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…Building Strategic Advantage through Enterprise Wide Improvement…
Tool
TechniquesBeliefs
Simpler Business System® 11.0© Simpler Consulting, L.P. 1996-2009 ALL RIGHTS RESERVED For the Express Use of Simpler Members and Simpler Clients
SBS Tool -A3 Thinking
Tool
TechniquesBeliefs
Simpler Business System® 11.0© Simpler Consulting, L.P. 1996-2011 ALL RIGHTS RESERVED For the Express Use of Simpler Members and Simpler Clients.
2
Quality-checks-as-we-go By the end of this module we will have covered……. The A3 thinking approach The 9 steps required through a worked example Shown other example A3’s
Good
Tool
TechniquesBeliefs
Simpler Business System® 11.0© Simpler Consulting, L.P. 1996-2011 ALL RIGHTS RESERVED For the Express Use of Simpler Members and Simpler Clients.
3
In addition what questions do you need answers for?
Based on what you know about simpler or lean or A3’s…….. What specific questions do you want answered today?
Lets capture these questions and ensure we have answered them at the end
Tool
TechniquesBeliefs
Simpler Business System® 11.0© Simpler Consulting, L.P. 1996-2011 ALL RIGHTS RESERVED For the Express Use of Simpler Members and Simpler Clients.
4
What is A3 Thinking? A Toyota invented problem solving method
Executed on a single sheet of A3 sized piece of paper
A3 is the name for a metric paper size, similar to 11” x 17”
A3 Thinking Forces consensus building
Unifies culture around a simple
systematic, methodology
Becomes also a communication tool
that follows a logical narrative
Builds over years as organization learning
The essence distilled on to one A3 sheet
Context:
Link to Future State Map and/orTPOC/Mission A3
Problem statement (ref. PPS):
Scope and boundary (start/finish)
Therefore:
Improvements are required to:
a.
b.
c.
d.
Associate one of the true north metrics to each improvement requirement.Draw graph; in first session ID at least the axis, existing targets & status.
a. Morale b. Quality
c. Time d. Cost
Set break through goals for each of the above metrics in support of the Future State
a. Morale b. Quality
c. Time d. Expected Benefit = £ ____
Seek to show the tools and logic used to determine direct causes of problems and true root cause. Recommended approach; show fish bone or affinity diagram with:- Problem Statement from box 1 in head.- a, b, c & d improvement requirements as “rib” titles.- Primary Root Causes (the 5th Why) on the branches.- Prioritise Root Causes by numbering them; where 1 = highest impact, etc.The top 6 carried down in order to the Solution box 5 below…
- If VSA then add Current State Summary box..
Max 3 Actions WIP/person30-90d break through focus.Last Column is Status - use RAG (Red, Amber Green)Good events have no to do list!
a. Morale b. Quality
c. Time d. Actual Benefit = £ _____
This box is “GO” when Box 8 = Box 3Monitor ACTUAL results against the metrics defined in initial and target state
Actions What went well?
Consider; ProcessTeamLeaderSenseiCulture & Behaviour
What helped? What hindered?
What did not go well?
What are the fundamental lessons of the event and the improvement cycle?
2. Initial State 5. Solution Approach 8. Confirmed State
1. Reason for Action 4. Gap Analysis 7. Completion Plan
3. Target State 6. Rapid Experiments 9. Insights
Reflections:
Reflections:
Reflections: Reflections:
Reflections:
Reflections:Root Causes: If true root cause not clear then reviewabove.
Reflections:
No GoGo No GoGo No GoGo
No GoGo No GoGo No GoGo
No GoGo No GoGo No GoGo
What did you learn and what are you going to do as a result? AND SO WHAT?
Follow up Action
Actual Effect
Anticipated Effect
Experiment
2 3 4 5 6 7 8 91
SM
SimplerTeam Members Do not progress beyond box 3 without established Quorum in place.Guideline = 1/3 from team, 1/3 wild cards & 1/3 customer.
Start Date:Current Date:End Date:
Title: Start With The Title Then Complete The Title Box
Process Owner: Sponsor: Do boxes 1-3 with Sponsor
Facilitator Sensei
If actual effect = anticipate then proceed to box 7 if not then return to box 4:
OO1d200 daysA B C dSet up One Stop Clinic to reduce1
CEFSCurrent StateAffectingSolutionCause/Priority
RAG
DueOwnerTTAction
Add logo
What did you learn and what are you going to do as a result? AND SO WHAT?
What did you learn and what are you going to do as a result? AND SO WHAT?
What did you learn and what are you going to do as a result? AND SO WHAT?
What did you learn and what are you going to do as a result? AND SO WHAT?
What did you learn and what are you going to do as a result? AND SO WHAT?
What did you learn and what are you going to do as a result? AND SO WHAT?
Explanation of last 5 columns:- Affecting - If major affect on deliverable then use CAPITAL, if minor then lower case.- Current State = data point that describes current performance in terms used in boxes 2 & 3.- FS = Future state prediction (e.g. 1 day) - EASE O = Easy ? = Medium Ease X = Difficult.- COST O = High Cost ? = Medium Cost X = Low Cost
Context:
Link to Future State Map and/orTPOC/Mission A3
Problem statement (ref. PPS):
Scope and boundary (start/finish)
Therefore:
Improvements are required to:
a.
b.
c.
d.
