Using lean for continuous improvement

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1 April 2012 Top international award for Bolton NHS FT and BICS We are delighted to announce that Bolton NHS Foundation Trust s Bolton Improving Care System (BICS), which uses lean principles and processes to improve services for patients, has won a major international award - the European Process Excellence Awards for Best Mature Improvement Programme during April. Bolton NHS FT has become internationally renowned and respected for its work using lean methodology to improve healthcare through BICS. Based on a system pioneered in the Japanese car industry using lean, BICS is the Trust s philosophy and evidence base for quality improvement, and involves staff redesigning their own processes to make them more efficient and patient focussed. Since it was introduced in 2005, BICS has resulted in major improvements including lower mortality, reduced length of stay, and many other initiatives which have ultimately saved lives. Despite these successes, the Trust has a quest for continuous improvement and there is still more work to be done on areas such as waiting times, and BICS will be key to making this happen. Using lean for continuous improvement The European Process Excellence Awards are one of the most prestigious awards across all sectors including private and public, and are given to companies which show excellence in using systems like lean to improve services. Last year the Trust s respiratory nursing team won Best Process Improvement Project in Service & Transaction for its work to improve care for its work to improve services for patients. Joy Furnival, Associate Director of Transformation and lead of BICS, said: We are delighted to win this award. It is a major stamp of approval for the improvement work we do for our patients and staff. It is particularly encouraging that this award is not just for the healthcare sector, and demonstrates that our processes and quest for improvement is respected in wider circles, and has been peer reviewed by respected improvement leaders. The judging panel included Adrian Dunn, BP; Peter Evans, formerly Virgin Media; Adam Nowarski, ABB; and Richard Turner, Nationwide. They are pictured above with Joy Furnival and Jo Bolger Leece from the BICS team. They said: The Bolton NHS Foundation Trust entry was a fantastic example of the power of a Lean, Operational Excellence, Programme. Against very stiff opposition from a range of industries including, Power, Banking, Logistics and Financial Services, the team displayed their great passion for all things excellence and were able to demonstrate the commitment of the whole Trust. They ably conveyed a complete understanding of what makes a great Operational Excellence programme and shared with the judges panel a series of benefits that not only spanned customer, financial and people but could show a clear relationship between their programme and lives saved! The team also acknowledged the difficulties they face in the future as they strive to sustain the gains already made, continuously improve in all areas, achieve their cost challenges and spread their focus wider as the Trust expands. Neuro long term conditions 2 Heart failure 2 Stroke therapy services 2 District nursing 3 Children s Outpatients 3 Estates 3 Bolton One 5 Theatre day care unit 5 Academy news 5 Coming up 6 Welcome Welcome to our April newsletter. As you can see above, the BICS work at Bolton has had a major stamp of approval this month, winning a major award. We remain very proud and pleased with our success, but we are conscious that this comes at a time when the Trust continues to face difficult times in both our financial and performance areas, and so our next step is for all of us to put our hearts into using BICS to fulfil its potential. To gain this award is testament to all the improvement work that has already taken place suing BICS, but it also gives us further encouragement that using BICS is the right path for continuous improvement in our Trust. With effort and perseverance, we can continue to improve our services for patients, especially during these difficult times. Joy Furnival, Associate Director of Transformation

2 Please contact for further information. Two ACUTE ADULT DIVISION: Neuro Long Term Conditions Pathway The Neurological Long Term Conditions team, based at Little Lever, provide care to Bolton patients who suffer from conditions such as Parkinson s, Epilepsy and Multiple Sclerosis. The purpose of the event was to ensure the timely delivery and responsiveness of the Consultant-led element of the Community team, in compliance with national targets for new and follow up appointments for 18 weeks referral to treatment. During the event the team: Came up with a number of new agreed patient pathways for consultants, specialist nurses and wards, with regards to patient timelines and when they need review. Identified better utilisation of Lorenzo in order to track when patients need a review. Designed components of a patient partnership agreement in order to reduce DNA s, and this will be tested out with a patient focus group. Came up with a number of options in order to reduce the waiting times for Nurse led Epilepsy and Neuro Consultant clinics. To address the number of inappropriate referrals the team plan to set up an administration triage system for all external referrals, and all internal referrals will now have a single point of access. Please contact Janet.Priest@boltonft.nhs.uk or phone for further information. ACUTE ADULT DIVISION: Heart