Agenda Item No

Meeting Trust Board

Date July 2011

Title Five Year Strategy for the Bolton Improving Care System (BICS)

Purpose Why is this paper going to the Board

• To update the Executive Board on progress in the development of BICS against the goals set out in our last strategic plan for BICS

• To set out the strategy for BICS, supporting the Trust’s renewed five-year vision and strategy • To link with the associated paper regarding cultural transformation.

Key Points for Trust Board members. Summarise the main points and key issues that the Board should focus on including conclusions and proposals

• In 2006, the Trust set out its intention to use lean methodology and philosophy as the basis of its own system for improvement (BICS).

• The last five years have been a period of learning – reflecting on our original objectives, there has been a high level of achievement.

• The Trust has not yet achieved a systemic embedding of BICS as ‘daily work’, but there are some realised in major valuestreams. This has been, notably, where front-line, clinical and divisional work, inspiration and persistence of these teams is recognised both internally and externally and provides invaluable learning for the next phase of improvement.

• Our challenges for the next five years are to widen and deepen the BICS approach (which incorporates engagement methodologies), across our new organisation, geared to the Trust’s major strategic priorities – essentially the improvement of what we do through learning, doing and promoting the culture of transformation which would be central to achieving our ambition to be a leading integrated care organisation.

• The strategy for BICS sets out proposals relating to: • Service redesign priorities • Learning and Development / the BICS Academy • Benefits Realisation • Roles and Responsiblities in the new organisation incl. the BICS team • Sustainability, Cultural Change and Engagement

Next steps/future actions

• To gear BICS team L3 Objectives to the priorities set out • To work with Divsions and Directorates to develop more detailed plans and assessment of risk Discuss X Receive Approve X Note

Prepared by Joy Furnival, Head of Lean Transformation Presented by Ann Schenk, Director of Strategy and

Improvement

This Report Covers (please tick relevant boxes)

Strategy X NHS constitution rights and pledges Better Care for Better Health X CQC registration Valued, Respected and Proud X Monitor Compliance Responsible use of Resources X NHSLA Assurance Quality Governance Framework Legal Implications Equality Impact Assessed For Information Confidential

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VALUED, RESPECTED and PROUD – Continously Improving

the Bolton Improving Care System (BICS)

INTRODUCTION

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We Aim to Deliver Best Care for Better Health for our Patients by Valuing and Respecting all Staff in a

Continuous Effort to Improve the Quality of Our Services through the Bolton Improving Care System

Bolton NHS Foundation Trust (formerly Royal Bolton Hospital NHS Foundation Trust),

has recently published its five-year Vision and Strategy for Better Care Together. A

strengthened commitment to using lean approaches to achieve transformational service

improvement – breakthrough change in the quality and safety of our services together

with simultaneous cost reduction through minimising waste and though the engagement

and involvement of all our staff.

This will be continued to be shown by:

Reductions in hospital and community mortality rates

Improvements in a range of clinical quality indicators

Reduction in infection rates

Improvements in patient satisfaction and staff morale

Improved efficiency and productivity as shown, for example, in reducing

length of stay, and increasing day case rates and clinic productivity – ‘’shifting

the big dials’’

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Improvements in access times across the whole patient journey and reduced

duplication of activity

The continued development of a continous improvement culture involving and

engaging all staff and embedding BICS further and faster across the new

integrated care organisation building on the best of both improvement

legacies and building ‘one team’

Significantly increasing the skills transfer and growth of capability,

competancy and individual confidence doing improvement activity and

projects.

Increasing staff engagement, satisfaction and Trust reputation as a great

place to work (See Appendix 1).

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What is Lean and the Bolton Improving Care System (BICS)?

Lean is an academically coined name that tried to articulate in western language the

work, behaviours and systems, originally developed by Toyota over 50 years, under the

banner of the Toyota Production System (TPS), (1996, Womack and Jones. Lean

Thinking). This has been adopted by various commercial and some public sector

organisations, including the Ministry of Justice, HMRC and the Armed Forces. It is a

practical way of looking at and improving processes, systems and pathways, through

changes in mindset, attitude and behaviours. It can be applied across all activities of an

organisation, aimed at maximising value and eliminating waste and error. It is also a

way of thinking and learning about problems and solutions through teamworking.