Associate one of the true north metrics to each improvement requirement.Draw graph; in first session ID at least the axis, existing targets & status.
a. Morale b. Quality
c. Time d. Cost
Set break through goals for each of the above metrics in support of the Future State
a. Morale b. Quality
c. Time d. Expected Benefit = £ ____
Seek to show the tools and logic used to determine direct causes of problems and true root cause. Recommended approach; show fish bone or affinity diagram with:- Problem Statement from box 1 in head.- a, b, c & d improvement requirements as “rib” titles.- Primary Root Causes (the 5th Why) on the branches.- Prioritise Root Causes by numbering them; where 1 = highest impact, etc.The top 6 carried down in order to the Solution box 5 below…
- If VSA then add Current State Summary box..
Max 3 Actions WIP/person30-90d break through focus.Last Column is Status - use RAG (Red, Amber Green)Good events have no to do list!
a. Morale b. Quality
c. Time d. Actual Benefit = £ _____
This box is “GO” when Box 8 = Box 3Monitor ACTUAL results against the metrics defined in initial and target state
Actions What went well?
Consider; ProcessTeamLeaderSenseiCulture & Behaviour
What helped? What hindered?
What did not go well?
What are the fundamental lessons of the event and the improvement cycle?
2. Initial State 5. Solution Approach 8. Confirmed State
1. Reason for Action 4. Gap Analysis 7. Completion Plan
3. Target State 6. Rapid Experiments 9. Insights
Reflections:
Reflections:
Reflections: Reflections:
Reflections:
Reflections:Root Causes: If true root cause not clear then reviewabove.
Reflections:
No GoGo No GoGo No GoGo
No GoGo No GoGo No GoGo
No GoGo No GoGo No GoGo
What did you learn and what are you going to do as a result? AND SO WHAT?
Follow up Action
Actual Effect
Anticipated Effect
Experiment
2 3 4 5 6 7 8 91
SM
SimplerTeam Members Do not progress beyond box 3 without established Quorum in place.Guideline = 1/3 from team, 1/3 wild cards & 1/3 customer.
Start Date:Current Date:End Date:
Title: Start With The Title Then Complete The Title Box
Process Owner: Sponsor: Do boxes 1-3 with Sponsor
Facilitator Sensei
If actual effect = anticipate then proceed to box 7 if not then return to box 4:
OO1d200 daysA B C dSet up One Stop Clinic to reduce1
CEFSCurrent StateAffectingSolutionCause/Priority
RAG
DueOwnerTTAction RAG
DueOwnerTTAction
Add logo
What did you learn and what are you going to do as a result? AND SO WHAT?
What did you learn and what are you going to do as a result? AND SO WHAT?
What did you learn and what are you going to do as a result? AND SO WHAT?
What did you learn and what are you going to do as a result? AND SO WHAT?
What did you learn and what are you going to do as a result? AND SO WHAT?
What did you learn and what are you going to do as a result? AND SO WHAT?
Explanation of last 5 columns:- Affecting - If major affect on deliverable then use CAPITAL, if minor then lower case.- Current State = data point that describes current performance in terms used in boxes 2 & 3.- FS = Future state prediction (e.g. 1 day) - EASE O = Easy ? = Medium Ease X = Difficult.- COST O = High Cost ? = Medium Cost X = Low Cost
Tool
TechniquesBeliefs
Simpler Business System® 11.0© Simpler Consulting, L.P. 1996-2011 ALL RIGHTS RESERVED For the Express Use of Simpler Members and Simpler Clients.
5
Why Promote A3 Thinking? A structured cycle of improvement A framework for organizing thinking
For individuals and teams Eliminates the waste of debating method Reveals to issues, problems and thinking Makes problem solving visual Tells a Story – like a story board for a film
The A3 should “tell the story”
Tool
TechniquesBeliefs
Simpler Business System® 11.0© Simpler Consulting, L.P. 1996-2011 ALL RIGHTS RESERVED For the Express Use of Simpler Members and Simpler Clients.
6
How to Achieve A3 Thinking? The process must be inclusive as
possible Hand drawn vs. Computer Pictures vs. text
Work step-by-step Work with consensus Distill thoughts to fit each box Capture the essence Tell the story without the
need for ‘interpretation’
Why is story telling one of the most effective ways of building culture ?
Tool
TechniquesBeliefs
Simpler Business System® 11.0© Simpler Consulting, L.P. 1996-2011 ALL RIGHTS RESERVED For the Express Use of Simpler Members and Simpler Clients.
7
Where does it apply?
A3’s work for all types of activities Strategic Planning
Problem Solving/Decision Making
Sharing ideas/Proposing Change
Value Stream Analysis
Rapid Improvement Events
A3 should become the default way of making improvement
Tool
TechniquesBeliefs
Simpler Business System® 11.0© Simpler Consulting, L.P. 1996-2011 ALL RIGHTS RESERVED For the Express Use of Simpler Members and Simpler Clients.
8
Starting an A3
A Typical A3 life cycle is 12 months!
Context:
Link to Future State Map and/orTPOC/Mission A3
Problem statement (ref. PPS):
Scope and boundary (start/finish)
Therefore:
Improvements are required to:
a.
b.
c.
d.
Associate one of the true north metrics to each improvement requirement.Draw graph; in first session ID at least the axis, existing targets & status.
a. Morale b. Quality
c. Time d. Cost
Set break through goals for each of the above metrics in support of the Future State
a. Morale b. Quality
c. Time d. Expected Benefit = £ ____
Seek to show the tools and logic used to determine direct causes of problems and true root cause. Recommended approach; show fish bone or affinity diagram with:- Problem Statement from box 1 in head.- a, b, c & d improvement requirements as “rib” titles.- Primary Root Causes (the 5th Why) on the branches.- Prioritise Root Causes by numbering them; where 1 = highest impact, etc.The top 6 carried down in order to the Solution box 5 below…
- If VSA then add Current State Summary box..