Failure Pathway During the week of April 9 th, a multidisciplinary team came together to look at the patient pathway for Heart Failure. The week started off with the opportunity to talk to a lady who has been the main carer for her partner since diagnosed with heart failure. This provided valuable insight to the team when developing improvements and aided the development of a Value Statement which helped frame the ongoing improvements. The team also carried out interviews with heart failure patients, learnt how each team member can increase value to patients and carers, mapped the patient s journey, and identified how waste could be removed. News from improvement teams Achievements from the week included: Agreeing Prognostic Indicators for Gold Standard Framework - and an associated educational programme. Referral Guidance for Staff - to minimise confusion and ensure the focus remains on the patients and carers. The establishment of a Multidisciplinary forum across the health economy to support and promotes best practice. Recommencement of board rounds three times per week on Cardiology including a Long Term Care Practitioner. Implementing a 48 hours post discharge telephone follow-up for heart failure patients. Overall the week provided opportunities to learn from one another, not only health care professionals, but patients and carers. Please contact Tracey.Garde@boltonft.nhs.uk for further information. ACUTE ADULT DIVISION: Integrated Stroke Therapy Team Event week of April 16 th provided the opportunity for hospital stroke therapy staff and community stroke therapy team to come together to look at the patient s end to end therapy pathway. The team mapped the patient s therapy journey, and looked in detail at all of the waste involved. A future state was designed and has the potential to deliver a more responsive and timely service, by focusing resources appropriately. Achievement in week included: A shared vision of working as one team, guided by an agreed Value Statement The development of a streaming model based on work carried out in Warrington hospital, that will help to focus team resources to help achieve key indicators identified as best practice. Reduction in handoffs and Duplication A realistic action plan, which includes actions for dealing with the backlog for the Community Stroke Therapy Team

3 Three ACUTE ADULT DIVISION: District nursing team News from improvement teams District Nurses work in 23 teams across 10 health centres in Bolton. There were 14 different work allocation systems across the 23 teams and only 4 health centres used the same system across both teams. The problems faced by the teams included no standard way to allocate work, potential for unsafe work in winter conditions, no audit trail of which clinicians had seen patients each day, and teams requiring support with their caseload couldn t allocate work out to other teams The improvements made by the teams included a daily file with the early and return visits to eliminate missed visits, an A-Z patient index card detailing patient biographical information and a team diary where each day all patient visits are now listed with allocated staff. A one card patient information index system and a named nurse for town centre residencies was also introduced. Data was collected about different types and times of visits and this data will help with the caseload weighting tool which is going to be rolled out. The benefit of all this work is that it is now transparent of what a fairs day work should be across each District Nursing Team and role within that team. For more information please contact gina.riley@boltonft.nhs.uk or caroline.greenhalgh@boltonft.nhs.uk FAMILY CARE DIVISION: Children s Outpatient Services Integration and Relocation During a weeklong event the hospital and community staff came together to review and plan the future arrangements for the children s outpatient service across the whole of Bolton. The Children s Outpatients building on the hospital site is expensive to run and in need of significant backlog maintenance, therefore it has been agreed that this should be closed and clinics being held there relocated into less acute settings by September To enable this relocation all paediatric clinics in Bolton were evaluated to identify their most appropriate delivery environment and their care delivery links considered to create more integrated services. The integrated team identified facilities and resource that will meet the requirements of children, young people and their families, delivering care closer to home, whilst providing appropriate capacity to meet demand. We mapped the demand by postcode and those referred from out of area to identify where the children and young people live who access our services. This showed a clear need to provide services centrally as well as in the east and west of Bolton. It is envisaged that the benefits of the event will include: improved access for children and young people whilst enabling a reduction of the footprint (number or clinical and non-clinical rooms) by 25% to ensure sustainability of the service and creating integrated services and identifying standard processes will help us provide an efficient and effective service in line with all the statutory requirements and guidelines. An action plan (vertical value stream map) was developed with clear timescales and key project leads / sub groups were nominated to co-ordinate actions. Throughout the week we focused on the needs of children, young people and families. A small survey carried out prior to the event to capture