1. Introduction into Lean and the Every Patient Matters Transformation Programme Section A1

2. Introductions/Objectives Introduce yourself Why have you come along today? Section A2

3. Objectives Explain what Lean is Describe the aims of the Every Patient Matters Transformation Programme Be able to apply at least one Lean technique in your workplace Section A3

4. Introduction into.. Section A4

5. Why do we need Transformation? Fire-fighting has become the norm Patient’s are pushed through the system – no flow Stressed out staff Outdated processes Section A5

6. Previous ‘Change’ Initiatives Productive Leader (on- going) RUH 2010 Orthopaedic Lean Project Productive Operative Theatre (TPOT) Productive Ward Section A6

7. Improving Quality Quality, Innovation, Productivity and Prevention What are the programme objectives? Perception is that it’s all about efficiency savings Every Patient Matters falls under the QIPP umbrella and reports to PMO (programme management office) Section A7

8. QIPP Projects Acute Oncology Ambulatory Care Emergency Surgery Pathway Theatre Scheduling Outpatients And many more… Quality and the impact on patient experience is the most important factor to consider when scoping a project Section A8

9. 9

10. Vision for Transformation “To deliver the best possible care to ‘every patient’ involving all staff in developing a culture of ‘continuous improvement’” Section A10

11. What is Lean? What do you think the term ‘Lean’ implies? “Lean is not an acronym, it is a collection of tools that assist in the identification and elimination of waste (e.g. queues, duplication, re-work, waits and delays) and focuses on the customer/patient” Section A11

12. History of Lean Lean thinking, developed from the Toyota Production System, has been applied in many competitive sectors. It is about changing a business from the roots up; working to a set of principles to produce a culture of continuous improvement that will drive sustainable results. Section A12

13. Industry Examples of Lean Section A13

14. Why use Lean? Such thinking is increasingly being applied to health services in the UK and overseas to: improve the quality of patient care improve safety eliminate delays reduce length of stay while using no more resources Section A14

15. 5 Principles of Lean 1. Value: Specify value, this must be defined by the customer/patient. Otherwise known as Voice of the Customer 2. Value Stream: Identify the value stream/patient journey and the processes that define it. 3. Flow: Align healthcare processes to facilitate the smooth flow of patients and information 4. Pull: Deliver care on demand with the resources needed for it. 5. Perfection: Develop and amend processes continuously. Section A15

16. Value Stream Mapping Used to identify the processes involved in the value stream and which elements had value to the customer Different from process mapping in that you identify value added and non value added steps for the customer and quantify time. Section A16

17. Section A17

18. Section A18

19. Lean Principles Exercise Exercise 1: In groups look at the value stream in front of you and complete the questions in the exercise sheet Section A19

20. 5s – a simple tool to start with 5s is a good first lean technique to use back in your work area; Sort Standardise Set in Order Sweep and Shine Sustain Section A20

21. Before and After pictures Section A21

22. 5s Principles Engage others in your workplace with the 5s Start small with your own desk! Take photos before and after Section A22

23. Waste Waste is anything other than the minimum amount of equipment, space, staff time, which are essential to add value to the product or service. In Lean 7 types of wastes have been identified, there may be more that you can think of Section A23

24. 7 Types of Lean Waste Section A24

25. Waste Exercise Exercise 2: In pairs, spend 15 minutes thinking of NHS examples for each of the 7 wastes Section A25

26. Waste Walk ‘Walking’ the process from beginning to end (or end to beginning); Walking each step, watching what actually happens (as opposed to what you are told that happens or what is contained in a process flow chart or procedure); Talking to the people who undertake each task to establish how it happens (and does it happen this way each and every time?); Observing for ‘wasteful’ activities; Developing a ‘shopping list ’of measures (data) required that will inform the investigation; Photographs –anything and everything that appears relevant (do you require permission?); Section A26

27. “Best possible care through lean thinking is not a project, it is a fundamental change to the way in which the hospital delivers its services to patients” Section A27

28. Lean Awareness 200 RUH staff Section A28

29. Lean Leadership Section A29

30. Culture and Climate “Change in an organisation calls for leaders to recognise and balance culture and climate dimensions.” Culture can be divides into five components: values, beliefs, myths, tradition and norms. Climate is the label used to describe the dimensions of the work environment E.g. organisation structure, leadership style, communication, historical forces. Section A30

31. Culture and Climate Exercise Do we have a climate and culture that encourages change? Exercise 3: Group 1 - Describe the current Culture and Climate of this organisation Group 2 - Describe what the Culture and Climate of this organisation needs to be. Section A31

32. What do our leaders think? Link to chief exec conference culture question http://webserver.ruh- bath.swest.nhs.uk/everypatientmatters/Lean/leader ship/index.asp?menu_id=5 Section A32

33. Factors to achieve desired culture and climate 1. Clear Vision 2. Set of values in alignment with the vision 3. Accountability for both performance and behaviours with consequences when standards aren’t met. 4. High performing teams that work independently and put the needs of the organisation before personal needs. 5. Value added communication 6. Rewards/Recognition Section A33

34. Next Steps Get your colleagues involved in a 5s activity Think of a problem that you think you could apply some lean principles too Book yourself onto the two day change agent training Discuss location for waste walk Section A34

35. Lean Change Agent Training Two day change agent training follows this half day and includes; Exercises and group work to demonstrate lean principles Waste Walk in your department Process mapping – value added, non value added Human dimensions of change Handbook provided with Lean toolkit incl. Transformation Approach Please complete feedback sheets – be honest as you like! Section A35

36. Section A36