Max 3 Actions WIP/person30-90d break through focus.Last Column is Status - use RAG (Red, Amber Green)Good events have no to do list!
a. Morale b. Quality
c. Time d. Actual Benefit = £ _____
This box is “GO” when Box 8 = Box 3Monitor ACTUAL results against the metrics defined in initial and target state
Actions What went well?
Consider; ProcessTeamLeaderSenseiCulture & Behaviour
What helped? What hindered?
What did not go well?
What are the fundamental lessons of the event and the improvement cycle?
2. Initial State 5. Solution Approach 8. Confirmed State
1. Reason for Action 4. Gap Analysis 7. Completion Plan
3. Target State 6. Rapid Experiments 9. Insights
Reflections:
Reflections:
Reflections: Reflections:
Reflections:
Reflections:Root Causes: If true root cause not clear then reviewabove.
Reflections:
No GoGo No GoGo No GoGo
No GoGo No GoGo No GoGo
No GoGo No GoGo No GoGo
What did you learn and what are you going to do as a result? AND SO WHAT?
Follow up Action
Actual Effect
Anticipated Effect
Experiment
2 3 4 5 6 7 8 91
SM
SimplerTeam Members Do not progress beyond box 3 without established Quorum in place.Guideline = 1/3 from team, 1/3 wild cards & 1/3 customer.
Start Date:Current Date:End Date:
Title: Start With The Title Then Complete The Title Box
Process Owner: Sponsor: Do boxes 1-3 with Sponsor
Facilitator Sensei
If actual effect = anticipate then proceed to box 7 if not then return to box 4:
OO1d200 daysA B C dSet up One Stop Clinic to reduce1
CEFSCurrent StateAffectingSolutionCause/Priority
RAG
DueOwnerTTAction
Add logo
What did you learn and what are you going to do as a result? AND SO WHAT?
What did you learn and what are you going to do as a result? AND SO WHAT?
What did you learn and what are you going to do as a result? AND SO WHAT?
What did you learn and what are you going to do as a result? AND SO WHAT?
What did you learn and what are you going to do as a result? AND SO WHAT?
What did you learn and what are you going to do as a result? AND SO WHAT?
Explanation of last 5 columns:- Affecting - If major affect on deliverable then use CAPITAL, if minor then lower case.- Current State = data point that describes current performance in terms used in boxes 2 & 3.- FS = Future state prediction (e.g. 1 day) - EASE O = Easy ? = Medium Ease X = Difficult.- COST O = High Cost ? = Medium Cost X = Low Cost
Context:
Link to Future State Map and/orTPOC/Mission A3
Problem statement (ref. PPS):
Scope and boundary (start/finish)
Therefore:
Improvements are required to:
a.
b.
c.
d.
Associate one of the true north metrics to each improvement requirement.Draw graph; in first session ID at least the axis, existing targets & status.
a. Morale b. Quality
c. Time d. Cost
Set break through goals for each of the above metrics in support of the Future State
a. Morale b. Quality
c. Time d. Expected Benefit = £ ____
Seek to show the tools and logic used to determine direct causes of problems and true root cause. Recommended approach; show fish bone or affinity diagram with:- Problem Statement from box 1 in head.- a, b, c & d improvement requirements as “rib” titles.- Primary Root Causes (the 5th Why) on the branches.- Prioritise Root Causes by numbering them; where 1 = highest impact, etc.The top 6 carried down in order to the Solution box 5 below…
- If VSA then add Current State Summary box..
Max 3 Actions WIP/person30-90d break through focus.Last Column is Status - use RAG (Red, Amber Green)Good events have no to do list!
a. Morale b. Quality
c. Time d. Actual Benefit = £ _____
This box is “GO” when Box 8 = Box 3Monitor ACTUAL results against the metrics defined in initial and target state
Actions What went well?
Consider; ProcessTeamLeaderSenseiCulture & Behaviour
What helped? What hindered?
What did not go well?
What are the fundamental lessons of the event and the improvement cycle?
2. Initial State 5. Solution Approach 8. Confirmed State
1. Reason for Action 4. Gap Analysis 7. Completion Plan
3. Target State 6. Rapid Experiments 9. Insights
Reflections:
Reflections:
Reflections: Reflections:
Reflections:
Reflections:Root Causes: If true root cause not clear then reviewabove.
Reflections:
No GoGo No GoGo No GoGo
No GoGo No GoGo No GoGo
No GoGo No GoGo No GoGo
What did you learn and what are you going to do as a result? AND SO WHAT?
Follow up Action
Actual Effect
Anticipated Effect
Experiment
2 3 4 5 6 7 8 91
SM
SimplerTeam Members Do not progress beyond box 3 without established Quorum in place.Guideline = 1/3 from team, 1/3 wild cards & 1/3 customer.
Start Date:Current Date:End Date:
Title: Start With The Title Then Complete The Title Box
Process Owner: Sponsor: Do boxes 1-3 with Sponsor
Facilitator Sensei
If actual effect = anticipate then proceed to box 7 if not then return to box 4:
OO1d200 daysA B C dSet up One Stop Clinic to reduce1
CEFSCurrent StateAffectingSolutionCause/Priority
RAG
DueOwnerTTAction RAG
DueOwnerTTAction
Add logo
What did you learn and what are you going to do as a result? AND SO WHAT?