the views and preferences of the client group will be replicated on a much larger scale in the first 30 days following the event. This will then inform the timings of clinics delivered. We recognise this is only the start and not the end of the process. However, working together we believe we can implement and achieve the plan within the defined timescale. Thank you for everyone s patience and commitment during the week. For more information please contact kathy.rowlands@boltonft.nhs.uk CORPORATE DIVISION: Improving information quality in Estates Estates recently held a BICS event to examine their governance and assurance processes to improve accuracy and quality of information kept. This will help reduce Trust risks relating to statutory maintenance and inspection and can be used to improve efficiency and productivity in future improvement work. A lean cell was created to clearly identify responsibilities and create standard work which could be tested out on their fire inspection activities. A standard checklist was created for setting up planned maintenance schedules on newly commissioned buildings. It was also agreed to have a central log for job docket amendments to make the administrative workload visible and ensure tasks do not get missed. For further information please contact Shirley.Ryan@boltonft.nhs.uk

4 Four News from improvement teams ELECTIVE CARE DIVISION: Bolton One Update A number of health services provided by Bolton NHS Foundation Trust will be moving into a new building in the town centre during May & June. Patient services due to transfer to Bolton One include: breast screening; elective orthopaedics; rheumatology; thoracic and some general outpatient services with radiological and therapy support. A GP practice will also be based at Bolton One. Plans are ongoing in the various specialty areas to ensure the safe and smooth transition of services. Some of the outpatient moves will enable the development of a Clinical Decisions Unit at the hospital site, however this will require significant clinical input to ensure delivery within very tight timescales. The transfer of services was delayed due to technical delays by BT and Virgin Media and therefore the first moves will start on 14 th May 2012 and will continue during May and June.. Contact carol.bernstein@boltonft.nhs.uk for more information. ELECTIVE CARE DIVISION: Day Care Unit 6S Following on from previous work carried out in both main theatres and on the Day Care Unit (DCU) the aim of the week was to carry out a 6S in the DCU storeroom and implement the shopping lists which main theatres have been developing over the past 18 months. The Day Care Unit, prior to the event had a separate store room which held 49,000 worth of stock for the three theatres and recovery area this storage area also held some items for the DCU ward. After 18 months of using the shopping lists in the main theatre store they reduced the stock held from 34,599 to 21,000 (a 38% reduction) to cover 8 theatres and a recovery area. This next step will see whether the shopping lists can be utilised in DCU to achieve the same level of improvement. In order to increase the visibility of the stock the storage areas were arranged to ensure staff had the right equipment at the right time in the right place and excess stock was removed from the areas and returned to main theatre stores ( 20,000 worth of stock was returned) the shopping list and new stock layouts will be continuously reviewed throughout the 90 days to ensure all staff within DCU have been involved and are comfortable with the new system. By continuously reviewing the new process the team hope to achieve: A smooth, efficient system that will contribute towards patient care and safety because stock will be visible and available in the right place at the right time. Engaged staff who are happy and confident that equipment is available when they need it and who feel their opinions are valued. Clinical staff in DCU will be able to spend less time on stock management. Lower stock levels will be held on the shelves providing a one off saving which will contribute towards the department s savings targets. The next steps will be to ensure all DCU staff are familiar with the new process and are able to give feedback so that further improvements can be made to the shopping lists, communicate the work carried out during the week and also ensure all staff are aware of the new locations for items. For further information please Jacqueline.Furlong@boltonft.nhs.uk ELECTIVE CARE DIVISION: Implementation of digital mammography in Rochdale BICS methodology has been used to implement digital mammography in Rochdale. The work has been facilitated by BICS Academy delegate and breast unit programme manager Claire Mercer, using skills learnt through the BICS Academy. The introduction of a digital service has meant mammogram images are now sent to Bolton electronically immediately, rather than being couriered by taxi for processing. Not only has this speeded up the service for patients, it has saved 12,000 by stopping the use of taxis. The use of a paperless system has also contributed to savings. Thanks to the work, flow time has been reduced by over 80%, and staff engagement has also increased. The team s work has been chosen as a poster presentation at the UK Radiological Congress 2012 in Manchester in June. For more information, contact Claire.mercer@boltonft.nhs.uk

