PU 5004 - Group 6 Presentation

Using Quality Improvement Tools to Deliver Better Health care

Members

Arnab Comfort

Michael Santosh Stella

Victor Vishal

Content

IntroductionHistoryTriggersDimensionsPrinciplesStakeholdersProgress

Challenges, Critique, Conclusion

Introduction

Quality improvement is not only an important aspect of health care delivery; it is also used in other industries

Quality improvement - an active, continuous process by all stakeholders (patients, tax payers, healthcare providers) to improve the quality of health care

Different models(tools) have been developed overtime to effect quality improvement-

TQM,BPR,FADE,PDSA,SIGMA, AND LEAN PRINCIPLES 

History

• Conceived in the automobile industry in 1950s

 • Popularized in automobile industries by early

1980s • Introduced into the healthcare sector

(U.K.USA, AUSTRALIA, EUROPEAN COUNTRIES) by 1990s

 • Recently, in NHS, lean thinking is widely used

by most hospitals. One of its early users is Royal Bolton Hospital Pathology department (August 2005)

Trigger

• Internal – Increased incidence of hospital

acquired infection and avoidable injuries

– Constraint in hospital capacity and space

– Excess pressure on the staff leading to low morale

– Increasing waiting list and queues

Trigger

• External- Political and public concerns

- Economic- huge financial deficit incurred by NHS

- Sociological

- Legal

Why LEAN Management

What is Lean?

It is creating a culture of value and eliminating waste in order to maximize quality of service.

Lean process involves :

“…determining the value of any given process by distinguishing value-added steps from

non-value-added steps and eliminating waste so that ultimately every step adds value to

the process”

(Institute for Healthcare Improvement 2005: 2)

The 5 Lean principles

- Value

- Value Stream

- Flow

- Pull

- Perfection

Lean thinking categories of waste and health care examples

• Correction (defects): – Adverse drug reactions – Readmission because of inappropriate discharge

• Waiting: – Waiting for doctors to discharge patients– Waiting for test results

• Transportation: – Central equipment stores rather than ward based

stores for commonly used items

Lean thinking categories of waste and health care examples• Over processing:

– Asking patients for the same information– several times

• Inventory:– Waiting lists– Excess stock in stockrooms

• Motion: – Unnecessary staff movement to obtain– information or supplies

• Overproduction – Requesting unnecessary laboratory tests– Keeping beds or slots free ‘just in case’

(Adapted from NHS Institute for Innovation and Improvement: Going lean in the NHS (2007)

The Hierarchy of improvement

1.Eliminate the non-value adding activity

2.Reduce the size of non value adding activity.

3.Combine it with another values adding activity.

Key lean management tools

The 5S

1. Sort – Remove Waste.

2. Set– Set what remains in order. 1-2-3-4-5

3. Shine– Keep a clean environment that allows process flow.

4. Standardise- Maintain good activity standards for teams and managers.

5. Sustain – Audit and improve the quality attained.

NHS LEAN Implementation Principle

• The NHS has come up with 6 principles that should guide the lean thinking implementation

1. Philosophy as the foundation. See the whole process.

2. Level out workloads. Match demand with capacity. Lean is not mean.

3. Work on flowing work through values streams mapping

4. Get quality right the first time. Plan customer value into your process.

5. Standardise tasks. No rigidity just lean- removing non-value adding steps in the process.

6. Grow lean leaders and managers. This is necessary to sustain the gains off the implementation. Lean thrives when there is strong leadership support.

Value stream Mapping

• The following are the steps involved in mapping out values streams in an organisation so that lean principles can be applied

Map the processInvolve those who are involved in the

process Ask why the queues and delay happens

Look to where demand is coming from and smooth it in to the process

Sustain value streams

Analysis of Organisational change

What is organisational Change? According to Patrick Dawson, “it is

a new way of thinking and working”(1994).

This is exactly what lean management is about.

The five dimensions to Organisational Change

• Content/ Character of Change of the change – TQM, Technological change, BPR, Cultural Change.

• Temporal Dimension – rate or pace of change.

• Scale of change – incremental or transformational.

• Political Dimension – Change contested or accepted?

• Intentionality.

LEAN as a tool for organisational change

It is cultural change, with a view for total quality management.

It is slow pace but its gains appears soon

Incremental and transformational It is political accepted tool in the

NHS. Steve Mason, Audit Commission during the Cranfield round Table shows its acceptance in other sectors and introduction to the NHS.

It is an intentional tool employed by change drivers

Lean management

1. It is a transformational process and not a transactional one.

2. It employs the processual approach.

3. It is leadership driven and fits into the Katter's view of leadership change model

4. It is a leadership process that engages the bottom-up approach.

Progress of Change

QI tools are being applied in the healthcare industry in other parts of the developed world

Bolton Hospitals NHS a reduction by one third of death rates for

patients having hip operations reduced paperwork in the trauma unit by 42

per cent and a fifty per cent reduction in the amount of space needed by the pathology department. – Aircraft technicians from the RAF were

invited to help them develop lean techniques

Progress of Change

The Pathology Department of the Royal

Bolton Hospital, yielded a 70% reduction in wasteful activities; 40 per cent reduction in floor space needed; up to 90 percent reductions in the times taken to do its job – all achieved with less, not more, staff and with limited capital investment.

~Powell et al (Feb 2009)

Sample collection after LEAN

BEFORE AFTER

Stocks and Supplies

Before LEAN After LEAN

Pharmacy after LEAN

Stakeholders

Progress of Change

The NHS confederation/LEAN Enterprise Academy

LEAN Healthcare Academy NHS Institute for Innovation and

Improvement Lean Simulation Suitcase

NHS Lean Implementation handbook draft Lean thinking plus Six Sigma.

Challenges

• Some challenges facing Lean have been identified (Young and Maclean 2009 )

• These are– Evidence– Value– Metrics– Resistance

Conclusion

But these challenges

notwithstanding, many writers and journals have expressed optimism that Lean will not only work as a strategy but achieve better service delivery if fully implemented in the NHS

LEAN IS NOT...

LEAN is not Mean

LEAN is not Cost cutting

LEAN is not restructuring

Thank You !