(Unfortunately, lean falsely has a reputation of being purely a set of efficiency tools used

for financial savings – this is actually ‘fake lean’).

The philosophy uses a set of proven tools and techniques but beyond these, it is the

underpinning principles which can create an organisation-wide impetus for improvement

and participation, especially when partnered with respectful and engaging leadership.

Key lean principles include:

Involving front-line staff in the redesign of work

Continuous removal of waste (muda), variation/un-eveness (mura) and

overburden, (muri).

Through

Specifying value from the customer’s (patient’s) stand point (value)

Seeing all work as a process and as an aspect of quality (value stream)

Achieving smooth continuous flow (flow)

Only to do things when there is a downstream demand for it (pull)

Seeking continuous improvement (perfection)

(1996) Jones, D and Womack J, Lean Thinking)

“Lean thinking is not a manufacturing tactic or a cost-reduction programme, but a

management strategy that is applicable to all organisations because it has to do with

improving processes. All organisations – including healthcare organisations – are

composed of a series of processes or sets of actions intended to create value for those

who use or depend on them (customers/patients)”. (2005, Institute for Healthcare

Improvement. Going Lean in Healthcare.

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Royal Bolton Hospital NHS FT has been pioneering the use of lean in healthcare,

through the development of the Bolton Improving Care System (BICS), “The Bolton

Way”, over the last five years with good early successes. NHS Bolton Provider

Arm, has also been using lean techniques via the Productive Community Services

Programme and Equip. However, arguably it is still early days for lean in healthcare

and there is still significant opportunity to continue to build skills, capabilities and

competancy to learn how to ‘do lean in healthcare’ and to continue to realise all the

benefits it can develop for patients, staff and the organisation. In addition whilst

theoretically quite similar there is work to do to integrate the two approaches from

the two former organisations, and build on the best of both to develop further and

enhance the Bolton Improving Care System.

Our Learning so far:

Be clear about value when seen from the patient’s and carers’ perspective –

placing a premium on safety and a high quality experience.

Embedding this in the leadership and engagement of front-line staff and their work,

and developing a culture which places safety and quality at the forefront and

develops a practice of continuous problem-solving and improvement, and helps

ensure sustainability

Organisation-level identification of key valuestreams (these will be dominant types

of activity with common characteristics – eg scheduled/unscheduled care/short stay

inpatients/day cases etc), helps to prioritise work and ensure deeper level results

Mapping current processes to identify waste and non-value added steps from the

customer’s point of view reduces localised ‘turf wars’

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Setting out the desired “future state” which eliminates/reduces non-value added

activity.

Running a cycle of intensive rapid improvement events, involving leaders and

front-line teams and service users, generating more detailed design, testing and

implementation and retesting of the future state, in situ. These create a culture of

rapid implantation and achievement which is not the norm in most NHS settings.

Our learning has evidenced that rapid improvement events can occur in all

healthcare settings.

Measurement of changes are key and should be comprehensive and transparent.

Focusing on Quality and Safety leads to reduction in costs as the ‘costs of poor

quality’ fall.

Agreeing plans for next step improvements to achieve the agreed future state - a continuous cycle - drawing particularly on a Trust-wide programme to embed

simple methods of observation and improvement in day-to-day delivery of care, linked to ‘lean leadership’ practices.

Bottom up – ‘pulled’ improvement activity linked to Quality, Safety, Productivity and

Morale, is more likely to engage staff and ensure sustained improvements.

Clinical Leaders working in a multi-disciplinary way to create the right environment

for improvement and who are sufficiently committed to ‘make it happen’ rather than

just ‘let it happen’ can really make the difference to successful implementation of

BICS. The use of a coaching and facilitative style of leadership building on a culture of

engagement is more suited to this type of transformation.

