NHS HighlandStuart Caldwell

Our Kaizen Programme

• 6 week programme in June 2008• 3 Work streams

– New patient referral– Re-referral– Depot

• MDT teams - everyone involved ~17 staff

What we did…

Value mapped processes to identify• Bottlenecks, duplication and constraints• Waste – non-value work• Information flow & understanding• KPI’s

Tools we used

• Process flow analysis• Value stream mapping• 5 S• 8 Wastes• Mistake Proofing (Poka Yoke)• PDSA• Root Cause analysis

– 5 Why– Fishbone

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

Workshop Conditions before and after 5S

Stores Changes and Control.

Before

After

Stores Changes and Control.

Well organised

stores area (easy to

control and find parts.

Reclaimed Materials

Examples of parts that used to be

scrapped off.

New Area for Reclaimed Materials

Old area (poor utilisation of space)

New area (better utilisation of space)

New Process for Reclaimed Materials

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 .

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 quicklyProblems 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

Other Major Improvement Opportunities

Top 2 concerns that must be addressed

Future Activities? / Areas of Concern

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

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

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

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

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