1. NHS Highland Stuart Caldwell

2. Our Kaizen Programme 6 week programme in June 2008 3 Work streams –New patient referral –Re-referral –Depot MDT teams - everyone involved ~17 staff

3. What we did… Value mapped processes to identify Bottlenecks, duplication and constraints Waste – non-value work Information flow & understanding KPI’s

5. Tools we used Process flow analysis Value stream mapping 5 S 8 Wastes Mistake Proofing (Poka Yoke) PDSA Root Cause analysis –5 Why –Fishbone

6. Soon and Routine Scheduling not Working Plate Numbers issued by Admin Team Excess Inventory (chairs) the Depot Quality of information on Referral Forms poor Assessment of chairs not conducted timely Sub optimal use of database Cushions not controlled correctly Depot condition very poor, 5S, Layout etc. Status against 8 major concerns identified by the Team New date priority system running Plate Numbers issued by Depot Inventory (chairs) reduced by 43% New referral form to be implemented Assessment of chairs conducted on arrival Current actions will only address 20% of inaccuracy Process now in operation New layout and processes to maintain implemented

7. Workshop Conditions before and after 5S

8. Stores Changes and Control. Before After

9. Stores Changes and Control. Well organised stores area (easy to control and find parts.

10. Reclaimed Materials Examples of parts that used to be scrapped off.

11. New Area for Reclaimed Materials Old area (poor utilisation of space) New area (better utilisation of space)

12. New Process for Reclaimed Materials

13. Results Summary Improved Service Performance Scheduling system eliminates the need for individuals to make prioritising decisions. Scheduling system will provide the team with accurate data which will keep patients informed. Time savings for Admin team gives extra capacity and reduces pressure on team. Calculated process lead time reduction (from activities implemented) is 8 working days. K.P.I.s will allow the department to understand current condition and prioritise future activities and improvements. Stock reduction of 40% saves wasted resource and gives cost saving. Removal of hired storage container returns a cost saving. Structure and procedures in the depot will generate productivity savings. Control of reclaimed parts will save money and increase accuracy of database.

14. Legacy Improved Service Performance Cost reduction Training in basic lean tools will help team continue with improvement activities -K.P.Is enable:- Problems to be located, understood and rectified quickly Problems to be located, understood and rectified quickly Visualisation of all the Key Performance Indicators in one location Management are able to prioritise & plan resources to optimum effect, thereby reducing waste & reducing costs With effective controls, a large number of management issues can be handled simultaneously Meeting structure will provide: Clarity for senior management team (policy deployment, new initiatives etc) Direction to teams within the Wheelchair Service. A process for continual improvement A ‘vehicle’ for good communication. Process for all employees to escalate concerns and constraints. Improved teamwork Improved Morale

15. Other Major Improvement Opportunities Job and process clarification extending the lead time Attendance extending the lead time Order chair to patient (specification set up) Cost saving by extending the reclaimed parts area Process clarification and process control Budgetary Control Accuracy of data and data control Teamwork development Top 2 concerns that must be addressed

16. Future Activities? / Areas of Concern Process Management and Knowledge Transfer K.P.I. Governance and K.P.I. Deployment Wheelchair Services best practice sharing and performance management Implementing and achieving Service Standards Attendance and Attendance Management Job Description (Roles and Responsibilities) Skill Matrix and Assessments

17. Strengths Structure to processes (defining, definitions, rules) Thinking about process from end to end Open and straight forward talking Passion in employees Autonomy given to the correct departments and people Support for top management team 6 week timing (time to assess and gather data. Introduction into the new tools and techniques New process will make the decisions and prioritise Weaknesses Time / Availability of Team Pressure on individuals Initial Attitude (people with baggage) Backlog of work created at depot Service understanding of programme SWOT Analysis of Programme

18. Opportunities Timing good to help redefine the business case Right person doing the right job Expands and develops peoples roles Setting targets for the future Robust governance and performance management Tools will help service development Applies lean methodology in a structured approach Threats Agenda to Change (demarcation, and working round ideal solution. Project management If people short cut the processes Backlog of work masking the improvements initially Succession Planning (Lack of) SWOT Analysis of Programme

19. Learning Points Better Availability Planning Better Understanding of the Process & Expectations Baggage Drop Cross-Functional Teams Work The 6 Weeks worked for the wheelchair service Tools & Techniques are Transferable

20. Staff Comments Opportunity to be heard Good for morale An opportunity to change things Been a good/positive experience Been suggesting all this for years Interfered with workload – built up a backlog Still need a new build with more space & better working environment

21. Ongoing Work Database processes and usage Competence development and job role expansion Inventory and reclaimed parts Referral information accuracy Developing standard operating procedures Implementation of new meeting structure