Over our first five years we have learnt that lean is a helpful framework because:

• It provides an overall philosophy and a way of setting priorities

• It has a body of evidence-based tools and techniques

• There is a vibrant “lean community”, including many outside of healthcare,

who are willing to share their experience and expertise

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• It focuses on safety and quality from the patient’s perspective but enables

these to be delivered at a lower cost.

• It creates a shared language for conversation and collaboration about

improvement regardless of professional or organiational background.

• It contributes to the development of positive media stories and Trust

reputation both as a great place to work, and also, more importantly as a high

quality place to receive care.

What have we achieved so far?

In 2006 our strategy to develop BICS, stated that over the next five years we would:

• Embed continuous quality improvement.g. 6S and Visual Management across

frontline teams (17 wards) – ACHIEVED via Exemplar Programme and 6S and

Cell Implementation RIEs

• Focus on Quality and Safety – ACHIEVED via True North Goal criteria for

improvement Planning

• Involve all staff – PARTIALLY ACHIEVED 81% of staff participated in BICS as at

April 2011 (via Green/RIE programme)(See Appendix 2) & Staff Survey results

show significant improvements (See Appendix 3)

• Develop toolkit and learning re: Lean – ACHIEVED via BICS Academy

• Develop Measures and Goals for improvement activity and support preparation

and analysis within improvement activity – ACHIEVED via the Award Winning A3

Thinking Process (Health and Social Care Awards, 2008) and ‘Information for

Improvement’ Programmes within BICS Academy

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• Develop Communications – ACHIEVED active intranet/internet site, monthly

newsletters and outbrief sessions

• Develop Financial Benefits Tracking – PARTIALLY ACHIEVED new process

designed 2010/11 and implemented (See Appendix 4)

• Seek external help – ACHIEVED OJEU advertised, partnership agreement in

place with Simpler Consulting – in place until November 2011.

• Give wide range of staff the opportunity to work in specalist team – NOT

ACHIEVED due to funding constraints (i.e. limited funding for additional posts, if

not funded by division and individual aspirations. Only 10 staff members rotated

through team during 5 years.

• Gear support departments to support rapid changes – PARTIALLY ACHIEVED,

some departments e.g. facilities extremely set up to support rapid change, other

areas less so.

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1. STRIVING FOR EXCELLENCE IN BOLTON THROUGH LEAN THINKING

USING THE BOLTON IMPROVING CARE SYSTEM

The Trust has set out its three-part purpose for the next five years:

• Best Care for Better Health

• Responsible use of Resources

• Valued, Respected and Proud

Best Care for Better Health means:

• Services which are SAFE, in which there are no needless deaths

• Services which are EFFECTIVE, in which there is no needless pain

• Services which are TIMELY, in which there are no delays

• Services which are EFFICIENT, in which there is no waste

• Services which are EQUITABLE, in which there are no inequalities

• Services which are PATIENT-CENTRED, in which there are no feelings of

helplessness

(2001, Institute of Medicine. Crossing the Quality Chasm)

We believe that we can use lean approaches to achieve services which have all of

these characteristics and an organisation which strives to deliver best care for better

health from top to bottom. The way we plan and deliver services will be shaped by

making lean the “way we do business round here”, based upon a workforce that values

openness, change, improvement and flexibility.

• Lean Improvement: In delivering continuous improvement at the

front-line

• Lean Operations: Processes and decision-making and planning for the

organisation

• Lean Strategy: The way healthcare is planned and organised

• Everybody looking for a better way of serving patients & making it happen

• Routine use of observation & 6S

Continuous Improvement

• Planning & implementing change • Focusing on delivery • Designing working practices

Operational Management

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All of this will thrive most successfully within a culture of engagement, trust and

willingness to learn from mistakes and best practice.

