Transformation and Lean UHNS Strategic Approach

1. Transformation and Lean UHNS Strategic Approach 

2. Content Background What and why Transformation important Overview of Transformation programme Where does Lean fit in Examples of Lean methods in practice Productive Ward Lean Office

3. Background Service transformation � one of the 6 strategic objectives Service and workforce transformation is key to: Move into the new hospital Sustain the 18 week target Manage emergencies effectively Become a Foundation Trust We need to transform our services so that we can move into the new hospital that is being built, so we can sustain the delivery of 18 weeks for all patients requiring an operation, manage emergencies effectively and also become a Foundation Trust. We need to ensure that this hospital is here for years to come offering high quality services for people of StaffordshireWe need to transform our services so that we can move into the new hospital that is being built, so we can sustain the delivery of 18 weeks for all patients requiring an operation, manage emergencies effectively and also become a Foundation Trust. We need to ensure that this hospital is here for years to come offering high quality services for people of Staffordshire

4. What is Transformation ? Low cost airlines have transformed travel CitiBank transformed queues at the teller window through the idea of the ATM Apple has transformed the music industry from records / cassette tapes to CDs to iPOD and downloads So what is transformation and what do we mean by it? Transformation isn�t just about minor tweaks or changes, its about thinking differently. Thinking differently has changed the face of many industries. Low cost airlines have, for example, transformed travel. 10 years ago the world wasn�t so accessible as it is today. CitiBank was the first bank to think differently � they didn�t want queues at the tellers window and so came up with the ATM and cash machines are accepted and used day in day out now. Likewise Apple have transformed the music industry. Some of you in the audience will remember cassettes, then we had CDs and now we�re downloading music onto iPODs and computers. When downloading music came up as an idea, people probably thought it was mad but now it has completely changed the music industry.So what is transformation and what do we mean by it? Transformation isn�t just about minor tweaks or changes, its about thinking differently. Thinking differently has changed the face of many industries. Low cost airlines have, for example, transformed travel. 10 years ago the world wasn�t so accessible as it is today. CitiBank was the first bank to think differently � they didn�t want queues at the tellers window and so came up with the ATM and cash machines are accepted and used day in day out now. Likewise Apple have transformed the music industry. Some of you in the audience will remember cassettes, then we had CDs and now we�re downloading music onto iPODs and computers. When downloading music came up as an idea, people probably thought it was mad but now it has completely changed the music industry.

5. Why Transformation? Only sustainable way to get us from where we are now to where we would like to be Transformation is really the only SUSTAINABLE way to get us from where we are now to where we would like to be. Transformation is really the only SUSTAINABLE way to get us from where we are now to where we would like to be.

6. There is a Transformation Programme of work for 2008/9 which looks like this. There is an enormous amount of work going on across the Trust, some huge pieces of work, some on a smaller scale and some that cross the whole organisation. This is a big agenda and I have Dr Gavin Russell and Vanessa Scott heading this up for me, working with the Divisions and Directorates to ensure that this can be delivered.There is a Transformation Programme of work for 2008/9 which looks like this. There is an enormous amount of work going on across the Trust, some huge pieces of work, some on a smaller scale and some that cross the whole organisation. This is a big agenda and I have Dr Gavin Russell and Vanessa Scott heading this up for me, working with the Divisions and Directorates to ensure that this can be delivered.

7. So Where Does Lean Fit in? Building Capability to enable Transformation to take place There are a wide variety of skills required in order to deliver the Transformation agenda and the aim is to grow these within the existing workforce wherever possible. In addition, a change in culture is required in order to adopt and embrace lean principles throughout the organisation. There will be specific development opportunities aimed at Clinical Directors / Directorate Managers and Clinical Teams / other interested parties. It will be made clear when marketing these courses whether or not they are seen as key to the Transformation agenda. These will include:- Action based learning Care Pathway Development Workforce Planning Project Management Leading and Managing Change Business Improvement Techniques/LEAN thinking Part of the Transformation Programme Plan will require a clear strategy for building capability to provide a sustainable model of continuous improvement. The Trust has used a wide range of different consultancies to provide external support and expertise on specific projects; often utilising similar methodologies e.g. process mapping, lean thinking. For economies of scale it would be beneficial to the Trust to form a partnership with one main external agency to support the organisation in building the capability and providing some of the capacity to deliver the Transformation Programme and culture change. There may be specific projects which will still require expertise over and above that offered by one main provider.Building Capability to enable Transformation to take place There are a wide variety of skills required in order to deliver the Transformation agenda and the aim is to grow these within the existing workforce wherever possible. In addition, a change in culture is required in order to adopt and embrace lean principles throughout the organisation. There will be specific development opportunities aimed at Clinical Directors / Directorate Managers and Clinical Teams / other interested parties. It will be made clear when marketing these courses whether or not they are seen as key to the Transformation agenda. These will include:- Action based learning Care Pathway Development Workforce Planning Project Management Leading and Managing Change Business Improvement Techniques/LEAN thinking Part of the Transformation Programme Plan will require a clear strategy for building capability to provide a sustainable model of continuous improvement. The Trust has used a wide range of different consultancies to provide external support and expertise on specific projects; often utilising similar methodologies e.g. process mapping, lean thinking. For economies of scale it would be beneficial to the Trust to form a partnership with one main external agency to support the organisation in building the capability and providing some of the capacity to deliver the Transformation Programme and culture change. There may be specific projects which will still require expertise over and above that offered by one main provider.

