The sensitive application of lean six sigma tools in healthcare

1. The sensitive application of lean six sigma tools in healthcare Graphic from www.scotland.gov.uk “Living Well with Long-Term Conditions” Austin Davey Minitab Quality Seminar Sheffield 22 September 2010

2. Overview: • You are probably used to hearing about process improvement within manufacturing and transactional environments. • Today, I would like to spend a little time describing how Minitab and Quality Companion are applied within the UK healthcare / the NHS. • Overview (now!) • The NHS • Popular tools and applications of Minitab • Popular tools and applications of Quality Companion • Review • Any questions?

3. Setting the scene (1): • The sensitive application of lean six sigma tools in healthcare? • Minitab has been used for data analysis within service improvement projects within the NHS for more than a decade • One of the drivers is as follows – ten-year NHS plan... • [section 5.4] “We have set out a vision for change...much excellent work on which to draw, but too often it is fragmented in its approach...keep and build on existing good practice...” • [section 5.5] “...cannot happen overnight...but the NHS must change to respond to a changing world” • [section 5.6] “...achieving meaningful and sustainable quality improvements...requires a fundamental shift in culture, to focus effort where it is needed ...” • [section 5.7] “...a continuous programme for quality improvement” • [section 5.10] “...There is a view that high quality care costs more money. But this fails to recognise that poor quality is itself costly” • From ‘A first class service: Quality in the new NHS’ (July 1998)

4. Setting the scene (2): • Classic need for applying lean-sigma toolset: • 5.4 Issues. Future vision set, blame process not people. • 5.5 Must change, will change. This will take time. • 5.6 Need to change culture... • 5.7 ...to one of continuous improvement. • 5.10 Poor quality costs– repeat operations, readmissions, unnecessary/inappropriate treatment, complaints, litigation, contracting/treating infections – these are all WASTE! • More recently, now have Andrew Lansley as Health Secretary. The DoH published ‘Equity and excellence: Liberating the NHS’ (July 2010) – bit of a political hot-potatoe... • Retains continuous-improvement ethos.

5. Examples of large NHS CI programmes: • 18-week healthcare: • This originated within the NHS improvement plan in June 2004: A key objective was to reduce the wait for hospital treatment to 18-week maximum from GP referral • Releasing time to care (a.k.a “productive ward): • Aim is to help improve the way a ward is run (through lean tools) so they can spend more time with patients, at the same time improving safety, increasing efficiency, and reducing waste (‘Releasing resources to the front line – HMT July 2004) • Quality Innovation Productivity and Prevention (“QIPP”): • 2010/11 £102bn budget for NHS. Future growth to be limited to inflation. Affecting all within NHS, aiming to make £15-20bn efficiency savings by end 2013/14 to reinvested to delivery year-on-year quality improvements

6. Sensitive Application (1): Terminology: • Those working in the NHS, particularly at ward level, can be sensitive to certain terms. • Workers generally comfortable with ‘Continuous Improvement’. • Any phrase containing “sigma” or the “σ” symbol viewed with hostility – association with reduction in staff levels/conditions, and saving money for the institution. Use tools, not name! • The terms ‘lean’, ‘process’, ‘5S’, ‘Kaizen’ and ‘VSM’ accepted. • The term ‘waste’ can be taken very emotionally – ‘efficiencies’ focusing on the future generally more palatable. • The term ‘customer’ can get frosty reception. Use ‘Patients’. • Similarly, the terms ‘defect’ and ‘defectives’ are best avoided – perhaps consider as part of efficiencies.

7. Sensitive Application (2): Attitude to change: • In common with all businesses, workers within the NHS tries to resist change, on the assumption that change=bad. NHS can be particularly set in its ways due to some of the guiding principles from when it was founded in July 1948. • Working on continuous improvement teams can be viewed as waste by workers, as this is time not spent with patients. • There is now a clear and shared vision for the NHS. • This vision describes why the change is necessary, the benefits to the patient, the staff and the organisation. • Getting commitment, or at least compliance is an ongoing challenge for NHS leaders, but is happening through sharing of success stories. Gaining momentum.

8. Sensitive Application (3): Attitude to technology: • Those tasked with delivering continuous improvement see the need for analytical software very early in their programme. • Procurement of the software can be challenging (tender). • Installation of the software can be challenging (bias for action). • Purchase of an analytical package and/or carrying out work on a computer not directly related to customer care can be a challenge. • Workers now generally understand the importance of being able to measure a process against objectives to deliver and control improvements. • They appreciate the time the use of appropriate tools can save in analysis and communication of data, status, change etc.

9. Popular tools and applications of Minitab: • I-chart (ward level) • I/mR-chart (business level) • Pareto • Graphical summary • Macros (eg: “Funnel plot”)

10. Popular tools and applications of Companion: • Cause-and-effect • Process map • FMEA • Value stream map • A3-report

11. Review: • Compelling reasons why the NHS is changing. • Some large-scale CI initiative described. • There are certain sensitivities within the NHS – need to be sensitive to this. • Thus, public face of CI within the NHS is generally a “lean” one, but tend to draw on full range of 6S tools, discreetly. • Described several common tools used in Minitab. • Described several common tools used in QC. • Any questions?

12. Thank you for your attention! • Talk to the team today! • Visit www.minitab16.com • Visit www.qualitycompanion.com • Contact us Minitab Ltd Telephone: +44 (0)24 7643 7500 Email: sales@minitab.co.uk Website: www.minitab.co.uk