“The fastest way to succeed is to double your failure rate”

James Dyson cited in 2010, Mayer, L et al. ‘Creating the Culture for Innovation’, Coventry:

Institute for Innovation and Improvement,

Lean as a Strategic

Framework

• Identifying key processes across whole patient pathways

• Setting goals • Identifying priorities for change • Growing the right culture • Embedding it in leadership

Joint Boards and management teams

Executive Board, Heads of Division and Associate Divisional Directors

Service Leaders at all Levels in all services – front line and ‘back office’

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2. LEAN IMPROVEMENT

“It’s easier to act yourself into a new way of thinking than to think

yourself into a new way of acting”.

A.J.Jacobs (New York Times, Best Selling Author)

Fundamental to a continued Trust-wide change in the way we do things will be

continued workforce-wide involvement in “hands on” activities and events, building on

geared to clear improvement goals with a focus on safety and quality to further

embed, sustain and take BICS to the next level within the new integrated organisation

through leadership of an engaged workforce.

We Will

Continue to Embed continuous improvement in front-line teams and their leaders using techniques such as 6S, standard work, visual management and simple observation, aiming to make best practice the standard in everyday delivery of care. This will focus on behaviours and systems to ensure standard work is the way we do things around here and that standard work is contantly improved upon – cultural change. This will also build ono the best of both improvement work within the former two organisations as the new organisation becomes more integrated.

Continue the intensive programme of rapid improvement events (RIEs) geared to priority improvement goals, aimed at comprehensive engagement of front line teams – every member of staff within the new organisation involved in at least 50% of staff have one RIE or improvement cycle over the next five years. Further develop and join up this activity with the Trust Engagement Strategy, Exemplar Programme and Productive Series activity – ‘’Further and Faster’’

Continue to Support all participants with learning in the basic tools and concepts of lean. Aim for 80% of staff in Band 8 and above at Bronze Level and 20% at Silver level within 5 years and 95% at all staff at Green Level. Develop and implement a ‘depth’ spread measure for BICS.

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Skills Transfer - Continued Development of the BICS Academy building

on exisiting community and Academy programmes and leadership development, detailing the “toolkit” of materials and support to assist leaders and their teams in making and sustaining change for Safety, Quality and Productivity. Develop qualitative measures for ‘how confident are you to lead your teams in BICS activity’ and explicit skills transfer measures.

Communicate widely on the content, progress and outcomes of BICS Activity

Increase staff opportunity to work within the specialist service improvement team, to develop knowledge and skills within funding and aspirational constraint. Move to expectation that senior leaders will have worked on BICS activity as an essential requirement of roles.

Continue to develop exceptional people and teams who follow the Trust’s philosophy on improvement and working together.

Seek external review and recognition of our progress so far by applying

for the Shingo Prize (Western Prestigious Prize for orgnisationation pursuing excellence in all they do via Lean, Six Sigma and other operational excellence approaches.) Use learning from this to identify improvement areas and gain new ideas and insights. (See Appendix 5)

Strengthen and embed benefits tracking process for all aspects of

improvement, safety, quality and financial gains – shift the big dials.

Continue to seek and share learning about lean healthcare within our local area and with other pioneers in lean from other sectors

Integrate more closely all aspects of service improvement, effective

people management, change projects and leadership and clinical leadership development.

Continue to grow leaders who thoroughly understand BICS, the

philosophy and who can teach it to others.

Learn from organisations that have a track record of innovation and make it easy to find and share knowledge about improvement (yokoten).

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3. Challenges Ahead - Sustainability

The generic experience and learning of organisations organising for quality in

healthcare who have employed lean (or similar approaches) to continous quality

improvement, is that to continue to leverage the improvement projects and cycles to

deliver competative advantage is in two key areas.

These two key areas are:

1) Leadership interest, discretionary effort, passion and continuity and longevity of

vision and related environment led by them in which an improvement and

engagement culture can thrive.

2) Capacity, capability and competancy of improvement and change management

skills (consummate skill) within the organisation in which to deliver improvement

projects and cycles.

(2008, Bate, P., Mendel, P and Robert, G. Organising for

Quality)

These two areas are significantly still relevant to Bolton as we continue to move forward

with the transformational work, and these are particularly more poignant during this

period of integration and austerity.