What did you learn and what are you going to do as a result? AND SO WHAT?
What did you learn and what are you going to do as a result? AND SO WHAT?
What did you learn and what are you going to do as a result? AND SO WHAT?
What did you learn and what are you going to do as a result? AND SO WHAT?
What did you learn and what are you going to do as a result? AND SO WHAT?
Explanation of last 5 columns:- Affecting - If major affect on deliverable then use CAPITAL, if minor then lower case.- Current State = data point that describes current performance in terms used in boxes 2 & 3.- FS = Future state prediction (e.g. 1 day) - EASE O = Easy ? = Medium Ease X = Difficult.- COST O = High Cost ? = Medium Cost X = Low Cost
1.1. Fill in Title Fill in Title Name (Dept, Division, Name (Dept, Division, Product/Service) Product/Service)
2.2. Fill in Start Date Fill in Start Date (Start of (Start of A3)A3)
3.3. Fill in Current Date Fill in Current Date (Date and Rev)(Date and Rev)
4.4. Record the team Record the team membersmembers
5.5. Select the review teamSelect the review team(team that will support(team that will supportthe A3 team with the A3 team with relevant knowledge & relevant knowledge & guidance)guidance)
Tool
TechniquesBeliefs
Simpler Business System® 11.0© Simpler Consulting, L.P. 1996-2011 ALL RIGHTS RESERVED For the Express Use of Simpler Members and Simpler Clients.
9
Box 1 – Reason for action
A Typical A3 life cycle is 12 months!
• Reason for Action Reason for Action
• Chief Complaint orChief Complaint or
• Problem StatementProblem Statement
• Why are we talking Why are we talking about this issue?about this issue?
• Understanding the Understanding the true problem is 50% true problem is 50% of it’s solutionof it’s solution
The VSA highlighted patients
typically visit the Renal clinic 8
times, taking 201 days to obtain a
date for surgery. Consequently 42%
of patients need temporary access
impacting SMR (113) and income.
Therefore the event themesare:
a. Too many visits: focus is to reduce # of visits to the clinic.
b. Flow Time too long: focus is to reduce time from referral to getting a date for surgery.
c. Too many have temp access: focus is to reduce % of population with temp. access.
d. Demand > Capacity: focus is to meet demand.
a. # Visits (Morale)b. Time to get Date (Timeliness)
c. Temp v Def Access (Quality)
a. Morale
c. Timed. Increased activity= £ 375K net profit pa
a. Morale b. Quality
c. Time d. Actual Benefit = £ _____
This box is “GO” when Box 8 = Box 3Monitor ACTUAL results against the metrics defined in initial and target state
Actions (Follow Up Req’d!)
1. Invite appropriate people
for discussion @ that time.
2. Manage more closely the
agenda for week
3. Make agenda available
before event in normal
“lingo” - clarify Day 4!
4. Involve Team Leader in
Simpler/Trans. Team calls
5. Plan to Run the Process
every time - it drives the
change in one week!
What went well?
Excellent Buy in from attendees.
Clinic trial (“run the process”)
FUN WEEK!
Agreed Future Process.
Stuck to itinerary.
What helped?
Tosh’s support and insight!
What hindered?
Discussions going off track.
Transient clinic: did not find a way
To make change visible/physical.
What did not go well?
Not always one voice in the room!
Lack of Clinical Input (nursing &
Anaesthetist).
Lack of direction at times.
What are the fundamental lessons of the event and the improvement cycle?
2. Initial State 5. Solution Approach 8. Confirmed State
1. Reason for Action 4. Gap Analysis 7. Completion Plan
3. Target State 6. Rapid Experiments 9. Insights
Reflections:
Reflections:
Reflections: The throughput metric is directly correlated to income and thus captures both on one graph. The original VSA target was moderatedas it became clear that the higher target would require a third clinic.
Reflections:The Bar charts showed efficiency could jump from 55% to 83% and capacity from 6 to 8 complex Pts if Vein Mapping is moved into process flow!
Reflections: The Ease (E) and Cost (C ) column show the difficulty of implementation. A “O” signifies easy or low cost and a “X” is difficult or high cost; hence the transport solution should be the subject of another event.
Reflections: Running the rapid experiment identifiedIn the VSA gives confidence that the above are the main causes of the gap between initial and targeted state!
Root Causes: Ad hoc current process makes
Resource co-ordination impossible!
Reflections:
No GoGo No GoGo No GoGo
No GoGo No GoGo No GoGo
No GoGo No GoGo No GoGo
The process takes too long and patients are at best inconvenienced and at worst deteriorate. The trends for a, b, c & d must be understood ...
Do it!6 Pts6 PtsRun One Stop Clinic with “typical” Pt mix.
Follow up Action
Actual Effect
Anticipated Effect
Experiment
2 3 4 5 6 7 8 91
SM
Simpler
Team Members Left to Right; Steve Hart (GM),
Start Date:Current Date:End Date:
Title: Renal One Stop Clinic
Process Owner: Breeda McManus & JP Nolan
Sponsor: Zafar Chawdhery & Alistair Chesser
Facilitators: Jane Holmes & Andy Fleming
Sensei: Steve Garnett
??OnNot on callA b DEstablish “on call” translator to Rota
?OFullNo supportDAgree level required with Pt Services
O?1000% YieldA b CRedesign Pt Info. Collection process
?X010 complaints/wkA b C DRapid Redesign Event on Transport
OOYesNo auth.A B C dRegister & authorise Clinic
OO1d200 daysA B C DSet up One Stop Clinic to reduce
CEFSCurrent StateAffecting Themes
SolutionCause/Priority
30/7JP2hEnsure all docs. Prepared for first clinic.