5 Five Green Level Awareness Training May 2012 Due to demand, the BICS Team are please to announce extra places available on BICS Green Level Awareness for May, June and July 2012 What is BICS Green Level Awareness? This is part of the BICS Academy offering differing levels of BICS and Lean awareness, tools and techniques to staff in the hospital. Green is the introductory level, which is now mandatory for all staff. Other levels include: Bronze, Silver, Gold and Platinum What will be covered in the session? The session is a 3 hour basic introduction into the theory behind Lean methodology, history as to how and why Bolton became involved, in addition exercises and practical examples. It covers the case for change, methodology, the basics of BICS and examples of BICS in action. Who is it for? Any member of staff who has had no or little exposure to BICS and Lean methodology. Furthermore, any member of staff wishing to go on a BICS Improvement Event has to have gone through green level prior to their improvement event. BICS Green Level Awareness is now mandatory for all staff, participants will receive a certificate for their portfolio and be registered on ESR. From June 2010 BICS Green Level Awareness and Bronze training has been accredited by the Royal College of Nursing as a training course that can contribute to meeting the continuing professional development standard. Green training equates to 3 hours study time. Please note: if you have already attended BICS Green Level or EQIP Awareness you do not need to attend this session again, unless you wish to do so as a refresher. Dates available are on our intranet site: Bronze Training 2012 Dates are still available for our Bonze training course. Information was included in our March newsletter about course content and is still available on intranet. Dates available: 28 th 30 th May 2nd - 3rd July 24th - 26th September A successful year for the BICS Academy It has been a busy year for the Academy with training delivered from awareness to advanced levels new sessions developed and 6 Foundation Level doctors now on the Leadership Track Programme spending weekly sessions with the team. Over 1000 staff attended green training. 91 staff have been trained at Bronze level taking the total to 274. There have been two groups trained to the intermediate level of Silver and one group trained to the advanced Gold level. Evaluations of the courses have been excellent with 94% of staff rating Green training as good or excellent and 92% of Bronze participants stating that they would recommend the course to a colleague. Staff have been giving the BICS Team really positive feedback about being involved in the improvement events. 83% said that they would like to get involved in further events or would recommend participation to a colleague. Finally for those of you that have attended an outbrief session you may recall that we regularly have visitors from others organisations that come to learn about the improvement work that we do. 95% of our visitors said that they would recommend the day to a colleague, so teams that are feeding back to the group you clearly do make a good impression! For further information please contact Emma.Broda@boltonft.nhs.uk

6 Six Next Event Week: May 14th to 18th 2012 Our next Event Week will take place between Monday May 14th and 18th. Improvement teams during May will include Shared Decision Making in MSK and Antenatal, Please note that the Monday In brief starts at 8.30am, Musgrave House. Each Tuesday Out brief is held in the Boardroom at 4.30pm. Friday Out brief starts at 12 noon at the Sports & Social Club. Everyone is welcome. information on these and other events. Bolton forms Australian alliance Our Trust is forming a unique partnership with Eastern Health in Australia, so the two organisations can learn from each other to help improve patient care. Eastern Health is one of Australia s largest metropolitan health services, providing a range of emergency, medical and general healthcare services in Melbourne, both in hospital and in the community. Bolton is keen to learn about Eastern Health s approach to ambulatory care, where they provide a range of services that deliver healthcare to support patients in their transition from hospital to home, or to receive care in a clinic or at home. The programme aims to create opportunities and supportive environments to empower patients to develop health lifestyles and manage and prevent illness. And Eastern Health wants to learn more about how Bolton has used lean processes to transform services through BICS. the introduced in 2005, it has helped Bolton transform patient care, and the Trust is now nationally and internationally respected for its improvement work. Eastern Health Chief Executive Alan Lilly visited Bolton in April to learn more about the Trust, and to sign a Memorandum of Understanding with Bolton NHS FT Chief Executive Lesley Doherty to agree on a partnership between the two health services. The partnership will see Bolton and Eastern Health working together on improvements, research projects and other initiatives, including staff exchange programmes and secondments. More information will be included in future editions. Lesley Doherty is pictured with Alan Lilly above. BICS now on Twitter BICS now has a Twitter feed where you can keep up to date with all the latest news and announcements from the BICS team. You can follow us Contact us: T: E: BICS@boltonft.nhs.uk W: Bolton Improving Care System c/o Bolton NHS Foundation Trust Minerva Road Bolton BL4 0JR Created by L Tansey & S Bissell BICS Team March 2012 Bolton NHS Foundation Trust All rights reserved. Not to be reproduced in whole or in part without the permission of the copyright owner