1. Productive and Lean Improvement Initiatives Team Champions Training 26 th July, 2013 10:00 – 13:00 Parkland Hospital

2. Objectives for the day Ensure understanding of Productive and Lean methodologies Ensure clear understanding of implementation strategy Linking Productives and Lean methodology to trust QID strategy Gear up team support for Productives and Lean Identify and harnessing the strengths, opportunities and in implementing Productives and Lean improvement initiative To review and understand the purpose and application of Measurement for Improvement To look at how data can be used to drive improvement at the frontline

3. The Link between Productive and Lean Productive is a service improvement tool designed by NHS institute for all NHS and healthcare organisations for sustained continues improvement. Productive adopted all the improvement principles from Lean methodology.

4. What is Lean? Foundations of lean thinking are found deep within automotive production system, and is now being adopted by a number of different industries: Toyota to become the most profitable automotive company by 2010 helped by the implementation of LEAN Tesco the most successful supermarket Boeing eliminated 48,860 hours of lead time to building planes It is a practical way of looking at and improving processes. LEAN uses a set of proven tools and techniques to identify and eliminate waste.

5. What is Lean in healthcare? Lean is an approach that seeks to improve the patient journey- (the flow) It is the process of identifying and eliminating the least wasteful way to provide value to patients. Identifies where bottlenecks occur in patients journey; and improve the flow within the pathway.

6. REASONS FOR LEAN To be more business oriented in light of the recent commissioning and provision split. To not only meet but exceed customer expectations. To empower and motivate staff to excel in their area of work. To increase quality of services provided

7. Purpose of Lean in SHFT A tool to deliver service improvement and business strategy for SHFT and to achieve its objectives: Improvement Strategy- ‘to create an environment in which all our staff are encouraged and are able to develop and deliver high quality. Lean will support services to become streamlined to operate more efficiently and effectively with the resources available.

8. What will LEAN in SHFT look like? Phase One: Embed continuous improvement in front-line teams. Phase Two: Undertake Rapid Improvement Events, supporting reduction in waste, service improvement opportunities and ensuring resource efficiencies.

9. Critical success factors Lean must be part of long term Trust strategy This is not a FAD!!! Staff must be empowered to make improvements Board commitment and clinical leadership is essential Dedicated service improvement resources accelerate change Focus on the system, the flow that creates value, then apply the tools Get results quickly – deploy a series of rapid improvement events

10. What is flow & why is it important? To move or run smoothly with unbroken continuity To move the patient through their treatment journey as smoothly as possible. To eliminate bottlenecks from occurring To be able to achieve repeatable and consistent results

12. What is waste? Waste is: ‘Anything other than the minimum amount of equipment, materials, parts, space and peoples time which are absolutely essential to add value’. Can be defined as Value Adding and Non value adding.

13. Understanding Waste. The eight wastes: Idle time waiting Processing Overproduction Transportation Stock on hand Unnecessary motion Defective goods Not using peoples creativity

14. Group activity In identified groups give three health related examples of waste under each heading. Feedback findings

15. How do we Improve flow and eliminate waste? Specify value : What is important in the eyes of the patients and staff? Understand demand: What is the type and frequency of the demand? Flow: Analyse how will the patient and information flow through the patient journey?

16. Steps to improve flow Identify and improving what hinders the flow of the patients journey by employing the use of LEAN methodology. Identify current state (Measure for Baseline) Identify what needs to be eliminated in the process Create future state Implement change Monitor progress of change Measure success of change

17. Teamwork and Lean Why is this important? What are the advantages of a team approach to lean What are the disadvantages to a team approach to lean What could hamper your progress on your lean journey?

18. Team checklist Identify the champion(s) Ensure Lean implementation structures are followed to support a team approach Ensure shared goal in Lean outcome Ensure a climate of trust and openness within the team

19. Common Lean tools (principles) Lean methodology can be implemented in any environment using one or a combination of any of the following principles; 5s model PDSA (Plan, do Study Act) Process maps Visual management Rapid Improvement Events Why’s ( ask WHY? five times) Demand and capacity management Statistical Process control (SPC)

20. Using Process maps to evidence waste

21. 5s Improvement Principle The clinic/area/room/department in which you work needs you to apply……… Sort Straighten/Simplify (Set in order) Shine Standardise Sustain

22. More appropriate stock levels – based on clinical need BEFORE LEAN AFTER LEAN

23. 5 S BENEFITS An organised, efficient workplace for improved productivity. Improvement in safety and less clutter through a cleaner work place. Reduction in inventory and supply cost Better usage of valuable office space and minimising overhead cost Increase the “feel good” factor about the service, work environment and job satisfaction.

24. Measurements for Improvements Why Do You Need Data and Information? To plan for improvement For testing change For tracking compliance For determining outcomes For monitoring long term progress To tell their story “If you can’t measure it, you can’t IMPROVE it”

25. Model for Improvement Using Data to answer the questions posed in the plan for each PDSA cycle Using Data to understand progress toward the team’s aim

26. Need for Measurement Improvement is not about measurement. But measurement plays an important role: Key measures are required to assess progress on team’s aim Specific measures can be used for learning during PDSA cycle Data from the system (including from patients and staff) can be used to focus improvement and refine changes “You can’t fatten a cow by weighing it” - Palestinian Proverb

27. Factors influencing Sustainability Strategic Leadership, is implementation important to an organisation and senior leaders. Strength of ward/team leadership and continuity of ward leadership Linking Implementation to operational agendas with operational agenda. For example could an operational need to improve a deficit in practice be supported by KHWAD or a process module.

28. Factors influencing Sustainability Developing a process to assess sustainability; sustainability audits carried out at intervals.. Grouping wards/teams together to implement a module. 5 or 6 wards working together can bring a level of healthy competition.

29. Thank you for listening