30/7D J L1dEstablish Info. Centre to manage problems arising.
30/7DC1hConfirm Rota for August
30/7ZC1hAgree Surgical/ Anestheticprotocols.
30/7EW1hAgree Pt. Info
30/7JP4hIdentify Pts for first clinic
RAG
DueOwnerTTAction
Barts &The London
400 miles traveled by patients often using BartsTransport!
The process starts with DGH referral and ends with a date for surgery.
Vis
its t
o c
linic
8
2006/07
Many visits ˜ many miles NOK Patient Morale!
X
X X
Flo
w T
ime
/d
ays
200
Typically ˜ 8 Months to get surgery!
X
2006/07
%
Acc
ess
Typ
e
58
%
42
%
Lines Def. Access
d. Throughput (Cost)
Th
rou
gh
pu
t/w
ee
k
2006/07
The data was not complete enough to show trend however all conditions are bad (X Status); and targets are clear for below…
a. # Visits (Morale)
Vis
its t
o c
linic
8
1
O
3
134 Pts pa
2006 Aug 07 onwards
X
X
Step Change!
b. Time to get Date (Timeliness)
Flo
w T
ime
/d
ays
O200
1 X
X
Step Change!
c. Temp v Def Access (Quality)
%
Acc
ess
Typ
e
80
%
Lines Def. Access
20%
High SMR
Th
rou
gh
pu
t/w
ee
k
O12
6
3
X
X
2006 Aug 07 onwards
20/7 1/8 1/9 onwards
500 Pts paO
The cause of problems creating gap between initial & target state in themes a,b,c & d (ref box 1,2&3):
Why?
5th Why?
Another event!
IN BOX 8 WE TRACK AND SHOW THE BENEFIT/RESULTS.
THE FIRST UPDATE IS DUE 3RD AUGUST 2007 FOLLOWINGFIRST RUN OF ONE STOP CLINIC.
THE GRAPHS COPY ACROSS FROM BOX TWO AND THREE.
IF WE ARE NOT MEETING THE TARGETS WE NEED TO GOBACK TO BOX 4 TO UNDERSTAND WHY - AN EFFECTIVEINFO. CENTRE WILL EASE THIS TASK!
The VSA highlighted patients
typically visit the Renal clinic 8
times, taking 201 days to obtain a
date for surgery. Consequently 42%
of patients need temporary access
impacting SMR (113) and income.
Therefore the event themesare:
a. Too many visits: focus is to reduce # of visits to the clinic.
b. Flow Time too long: focus is to reduce time from referral to getting a date for surgery.
c. Too many have temp access: focus is to reduce % of population with temp. access.
d. Demand > Capacity: focus is to meet demand.
a. # Visits (Morale)b. Time to get Date (Timeliness)
c. Temp v Def Access (Quality)
a. Morale
c. Timed. Increased activity= £ 375K net profit pa
a. Morale b. Quality
c. Time d. Actual Benefit = £ _____
This box is “GO” when Box 8 = Box 3Monitor ACTUAL results against the metrics defined in initial and target state
Actions (Follow Up Req’d!)
1. Invite appropriate people
for discussion @ that time.
2. Manage more closely the
agenda for week
3. Make agenda available
before event in normal
“lingo” - clarify Day 4!
4. Involve Team Leader in
Simpler/Trans. Team calls
5. Plan to Run the Process
every time - it drives the
change in one week!
What went well?
Excellent Buy in from attendees.
Clinic trial (“run the process”)
FUN WEEK!
Agreed Future Process.
Stuck to itinerary.
What helped?
Tosh’s support and insight!
What hindered?
Discussions going off track.
Transient clinic: did not find a way
To make change visible/physical.
What did not go well?
Not always one voice in the room!
Lack of Clinical Input (nursing &
Anaesthetist).
Lack of direction at times.
What are the fundamental lessons of the event and the improvement cycle?
2. Initial State 5. Solution Approach 8. Confirmed State
1. Reason for Action 4. Gap Analysis 7. Completion Plan
3. Target State 6. Rapid Experiments 9. Insights
Reflections:
Reflections:
Reflections: The throughput metric is directly correlated to income and thus captures both on one graph. The original VSA target was moderatedas it became clear that the higher target would require a third clinic.
Reflections:The Bar charts showed efficiency could jump from 55% to 83% and capacity from 6 to 8 complex Pts if Vein Mapping is moved into process flow!
Reflections: The Ease (E) and Cost (C ) column show the difficulty of implementation. A “O” signifies easy or low cost and a “X” is difficult or high cost; hence the transport solution should be the subject of another event.
Reflections: Running the rapid experiment identifiedIn the VSA gives confidence that the above are the main causes of the gap between initial and targeted state!
Root Causes: Ad hoc current process makes
Resource co-ordination impossible!
Reflections:
No GoGo No GoGo No GoGo
No GoGo No GoGo No GoGo
No GoGo No GoGo No GoGo
The process takes too long and patients are at best inconvenienced and at worst deteriorate. The trends for a, b, c & d must be understood ...
Do it!6 Pts6 PtsRun One Stop Clinic with “typical” Pt mix.