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4. 2011/12 – 2016/17 Goals

The way that the Trust organises, delivers and performance manages its operational

business are the key to achievement of its strategic goals for improvement. We will

continue to use a lean approach to redesign.

We Will

Two pathways (value streams) will be established to lead priority work

− Musculo-skeletal − Urgent care (with a special interest in Respiratory and other Long Term

Conditions) These will be used as the starting point for planning changes in service delivery. This will expand over time to include families and alcohol related harm pathways and key back office value streams.

Lean analysis and problem-solving will also be used to plan and implement changes necessary to deliver the new A&E Clinical Quality Indicators and continued improvement activity in Theatres and Outpatients and the Community (via PCS)

Develop Patient Experience Based Design to understand the impact on our patients of the way we do things and develop voice of the customer approaches

Continue to Equip leaders to use lean tools to analyse root cause issues, and to solve problems and design solutions and support their staff in doing the same

Develop People in our organisation to be open, flexible, adaptable to change and to value diversity of ideas.

Continue to Develop measures and gear our performance management systems to measure what matters – Quality/Delivery/Cost/Patient satisfaction/Staff satisfaction/Workforce linking with key directorates including Clinical Audit, Finance, Information, Assurance, Nursing, Workforce and Safety.

Expect “standard work” approaches to become widespread – reducing variation and standardising on best practice

Enable Managers to lead RIEs, as an important part of their role in improving services and to support the implementation of “standard work” with their teams.

Continue to develop Policy Deployment as the Trust’s strategic annual planning

process building on the success of the Speciality Reviews

Continue to develop an account management (matrix style) approach to divisional improvement activity with centralised improvement leads connecting with divisions, departments and directorates as well as corporate priorities on the Level 1 and Level 2s from Policy Deployment.

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5. Roles and Responsibilities

4.1 Board Directors

The key roles of this group is to enable a supportive and inspirational environment in

which improvement and innovation can thrive, and in which mistakes can be learnt

from openly and transparently Evidence and our learning has shown that high level

visibility during and after RIEs, improvement cycles and promotion of improvement

activity at BICS outbriefs, from this group of individuals can make a significant

different to the level of change that teams are both prepared to make and actually do

make and sustain.

4.1 The Role of Line Managers and Clinical Leaders

Striving for Excellence through lean thinking and the Bolton Improving Care System,

(BICS) is not a project or a programme. It is a fundamental change to the way in

which the organisation delivers its services to patients. Consequently the main

responsibility for applying BICS, and leading the teams working on improvement,

sits with line managers and clinical leaders. They will be responsible for ensuring

BICS approaches become embedded and that continuous improvement becomes

day-to-day activity for front line staff. Our experience has shown that seriously

committed clinical leaders can inspire excellent and innovative improvement activity

that moves the improvement work from good to brilliant. “Making it Happen” rather

than just “Letting it Happen”. (Beckhard and Harris, 1987).

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4.2 Bolton Improving Care System Team

We Will

Continue to develop the in-house improvement team to be capable of supporting the organisation-wide improvement effort through improvement cycles and projects, and transferring skills further out across the organisation

They will o Continue to develop knowledge and competency and experience and

learning in lean methods so that they can act as expert advisers and practical support to leaders and teams operating across the identified priority value streams

o Provide co-ordination and facilitation and project management expertise for the centralised programme of RIEs and Improvement Projects and Cycles

o Continue to Develop standard “Bolton Improvement Care System” materials and working guides building on the best of both approaches within the Hospital and the Community including shared learning and knowledge capture systems (yokoten)

o Develop and maintain associated performance reporting frameworks, focusing on sustaining improvement from RIEs at 30,60 and 90 days.

o Continue working with Finance, Workforce and Divisions to embed and develop the embryonic financial and other benefits tracking process and develop return on investment processes and build in qualitative and quality and safety benefits into this methodology.

o Develop and maintain skills transfer measures for leaders and staff and develop a BICS quality assurance and shared learning process for dispersed improvement activity

o Assist in analysis and “work up” activities in preparation for RIEs and support to leaders in following through from these events, in particular focusing on standard work.

