to identify patients at risk to ensure staff can see at a glance those patient who need help. Following the rapid experiment the team did not see the reduction in falls anticipated and it was decided to undertake root cause analysis (RCA) on each fall to check that the initial root causes were correct. This RCA has been successful in verifying that the team had been working in the right areas and identified that some patients had fallen during times when there were least amounts of staff for example at handover. It is now planned to continue to review falls and staff education. The next experiment is to try to simplify the care plan and look at implementing a care bundle based on the Royal College of Physicians report which we plan to start in January 2012.
For further information please contact [email protected]
Safety Express—Falls
Intermediate Care Single Point of Access The Intermediate Care Single Point of Access was implemented on the 12th December. All referrals to Intermediate Care Units now go through the Referral and Assessment Team. This will ensure the appropriate allocation of patients into the Units and mean decisions are made sooner about whether patients are suitable for Intermediate Care.
For further information contact [email protected]
Created by D Carr – BICS Team – December 2011 © Bolton NHS Foundation Trust 2011. All rights reserved. Not to be reproduced in whole or in part without the permission of the copyright owner
Page 4 BICS Academy
Green Level Certification Training
Confused by Strategy (Policy) Deployment? Then come along the Policy Deployment Awareness sessions to find out more! Policy Deployment is the method the Trust uses to set its stretch annual objectives and ensure they filter up and down the organisation and to ensure departments are aware of how they contribute to the delivery of corporate goals.
Who is it for? The training is particularly relevant to Department Managers, Clinical Leaders and those who are involved in the setting of Departmental objectives. Date still available are: • 17th January, 1:30—4:30 pm BICS Room 1 Musgrave House, Royal Bolton Hospital • 26th January 1:00– 4:00pm (community venue to be confirmed)
Further dates in 2012 can be arranged should there be sufficient demand; alternatively we can deliver bespoke training and help you with the development of your Directorate/Departmental objectives for 2012/13. To book a place contact [email protected], further information about Strategy Deployment can be found via this link: Strategy Deployment
Due to demand the BICS Team are pleased to offer an additional date for BICS Bronze Accreditation in January 2012. Taking place on the following dates:
Monday 23rd to Wednesday 25th January 2012 – BICS Department, Musgrave House
Bronze Level Accreditation is the second level of the BICS Learning and Development Academy. The course focuses on enhancing leadership and BICS skills either to lead improvements or to be a more confident team member. It covers using tools such as A3 thinking, mapping and problem solving. It will help you to see waste and prepare for how your staff may react to change. The
course provides theory, supported by practical application and examples, reflection, group discussion and sharing experiences.
Pre-course criteria: Should you wish to apply, please ensure you fulfil the pre-course criteria of attending Green Level Awareness and participating in at least one improvement event. Please apply by in house application form, approved by your manager and return to [email protected]
Green Level Awareness Training - 2012 Dates Available
Strategy (Policy) Deployment—Training Session
BICS Bronze level Certification—Extra session
We are pleased to announce we are now taking bookings for the 2012 Green Level Awareness sessions based both in the community and hospital venues
Places are available on the January session based in the community at Pikes Lane Centre, Training Room 1 on the following date: • 10th January 2012 (9:30—12:30) Places are available January session based at the hospital in the BICS Department, Musgrave House: • 4th January 2012 (9:00—12:00) • 5th January 2012 (9:00—12:00) • 17th January 2012 (9:00—12:00) • 18th January 2012 (9:00—12:00)
Please click on Green Dates 2012 for alternative dates
Please note: if you have already attended BICS Green Level or EQIP Awareness you do not need to attend this session again, unless you wish to do so as a refresher. To book a place contact [email protected]
“Fantastic course, taught and delivered very well. Learnt a lot regarding change and will take it back to my workplace and recommend Green training.”
Created by D Carr – BICS Team – December 2011 © Bolton NHS Foundation Trust 2011. All rights reserved. Not to be reproduced in whole or in part without the permission of the copyright owner
SHARING THE LEARNING: Page 6
Events that took place in December
Microbiology
Emergency Department 6S MSK Pathway
Cancer Engagement
Take a look at our case study page on our intranet site for more information on these events.
Forthcoming Events
The following events/improvement cycles will take place in January:
Vascular Service Review
The Parallel Neuro-Rehab Microbiology
Exemplar Programme
Specialty Reviews: Rheumatology Adult Hearing
Podiatry Sexual Health Oral Surgery
Watch this space for more information
Next BICS Outbrief
10th February in the Sports &
Social Club
12.00 pm Everyone welcome!
For more information about this, any of our events or about BICS in
general, contact us or refer to our intranet site:
Contact details: [email protected]
01204 390482 (ext 5482)
Website:
“Bolton Improving Care System”
Handy Hints—Learning about Lean
New books available in the Trust Library: Each month the Library (based in the Education Centre) adds new books to its collection. This month’s sees a number of new titles are based on the subject of Lean and continuous improvement and standard work (see below):
If you are interested in any of the above books, please e-mail [email protected] to reserve a copy.
If you have an idea to share or to find out more email the BICS Team at [email protected]
Shelfmark Author Title
HD 70 GAW Gawande, Atul The checklist manifesto: how to get things right
WX 153 GRA Graban, Mark Lean hospitals: improving quality, patient safety and employee satisfaction
HD 70 MON Monden, Yasuhiro Toyota production system: an integrated approach to Just-In-Time. 4th edition.
HD 70 ROT Rother, Mike Toyota kata: managing people for improvement, adaptiveness and superior results
As part of the Trust’s commitment to Information Governance we are required to have assurance that 95% of staff have up to date data protection, information security and confidentiality training as part of their professional development. Information Governance is one of the key standards that external assessors such as the Care Quality Commission use to measure the Trust’s performance.
The IG Online Training Tool focuses on all aspects of learning about Information Governance, the aim being to develop and improve staff knowledge and skills in the IG work area and to support the provision of high-quality health and social care.
Please Note: All staff who have previously completed the Introduction to Information Governance or Beginner’s Guide to Information Governance must undertake the Refresher Module. Staff who have not done either of these modules must register and undertake the Introduction to Information Governance module. The training must be completed by March 2012.
The Information Governance training can be accessed via this link http://www.igte-learning.connectingforhealth.nhs.uk/
Information Governance Training
The BICS Team would thank those teams and individuals we have worked with in 2011 for their hard work, innovation and determination to improve
services for patients and staff alike.
We would like to wish all staff a very merry Christmas and look forward to working with you all in 2012.
Merry Christmas and Happy 2012