Follow up Action
Actual Effect
Anticipated Effect
Experiment
2 3 4 5 6 7 8 91
SM
Simpler
Team Members Left to Right; Steve Hart (GM),
Start Date:Current Date:End Date:
Title: Renal One Stop Clinic
Process Owner: Breeda McManus & JP Nolan
Sponsor: Zafar Chawdhery & Alistair Chesser
Facilitators: Jane Holmes & Andy Fleming
Sensei: Steve Garnett
??OnNot on callA b DEstablish “on call” translator to Rota
?OFullNo supportDAgree level required with Pt Services
O?1000% YieldA b CRedesign Pt Info. Collection process
?X010 complaints/wkA b C DRapid Redesign Event on Transport
OOYesNo auth.A B C dRegister & authorise Clinic
OO1d200 daysA B C DSet up One Stop Clinic to reduce
CEFSCurrent StateAffecting Themes
SolutionCause/Priority
30/7JP2hEnsure all docs. Prepared for first clinic.
30/7D J L1dEstablish Info. Centre to manage problems arising.
30/7DC1hConfirm Rota for August
30/7ZC1hAgree Surgical/ Anestheticprotocols.
30/7EW1hAgree Pt. Info
30/7JP4hIdentify Pts for first clinic
RAG
DueOwnerTTAction
Barts &The London
400 miles traveled by patients often using BartsTransport!
The process starts with DGH referral and ends with a date for surgery.
Vis
its t
o c
linic
8
2006/07
Many visits ˜ many miles NOK Patient Morale!
X
X X
Flo
w T
ime
/d
ays
200
Typically ˜ 8 Months to get surgery!
X
2006/07
%
Acc
ess
Typ
e
58
%
42
%
Lines Def. Access
d. Throughput (Cost)
Th
rou
gh
pu
t/w
ee
k
2006/07
The data was not complete enough to show trend however all conditions are bad (X Status); and targets are clear for below…
a. # Visits (Morale)
Vis
its t
o c
linic
8
1
O
3
134 Pts pa
2006 Aug 07 onwards
X
X
Step Change!
b. Time to get Date (Timeliness)
Flo
w T
ime
/d
ays
O200
1 X
X
Step Change!
c. Temp v Def Access (Quality)
%
Acc
ess
Typ
e
80
%
Lines Def. Access
20%
High SMR
Th
rou
gh
pu
t/w
ee
k
O12
6
3
X
X
2006 Aug 07 onwards
20/7 1/8 1/9 onwards
500 Pts paO
The cause of problems creating gap between initial & target state in themes a,b,c & d (ref box 1,2&3):
Why?
5th Why?
Another event!
IN BOX 8 WE TRACK AND SHOW THE BENEFIT/RESULTS.
THE FIRST UPDATE IS DUE 3RD AUGUST 2007 FOLLOWINGFIRST RUN OF ONE STOP CLINIC.
THE GRAPHS COPY ACROSS FROM BOX TWO AND THREE.
IF WE ARE NOT MEETING THE TARGETS WE NEED TO GOBACK TO BOX 4 TO UNDERSTAND WHY - AN EFFECTIVEINFO. CENTRE WILL EASE THIS TASK!
Tool
TechniquesBeliefs
Simpler Business System® 11.0© Simpler Consulting, L.P. 1996-2011 ALL RIGHTS RESERVED For the Express Use of Simpler Members and Simpler Clients.
10
Box 2 – The Initial State
The VSA highlighted patients
typically visit the Renal clinic 8
times, taking 201 days to obtain a
date for surgery. Consequently 42%
of patients need temporary access
impacting SMR (113) and income.
Therefore the event themesare:
a. Too many visits: focus is to reduce # of visits to the clinic.
b. Flow Time too long: focus is to reduce time from referral to getting a date for surgery.
c. Too many have temp access: focus is to reduce % of population with temp. access.
d. Demand > Capacity: focus is to meet demand.
a. # Visits (Morale)b. Time to get Date (Timeliness)
c. Temp v Def Access (Quality)
a. Morale
c. Timed. Increased activity= £ 375K net profit pa
a. Morale b. Quality
c. Time d. Actual Benefit = £ _____
This box is “GO” when Box 8 = Box 3Monitor ACTUAL results against the metrics defined in initial and target state
Actions (Follow Up Req’d!)
1. Invite appropriate people
for discussion @ that time.
2. Manage more closely the
agenda for week
3. Make agenda available
before event in normal
“lingo” - clarify Day 4!
4. Involve Team Leader in
Simpler/Trans. Team calls
5. Plan to Run the Process
every time - it drives the
change in one week!
What went well?
Excellent Buy in from attendees.
Clinic trial (“run the process”)
FUN WEEK!
Agreed Future Process.
Stuck to itinerary.
What helped?
Tosh’s support and insight!
What hindered?
Discussions going off track.
Transient clinic: did not find a way
To make change visible/physical.
What did not go well?
Not always one voice in the room!
Lack of Clinical Input (nursing &
Anaesthetist).
Lack of direction at times.
What are the fundamental lessons of the event and the improvement cycle?
2. Initial State 5. Solution Approach 8. Confirmed State
1. Reason for Action 4. Gap Analysis 7. Completion Plan
3. Target State 6. Rapid Experiments 9. Insights
Reflections:
Reflections:
Reflections: The throughput metric is directly correlated to income and thus captures both on one graph. The original VSA target was moderatedas it became clear that the higher target would require a third clinic.
Reflections:The Bar charts showed efficiency could jump from 55% to 83% and capacity from 6 to 8 complex Pts if Vein Mapping is moved into process flow!
Reflections: The Ease (E) and Cost (C ) column show the difficulty of implementation. A “O” signifies easy or low cost and a “X” is difficult or high cost; hence the transport solution should be the subject of another event.