8. Training Matrix to Support Transformation

10. Blood Sciences Department Rapid improvement event focusing on flow of blood science requests from A&E through department 33% reduction in turnaround time for A&E blood science requests

11. Acute Stroke Unit (ASU) Need to develop a ASU from 2 existing wards The team mapped out the current process, identified waste time and delays.

12. Maternity The antenatal clinic staffing arrangements have been re-designed Changes: One reception desk for scan and clinic appointments �All encompassing� appointments in clinic including investigations Midwives to be based on the wards and allocated to work with specific consultant clinics.

13. Theatres Improve theatre efficiency and prepare theatres for the new Hospital All 23 theatres to go through a staged programme including Well organised Theatre Knowing how we are doing SMED Standard Operational Procedures

14. Pharmacy Department Rapid improvement event focusing on flow of work through dispensary Anticipated benefits include: Reduction in number of steps in dispensing process. Reduction in time to dispense a prescription. Reduced staffing costs from savings in overtime

15. Oncology & Haematology The new Cancer Centre will open in July these two complex and diverse specialties will merge together in one unit The team mapped out the current process, identified waste time and delays.

16. Productive Ward & Lean An ideal partnership

17. Background National Project. UHNS � Wave 1 West Midlands 2 Year Trust Wide foundation module implementation of all inpatient areas Uses Lean principles to reduce �waste� and increasing direct care time.

18. Aims Engaging & empowering staff in redesign of ward environments & processes Improving patient experience & safety through a continuous cycle of improvement Delivering competing priorities within an acute NHS Trust

19. Using Lean Principles Corporate approach to Lean � collaborating with Pharmacy and Supplies Partnership with Lean Healthcare Academy E learning modules

20. Lean Thinking� Using 6 (5) �S� principles to reorganise ward areas to make them fit for purpose Less time spent looking for equipment

21. More reorganising..

22. Setting the standard..

23. Sustaining the change�

24. Examples of early achievements Showcase wards: Direct Care Time increased from 39% to 59% August 08 Reduction in motion by 10% Cohort wards: Interruptions reduced from 154 to 12 per shift Average savings per ward (each drug trolley � excess stock) �140.00 On average �1000.00 credited back to each ward from excess pharmacy stock returned An average reduction of 1 mile in distance travelled per shift. Reduction in motion 6% Direct care time increases from 43% to 55%

25. And finally� Our aim is to effect a shift in culture, through the empowerment of staff, enabling them to redesign their ward areas making them �fit for purpose� The �hands on� approach of the Project Facilitators, and the clear channels of communication within the organisation has contributed to it�s success so far Extensive preparation and planning has, and will continue to be, a key element in sustaining the work at the UHNS

26. Admin & Clerical Transformation Project Heidi Poole A&C Transformation Manager

27. Project Structure

28. Main objectives of Lean Office Introduce lean principles and tools Involve A&C staff to identify and reduce waste, maximising efficiencies Enable improvements and to sustain well-organised areas to support FftF Engage all members of a team through facilitated workshops Share local improvements in communications across the Trust

31. Well Organised Office � 6S

32. Knowing How We�re Doing � Visual Management Set the targets

35. Next Steps Promote Lean Office throughout the Trust attending Divisional Management Team meetings Identify and invite further groups of staff to attend the programme Supplies Department to begin programme April 09 Share improvements with Trust via communications