2. CAPA is Lean p198-199 Toyota mantra: People + Brilliant processes = Amazing results Always: Add value Smooth flow Pull not push Make decisions slowly, implement quickly Relentless reflection Go see for yourself

3. Add value Only 5% of NHS activity adds value!! What % in NZ? Cut waste (TIM WOOD) 1. Transportation-e.g have notes ready 2. Inventory- only have what is needed 3. Motion- reduce travel 4. Waiting-reduce and make active 5. Overproduction-not too many appts 6. Over-processing-not too many things 7. Defects correction- do it right first time

4. Smooth flow p 174-177 Analyse bottlenecks Full booking Daily referral screening Reduce number of queues with Core work Segment similar needs together Plan time for admin Give families things to do until next step HELPFUL Habit

5. Pull dont push Increase pull- draw resources to the user Flex capacity Use full booking systems in Choice and Partnership Specific work added, not another waiting list Reduce push systems: fixed appointments- urgent slots Avoid waiting lists

6. Toyota Production System Goal: highest value to customer, as fast as possible Respect for People Continuous Improvement Product Development: 14 Principles Foundation: Management applies and teaches lean thinking

7. Pillar 1: Respect for people Don't trouble your customer Includes the person after you in the production chain Develop people then build products Managers Walk the talk They are lean themselves; eliminate waste etc Develop teams Team work not group work Teams and individuals evolve their own practices and improvements

8. Pillar 2: Continuous improvement o Go see (gengi genbutsu) o Solve at the source not behind desks o Kaizen o My work is to do my work and to improve my work o Local experimentation o Continuous improvement o Value and waste o Perfection Challenge o Work towards flow

9. 14 principles Some highlights.. Use pull systems Stop and fix problems (this means attend to issues now to save time later Visual tools (e.g. not just printed schedule information but how to bring the processes and info to life in a visual way) Decide slowly by consensus, implement quickly Time boxing Setting small and near time limits to avoid outcome delay

10. Lean Thinking Is a set of tools and ideas that simplify the Toyota Production system Largely miss out the first pillar of Respect for People Effective none the less

11. Lean Principles Specify Value: every step must add value Would the customer pay for it? (don't forget the customer is also your colleague after you!) Identify the Value stream I.e. what acts add value? Make the Process flow Create Pull systems Pursue Perfection

12. Waste 1. T ransportation 2. I nventory (large stock) 3. M otion (having to move to complete tasks) 4. W aiting 5. O ver-processing 6. O verproduction 7. D efect Correction

13. Waste exercise (20 mins) Separate in small groups of 4-5. For each type think about your service See if you can find waste of this type Meet and discuss the identified wastes Longer exercise... As a group pick some of the wastes Go back into the small groups to think of possible solutions Meet up again to plan!!

14. Push vs pull systems Push Timing of items flowing through system is based on high level commands or schedules Up-stream or Top down commands Or number of things provided is based upon planning CAMHS examples?... Fixed number new patient appointments Pull Capacity provided or movement of items in a system based on down-stream requests Services or products are pulled to the customer by their demand CAMHS examples? Stock / inventory control examples Kanban cards in TPS Visual cards that signal a need for restocking (a pull request)

15. Exercise: is CAPA a Lean system? Think about the CAPA system and consider which bits are pull and which are push Think about which steps add value and eliminate waste cf traditional CAMHS