Reflections: Running the rapid experiment identifiedIn the VSA gives confidence that the above are the main causes of the gap between initial and targeted state!
Root Causes: Ad hoc current process makes
Resource co-ordination impossible!
Reflections:
No GoGo No GoGo No GoGo
No GoGo No GoGo No GoGo
No GoGo No GoGo No GoGo
The process takes too long and patients are at best inconvenienced and at worst deteriorate. The trends for a, b, c & d must be understood ...
Do it!6 Pts6 PtsRun One Stop Clinic with “typical” Pt mix.
Follow up Action
Actual Effect
Anticipated Effect
Experiment
2 3 4 5 6 7 8 91
SM
Simpler
Team Members Left to Right; Steve Hart (GM),
Start Date:Current Date:End Date:
Title: Renal One Stop Clinic
Process Owner: Breeda McManus & JP Nolan
Sponsor: Zafar Chawdhery & Alistair Chesser
Facilitators: Jane Holmes & Andy Fleming
Sensei: Steve Garnett
??OnNot on callA b DEstablish “on call” translator to Rota
?OFullNo supportDAgree level required with Pt Services
O?1000% YieldA b CRedesign Pt Info. Collection process
?X010 complaints/wkA b C DRapid Redesign Event on Transport
OOYesNo auth.A B C dRegister & authorise Clinic
OO1d200 daysA B C DSet up One Stop Clinic to reduce
CEFSCurrent StateAffecting Themes
SolutionCause/Priority
30/7JP2hEnsure all docs. Prepared for first clinic.
30/7D J L1dEstablish Info. Centre to manage problems arising.
30/7DC1hConfirm Rota for August
30/7ZC1hAgree Surgical/ Anestheticprotocols.
30/7EW1hAgree Pt. Info
30/7JP4hIdentify Pts for first clinic
RAG
DueOwnerTTAction
Barts &The London
400 miles traveled by patients often using BartsTransport!
The process starts with DGH referral and ends with a date for surgery.
Vis
its
to c
linic
8
2006/07
Many visits ˜ many miles NOK Patient Morale!
X
X X
Flo
w T
ime
/d
ays
200
Typically ˜ 8 Months to get surgery!
X
2006/07
%
Acce
ss T
yp
e
58
%
42
%
Lines Def. Access
d. Throughput (Cost)
Th
rou
gh
pu
t
/we
ek
2006/07
The data was not complete enough to show trend however all conditions are bad (X Status); and targets are clear for below…
a. # Visits (Morale)
Vis
its
to c
linic
8
1
O
3
134 Pts pa
2006 Aug 07 onwards
X
X
Step Change!
b. Time to get Date (Timeliness)
Flo
w T
ime
/d
ays
O200
1 X
X
Step Change!
c. Temp v Def Access (Quality)
%
Acce
ss T
yp
e
80
%
Lines Def. Access
20%
High SMR
Th
rou
gh
pu
t
/we
ek
O12
6
3
X
X
2006 Aug 07 onwards
20/7 1/8 1/9 onwards
500 Pts paO
The cause of problems creating gap between initial & target state in themes a,b,c & d (ref box 1,2&3):
5th Why?
Another event!
IN BOX 8 WE TRACK AND SHOW THE BENEFIT/RESULTS.
THE FIRST UPDATE IS DUE 3RD AUGUST 2007 FOLLOWINGFIRST RUN OF ONE STOP CLINIC.
THE GRAPHS COPY ACROSS FROM BOX TWO AND THREE.
IF WE ARE NOT MEETING THE TARGETS WE NEED TO GOBACK TO BOX 4 TO UNDERSTAND WHY - AN EFFECTIVEINFO. CENTRE WILL EASE THIS TASK!
The VSA highlighted patients
typically visit the Renal clinic 8
times, taking 201 days to obtain a
date for surgery. Consequently 42%
of patients need temporary access
impacting SMR (113) and income.
Therefore the event themesare:
a. Too many visits: focus is to reduce # of visits to the clinic.
b. Flow Time too long: focus is to reduce time from referral to getting a date for surgery.
c. Too many have temp access: focus is to reduce % of population with temp. access.
d. Demand > Capacity: focus is to meet demand.
a. # Visits (Morale)b. Time to get Date (Timeliness)
c. Temp v Def Access (Quality)
a. Morale
c. Timed. Increased activity= £ 375K net profit pa
a. Morale b. Quality
c. Time d. Actual Benefit = £ _____
This box is “GO” when Box 8 = Box 3Monitor ACTUAL results against the metrics defined in initial and target state
Actions (Follow Up Req’d!)
1. Invite appropriate people
for discussion @ that time.
2. Manage more closely the
agenda for week
3. Make agenda available
before event in normal
“lingo” - clarify Day 4!
4. Involve Team Leader in
Simpler/Trans. Team calls
5. Plan to Run the Process
every time - it drives the
change in one week!
What went well?
Excellent Buy in from attendees.
Clinic trial (“run the process”)
FUN WEEK!
Agreed Future Process.
Stuck to itinerary.
What helped?
Tosh’s support and insight!
What hindered?
Discussions going off track.
Transient clinic: did not find a way
To make change visible/physical.
What did not go well?
Not always one voice in the room!
Lack of Clinical Input (nursing &
Anaesthetist).
Lack of direction at times.
What are the fundamental lessons of the event and the improvement cycle?
2. Initial State 5. Solution Approach 8. Confirmed State
1. Reason for Action 4. Gap Analysis 7. Completion Plan
3. Target State 6. Rapid Experiments 9. Insights
Reflections:
Reflections:
Reflections: The throughput metric is directly correlated to income and thus captures both on one graph. The original VSA target was moderatedas it became clear that the higher target would require a third clinic.