o Operate across organisational boundaries with partners throughout the Health Economy

o Develop and deliver programmes of learning and development, coaching and mentorship at all levels (from basic to more advanced) via the BICS Academy in collaboration with Organisational Development and Learning. Ensure this programme is externally recognised and kept up to date with latest improvement practice.

o Co-ordinate a range of external contacts and manage the input of representatives of other organisations in improvement activities and

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negotiate training opportunities for Bolton NHS FT staff in external élan events and activity.

o Manage the BICS communications agenda together with the Trust communications and public relations strategy.

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Appendix 1: BICS Reputational Benefits Tracking: External Year Recognition Area/Title Team/Process 2006 Shortlisted, HSJ Awards - Clinical Service Redesign Laboratory Medicine 2008 Winner, Health and Social Care Awards (National and Regional) – Adopt, Adapt,

Improve Category BICS – A3 Thinking

2008 Runner Up, NW TrusTech Innovation Awards ‘MONstA’ Laboratory System 2008 Winner, NW Leadership Awards – Service Improvement through Leadership Dr Simon Stacey, Orthopaedics 2009 Shortlisted, HSJ Awards – Clinical Service Redesign Experience Based Design (EBD), Orthopaedics 2009 Regional Finalist, Health and Social Care Awards EBD, Orthopaedics 2009 Winner, Best Poster 2x Categories & Best Poster Overall at the IHI International

Forum on Quality and Safety in Healthcare BICS – All Trust

2009 National Pilot Site – Safer Clinical Systems Urgent Care 2009 Winner, Best Poster – British Geriatric Society Falls reduction in Complex Care 2009 TrusTech recognition for service innovation for ‘Patient Gateways’ Urgent Care 2009 3x Winner Bolton Diamond Care Awards BICS Academy, EBD, Stroke Pathway 2010 Winner, NW Leadership Awards – Service Improvement through Leadership & NW

Leadership Academy Bursary Award Suzanne Lomax, Stroke & BICS Academy/Exemplar Programme

2010 Highly Commended, HSJ Patient Safety Awards WHO Checklist, Theatres 2010 Winner Team of the Year Diamond Care Awards Respiratory 2010 Winner, NHS Leadership Awards, Quality Champion of the Year David Fillingham, Former CEO. 2010 Winner, Lilly Excellence in ADHD Awards – Reflective Practice, and Shortlisted

ADHD Champion CAMHS

2011 Winner, HSJ Patient Safety Awards & Shortlisted HSJ Patient Safety Awards Theatres & Exemplar Programme 2011 Winner, and Runner Up, BMJ Clinical Leader of the Year Dr Ian Dufton (CAMHS) & Dr Brian Bradley

(Respiratory) 2011 Winner, European Process Excellence Awards (public and private sector), Best

Improvement in Service and Transaction Respiratory Specialist Nurses

2011 Shortlisted 3x Teams, HSJ Efficiency Awards Health Records, Speciality Reviews and District Nursing Teams (PCS)

NB: Other awards also won incl. HRBM awards, Nicky Ingham, Catering and Nursing Times/HSJ Awards for Bereavement & Fiona Murphy, Clinical Leaders Network, Simon Kelly etc., not mentioned above, as not ‘directly’ BICS, but still more than worthy of mention.

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Appendix 2 – BICS Participation

Division No. Employe

es

RIE Participants

current employees

% Participated

Current Academy attendees

(inc 6s&A3) may inc

RIE participant

s

% attended Academy

No of individual

s engaged in BICS (current

staff)

% staff engagem

ent (current

individuals)

