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Initial Findings from Evaluation of Service Improvement Activity

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Independent evaluation assessing improvement activities that have ... Site Tours of both Royal Shrewsbury and Princess Royal Hospitals. Some Trust Documents ... – PowerPoint PPT presentation

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Title: Initial Findings from Evaluation of Service Improvement Activity


1
Initial Findings from Evaluation of Service
Improvement Activity
  • Dr Zoe Radnor
  • Giovanni Bucci
  • AtoZ Business Consultancy

2
Overview
  • Independent evaluation assessing improvement
    activities that have taken place over the past 2
    years.
  • Evaluate the impact of the activities and the
    readiness of the Trust to implement further
    improvement.
  • Evaluating the approach of what has been done,
    the process by which it has been implemented, its
    impact and factors which can support
    sustainability of improvement activity in the
    longer term.

3
Methods
  • Focused on Service Improvement Activities
  • Site visits over 4 weeks in January 2008
  • Interviewed 18 people including clinicians,
    managers, nurses and, support staff
  • Carried out 8 Focus Groups
  • Site Tours of both Royal Shrewsbury and Princess
    Royal Hospitals
  • Some Trust Documents

4
Initial Findings Perceptions and Understanding
  • Drivers for improvement have been turnaround and
    current aim to achieve Foundation Trust status
  • Main focus of the activity has been theatre
    stores, RIEs, Productive Ward
  • Number of Service Improvement projects have been
    consolidated in to 4 areas plus 18 RTT
  • Good understanding of the definition of Lean
  • Getting rid of waste, organising and
    prioritising things, being efficient
  • Lean is an improvement methodology. It includes
    process redesign, value stream mapping, removal
    of waste, patient journey, continual improvement
    and 5S

5
Initial Findings Impact
  • Reduced level of stock/ inventory
  • Audits introduced
  • Improved service for the patient
  • Better discharge process
  • Better preparation for surgical procedures
  • More direct time to care for patients (productive
    ward)
  • Tidying up areas cleanliness (5Ss)
  • Staff felt enthused, motivated and empowered to
    implement changes initially
  • It is now a better place to work.There was a
    buzz around the ward
  • Events had a real application to day to day work
    of staff and inspired staff immediately after the
    events. However, they were not followed up on
    and, this motivation has since disappeared.
  • Given an insight to the need to better understand
    the roles and relationship with other departments

6
Initial Findings Organisational Readiness
  • Process mainly seen as the department/ward
    process not as end-to-end process
  • Feeling that culture moving from fire fighting to
    more cause and effect analysis, starting to move
    from financial focus to the patient
  • Customers often seen as the commissioners (i.e.
    PCT).
  • Patient requirement not been fully defined how
    are we doing rather than how do we improve
  • Recognition that it is important to understand
    demand and need to match with capacity but
    information still needed to achieve this.
  • SPS/ Control charts started to be introduced in
    some areas.

7
Initial Findings Goods
  • Lots of improvement activities
  • Good understanding and support from Senior
    Management team (Board level) of the need to take
    Lean approach
  • Recognition that it is important to engage all
    levels of staff
  • Evolution not revolution
  • Doing with not done to
  • Greater awareness and understanding of the need
    for efficiency
  • Division 1 Lean, Division 2 Productive Ward,
    Division 3 TOC/Lean/EFQM
  • Seeing the change happen in real time (Productive
    Ward/5 Ss)
  • Team Briefs have been a useful to communicate
    service improvement activities.
  • Good level of impact where there have been
    champions

8
Initial Findings Issues
  • Uncertainty whether changes will be sustained
  • Not all the actions agreed at the RIE have been
    completed
  • Not all clinicians have engaged with improvement
  • More successful projects have clinical buy-in
  • Big picture not considered - the improvement
    activity is in pockets within the Divisions and
    departments
  • Lack of Learning opportunities
  • Fragmented, and even diverse activities
  • Each Division taking own approach
  • Impact/ Outcomes of Service Improvement often not
    known outside of the departments/ wards
  • Communication could be more effective all levels

9
Reflections Areas for Improvement
  • Communication
  • Engage staff in the communication process (e.g.
    Ward 26)
  • Promote success stories
  • Develop a Service Improvement Strategy that is
    linked with overall Strategy -i.e. what do you
    want to achieve through the improvement activity?
  • Consolidate and co-ordinate the various
    activities across the Divisions
  • Develop an Improvement framework using sets of
    tools within it.
  • Leadership support and challenging
  • Need to give visual support of the activities
    go and see
  • Develop a network of leaders/champions throughout
    the organisation
  • Sustainability
  • Need to embed an improvement culture
  • RIE themselves produced good outcomes but little
    learning or motivation is carried forward except
    by a few individuals
  • Find new ways to engage with the patients
  • Productive Ward is part not all of the journey

10
Are you on the right journey?
  • Should we be on an Improvement Journey?
  • Yes the impact and the extent of the outcomes
    indicate that improvements have taken place for
    the staff and patients.
  • Are we on the right journey?
  • Yes but need to take a whole systems view,
    create quality focused stable processes and embed
    an improvement culture through developing visible
    committed leaders, having clear communication at
    all levels in the organisation and organisational
    readiness
  • Still along way to go.
  • It takes an average of 7 years to implement Lean
    in manufacturing organisations

11
Initial Recommendations for Continued Service
Improvement
  • Create a Service Improvement Strategy/ Framework
  • Understand customer and patient requirements
    manage those expectations
  • Create process to capture and use demand
    information
  • Map the end-to-end processes (clinical and
    support)
  • Develop local champions (at all levels)
  • Develop Communications Strategy
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