Gaining agreement to implement TOC in healthcare. Practical approaches to stakeholder engagement in a healthcare environment

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Mary Manning
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1 Level 3 Basics Workshop Healthcare Gaining agreement to implement TOC in healthcare. Practical approaches to stakeholder engagement in a healthcare environment Presented By: Alex Knight Date: 8 June

2 Objectives To highlight who are the key stakeholders and what are the key messages To stress the importance of the Four Pillars of TOC in engaging key stakeholders To show the process and content of each step of gaining agreement To show the traps to avoid To outline the very first steps 2

engaging key stakeholders To show the process and content of each step

3 Key stakeholders Doctors, nurses, medics, clinicians, etc. Doctors, nurses, medics, clinicians, etc. Doctors, nurses, medics, clinicians, etc. Managers Fund organisations Politicians 3

Doctors, nurses, medics, Doctors, nurses,

4 The Four Pillars of TOC 4

5 A health and social care system finding the inherent simplicity GP referrals Electives 4 hours Home Days Home Home Home Social & Health Care Days Social & Health Care Days Social & Health Care Ambulances Minors ER AU Acute Rehab Residential & Nursing Care Outpatients Emergency Room Medical Assessment Unit Home 12 hours Days Acute Social & Health Care Social & Health Care Days Rehabilitation Hospital Residential & Nursing Care 5

ER AU Acute Rehab Residential & Nursing Care Outpatients Emergency Room Medical Assessment Unit Home 12

6 Why change every conflict can be removed The process The content Initial analysis from hospital data: number of discharges per period length of stay over time length of stay spread signals of disruptions and delay financial analysis, as per p165 Pride and Joy 6

period length of stay over time length of stay spread signals of

7 The core problem 7

8 Criteria for any solution Any solution must simultaneously: Improve the quality and timeliness of patient care. Be focused on achieving a true breakthrough in performance without demanding additional resources before an increase in revenue. Gain the commitment of people who have already been trying to solve the problem. Not put excessive demands on a number of already stretched resources. Achieve sustained and ongoing operational financial improvement. 8 8

increase in revenue. Gain the commitment of people who have already been trying to solve the problem.

9 The core problem How can we simultaneously provide higher quality care and more timely care for more patients within the same or a smaller resource envelope? 9

10 The core problem Any seemingly complex system of dependent events experiencing statistical fluctuations is highly likely to display delay. How can we identify the size and cause of delay through the patient s journey? 10

11 The core of the approach: Pride and Joy, page

12 What does the Theory of Constraints bring? Improving patient flow is the primary objective of the Theory of Constraints approach. A focused process of ongoing improvement to balance patient flow is achieved through a simple patient-centred, clinically led approach. A plethora of harmful local performance measures are replaced with much fewer measures across the whole chain of activities. Everything is focussed on answering two questions: Of all the patients I could treat next which one should I treat next? Of all the places I could improve what are the few key places that will deliver a rapid and sustained system-wide improvement? 12

A plethora of harmful local performance measures are replaced with much fewer measures across the whole chain of activities.

13 The core of the approach: Pride and Joy 13

14 The core of the approach: Pride and Joy, page

15 The general S&T for healthcare 15

16 People are good Remember this is a profession of extremely talented and well educated front-line staff Use an Analytocs style of analysis to create irrefutable evidence of the size of the prize for the hospital. Use the Solutions for Sales style of presentation to create engagement. Use the dice game and simulators to connect theory with intuition. Use relevant case studies to confirm the approach is practical and achieves expected results 16

Use the Solutions for Sales style of presentation to create engagement.

17 Gaining stakeholder engagement the client s view Chief Executive: Barking Havering and Redbridge University Hospitals Trust, Barnet and Chase Farm Hospitals NHS Trust, Barnet Primary Care Trust, City and Hackney Community Services Trust,

Barnet and Chase Farm Hospitals NHS Trust, 2004-2011 Barnet Primary

18 Never say I know: Quality of care is the primary interest of medics/clinicians. Introducing timeliness of care as an aspect of quality of care is key. Demonstrating both are severely compromised through disruption and delay. Be explicit that the financial affordability cannot be separated from the poor quality and timelines of care. They have a common cause. Be careful to apply the mindset and principles of the Theory of Constraints throughout. This is not a silver bullet. 18

Demonstrating both are severely compromised through disruption and delay.

19 Very first steps If you are interested in joining us in these endeavours to use the Theory of Constraints to provide a breakthrough in healthcare then please contact us at tocico@qficonsulting.com 19

Managing patient flow using time buffers

Managing patient flow using time buffers Presented by: Alex Knight, QFI Consulting, UK Roy Stratton, Nottingham Business School, NTU, UK Date: June 2010 2009 TOCICO. All rights reserved. 1 Presentation