Anaesthetics and Surgery Division 950 337 35% 506 53% 697 73% Corporate Services Directorate 56 20 36% 35 63% 38 68% Diagnostics Therapies and Facilities Division 921 351 38% 737 80% 899 98% Finance and Procurement Directorate 96 46 48% 90 94% 96 100% Medical Directorate 37 9 24% 23 62% 26 70% Medicine and Emergency Care Division 740 260 35% 259 35% 423 57% Nursing & Performance Improvement 18 6 33% 7 39% 9 50% Service Development Directorate 47 27 57% 45 96% 46 98% Womens Childrens and Outpatients Division 708 187 26% 574 81% 652 92% Workforce Directorate 67 39 58% 51 76% 64 96% Grand Total 3640 1282 35% 2327 64% 2950 81%

* * * RIE

current staff

Current Academy attendees

only

Current

staff Total

% Participation

BICS Staff Engagement (RBH individuals on RIEs/green training)

1282 1668 2950 81%

3

0

500

1000

1500

2000

2500

3000

3500

4000BICS Cumulative Engagement to April 2011

Green - 73%

A3 thinking & PD - 2%

6S - 7%

RIE Participant - 40%

Bronze - 5%

Silver - 1.4%

Gold - 0.3%

RBH StaffBICS

Academy started

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Appendix 2 – Staff Survey and BICS Participation

A&S M&ED&T

WCO

CORP

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

-100% -80% -60% -40% -20% 0% 20% 40% 60% 80%

Staf

f Sur

vey

Rela

tive

Sco

re E

quiv

alen

t

BICS RIE Participation

Scatter Plot of Staff Survey Pledge 4 relative scores vs BICS RIE Participation (correlation 0.9, Strong)

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Event Description of Saving Time Cost Productivity Qualitative Benefit Time Cost Productivity Qualitative Benefit

14.6.10 Outpatients VSA Release band 2 time re cancellations 94000 94000Improved utilisation of clinic lists x xReduce DNAs (confirmation pilot) x xReduce letter to appoinment by 4 days x x

29.6.10 TB Outpatients Reduction in specialist nursing admin timeTB Activity captured x x

29.6.10 ESC Quicker recruitmentImproved understanding of where each job is in process.Work load levelled to reduce peaks and troughs in individual's work loads.MIB work absorbed 18910 18910

12.7.10 Radiology Reporting Reduction in reporting time 20000Reduction in waiting time x

12.7.10 A&E Admin 140 hrs per week band 2 capacity generated 67000Reduction in queuing time x

12.7.10 Ante Natal Screening Redirect Calls 13000Ensure scanner available 9000Change barcode 10000Presort of requests 2500

12.7.10 Pharmacy Aseptics Identified growth potential within physical space x xReduce errors, infection risks & length of stay x xRelease time on the NNU re TPN prodcution x x33% improvement in productivity expected post MiB x x

31.8.10 Laundry Services Reduced Stock 30000 3000030% reduction in cost 90000 9000081% Reduction in flow time 130000 130000Reduction in floor space required x x

Respiratory Specialist Nurse Improve equity in service x xReduce LoS x xExtend to 7 day service x xIncrease input to areas other than resp ward x x

Theatre Productivity Increase lap chole daycase x xReduce late starts in theatre x xEstablish anaesthetic referral clinic x x

Lap Chole daycase 32% increase in patients going home within 23hrs x xReduction in cancelled ops x x

Theatre Stores Improve storage x xAvoid stock costs 4000 8000Improve delivery of stock to theares x x

Orthopaedic Improvement Reduce waiting time for Ortho scan x xIncrease in patients meeting best practice x 200000

Post Natal Los Reduce LoS to 24hrs x x6S Post natal wards 1244 1244Reduce community booking appointments from 1 to 2 x x

Central Prepping Increase space xCentralisation of process will save 90 hrs band 2 84000 92569

Outpatient slot utilisation Reduce waiting times , WLI & DNA x xReduce rebooking x xIncrease productivity 56000 45000

DNA Reminder Reduce DNA x x

Acute Care Gateways Reduce Los 884000 884000

Total 185,500.00£ 228,154.00£ 1,100,000.00£ 94,000.00£ 148,154.00£ 1,351,569.00£ Grand Total 1,513,654.00£ 1,593,723.00£

Actual at 90 DaysTarget from A3

Appendix 3: Financial Benefits Tracking BICS 2010/11 Source: Angela Sanderson Head of Divisional Financial Management, May 11

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Appendix 4: The Shingo Prize – Principle Centred Operational Excellence Dimension 1: Cultural Enablers Examples of Assessment Evidence Required Points

1.1 Leadership and Ethics Vision, Mission,Values, Principles of Improvement System; Voice of The Customer Approaches, Performance Management System, Go and See, Ethical Governance 50

1.2 People Development

1.2.1 Education, Training and Coaching

PDPs, Lean Training, Lessons Learnt & reflections, Coaching, Training in Standard work, External Training/Spread into the Community 50

1.2.2 Empowerment and Involvement

System for incouraging voluntary employee involvement in improvement, Succession Planning, Cross Training, Alignment of Job Descriptions to support improvement, Union Partnership working, Communication and measurement throughout organisation, Employee understanding of strategic goals and their contribution to them, teams for improvement activity, recognition systems 50

1.2.3 Environmental and Safety Systems

Proactive systems for ergonomic, safe and clean environments, life cycles issues, environmental issues, employee health and wellness, 6S, Safey IS First 25

Dimension 2: Continuous Process Improvement

2.1 Lean Principles Development of a System for Improvement and Organisational Philosophy of Improvement

2.2 Value Streams and Support Processes

2.2.1 Customer Relations Processes for Assessing Voice of the Customer and Customer Relations Measures 50

2.2.2 Product/Service Development

Use of Quality Function Deployment, Process Benchmarking, Market Testing, Lean Design and Innovation Approaches 25

2.2.3 Operations

Evidence of sustained application of key lean principles including: flow and pull, value stream mapping, TPM, SMED, 5S, Poke Yoke, Cells, SPC, Pareto, Ishikawa, A3 Thinking, RCA and 2P and 3P. 175

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2.2.4 Supply Integration across the value stream to design for customers across boundaries, distribution and supply transport arrangements to support flow and pull, commitment to supplier development 50

2.2.5 Management Alignment of Administration functions to support value stream, plus evidence of application of key lean principles (see 2.2.3). 100

Dimension 3: Consistent Lean Enterprise Culture

3.1 Enterprise Thinking

Reporting requirements based on lean principles and policy deployment, common reporting across enterprise, financial reporting embraces lean accounting practices, simple and visual information systems, leadership development integrated with lean principles 75

3.2 Policy Deployment Scientific Thinking as a philosophy, Policy Deployment, Catchball as a multi-lateral discussion to align objectives and projects, Constancy of Purpose (True Norths) 75

Dimension 4: Business Results

4.1 People Development Measures on: Safety, Training, Improvement Participation, Environmental Health, Employee Satisfaction 25

4.2 Quality Customer Quality - e.g. HSMR, Readmissions, Infections, Pressure Ulcers, Falls, Litigation and Complaint Costs, 30 Day survival rates post discharge etc. 50

4.3 Delivery

Lead Time - e.g. Waiting Times, 18 weeks, 4 hour A&E standard, Cancer Waits, Length of Stay, Supplies Lead Times, Complaint Management Response Times, Supply Payment Times, System Availability (e.g. Bed Occupancy, Clinic Occupancy) 50

4.4 Cost

Labour Productivity, Asset Productivity, Inventory Turns (incl. Length of Stay in Healthcare context), % Preventative Maintenance, Energy Productivity, Value Stream Margins, Floor Space utilisation 50

4.5 Financial Impact Revenue Growth, Surplus, Cashflow, Capital Expenditure Trend, Value Stream Margins 50

4.6 Competitive Impact Market Share, Customer Satisfaction, Lead Time (Flexibility), Customer Survey (Patient Satisfaction Survey), Awards 50

1000

8

575 points required for Bronze Medal

To achieve this level, the judges are looking specifically for:

Clear and ingrained understanding of lean principles through the leadership team

Widespread involvement and Empowerment and Strategic Alignment of Improvement Activity

Tenacious strategic focus on high value added processes and issues

Major fully completed value stream work that would be considered best practice