Reflections:The Bar charts showed efficiency could jump from 55% to 83% and capacity from 6 to 8 complex Pts if Vein Mapping is moved into process flow!
Reflections: The Ease (E) and Cost (C ) column show the difficulty of implementation. A “O” signifies easy or low cost and a “X” is difficult or high cost; hence the transport solution should be the subject of another event.
Reflections: Running the rapid experiment identifiedIn the VSA gives confidence that the above are the main causes of the gap between initial and targeted state!
Root Causes: Ad hoc current process makes
Resource co-ordination impossible!
Reflections:
No GoGo No GoGo No GoGo
No GoGo No GoGo No GoGo
No GoGo No GoGo No GoGo
The process takes too long and patients are at best inconvenienced and at worst deteriorate. The trends for a, b, c & d must be understood ...
Do it!6 Pts6 PtsRun One Stop Clinic with “typical” Pt mix.
Follow up Action
Actual Effect
Anticipated Effect
Experiment
2 3 4 5 6 7 8 91
SM
Simpler
Team Members Left to Right; Steve Hart (GM),
Start Date:Current Date:End Date:
Title: Renal One Stop Clinic
Process Owner: Breeda McManus & JP Nolan
Sponsor: Zafar Chawdhery & Alistair Chesser
Facilitators: Jane Holmes & Andy Fleming
Sensei: Steve Garnett
??OnNot on callA b DEstablish “on call” translator to Rota
?OFullNo supportDAgree level required with Pt Services
O?1000% YieldA b CRedesign Pt Info. Collection process
?X010 complaints/wkA b C DRapid Redesign Event on Transport
OOYesNo auth.A B C dRegister & authorise Clinic
OO1d200 daysA B C DSet up One Stop Clinic to reduce
CEFSCurrent StateAffecting Themes
SolutionCause/Priority
30/7JP2hEnsure all docs. Prepared for first clinic.
30/7D J L1dEstablish Info. Centre to manage problems arising.
30/7DC1hConfirm Rota for August
30/7ZC1hAgree Surgical/ Anestheticprotocols.
30/7EW1hAgree Pt. Info
30/7JP4hIdentify Pts for first clinic
RAG
DueOwnerTTAction
Barts &The London
400 miles traveled by patients often using BartsTransport!
The process starts with DGH referral and ends with a date for surgery.
Vis
its
to c
linic
8
2006/07
Many visits ˜ many miles NOK Patient Morale!
X
X X
Flo
w T
ime
/d
ays
200
Typically ˜ 8 Months to get surgery!
X
2006/07
%
Acce
ss T
yp
e
58
%
42
%
Lines Def. Access
d. Throughput (Cost)
Th
rou
gh
pu
t
/we
ek
2006/07
The data was not complete enough to show trend however all conditions are bad (X Status); and targets are clear for below…
a. # Visits (Morale)
Vis
its
to c
linic
8
1
O
3
134 Pts pa
2006 Aug 07 onwards
X
X
Step Change!
b. Time to get Date (Timeliness)
Flo
w T
ime
/d
ays
O200
1 X
X
Step Change!
c. Temp v Def Access (Quality)
%
Acce
ss T
yp
e
80
%
Lines Def. Access
20%
High SMR
Th
rou
gh
pu
t
/we
ek
O12
6
3
X
X
2006 Aug 07 onwards
20/7 1/8 1/9 onwards
500 Pts paO
The cause of problems creating gap between initial & target state in themes a,b,c & d (ref box 1,2&3):
5th Why?
Another event!
IN BOX 8 WE TRACK AND SHOW THE BENEFIT/RESULTS.
THE FIRST UPDATE IS DUE 3RD AUGUST 2007 FOLLOWINGFIRST RUN OF ONE STOP CLINIC.
THE GRAPHS COPY ACROSS FROM BOX TWO AND THREE.
IF WE ARE NOT MEETING THE TARGETS WE NEED TO GOBACK TO BOX 4 TO UNDERSTAND WHY - AN EFFECTIVEINFO. CENTRE WILL EASE THIS TASK!
2.Graphically Present Initial State2.Graphically Present Initial State• Where do things stand now?Where do things stand now?• What is happening now?What is happening now?• Express the situation in time and unitsExpress the situation in time and units• Use data that can later ‘prove the case’Use data that can later ‘prove the case’
Tool
TechniquesBeliefs
Simpler Business System® 11.0© Simpler Consulting, L.P. 1996-2011 ALL RIGHTS RESERVED For the Express Use of Simpler Members and Simpler Clients.
11
Box 3 – The Target State
The VSA highlighted patients
typically visit the Renal clinic 8
times, taking 201 days to obtain a
date for surgery. Consequently 42%
of patients need temporary access
impacting SMR (113) and income.
Therefore the event themesare:
a. Too many visits: focus is to reduce # of visits to the clinic.
b. Flow Time too long: focus is to reduce time from referral to getting a date for surgery.
c. Too many have temp access: focus is to reduce % of population with temp. access.
d. Demand > Capacity: focus is to meet demand.
a. # Visits (Morale)b. Time to get Date (Timeliness)
c. Temp v Def Access (Quality)
a. Morale
c. Timed. Increased activity= £ 375K net profit pa
a. Morale b. Quality
c. Time d. Actual Benefit = £ _____
This box is “GO” when Box 8 = Box 3Monitor ACTUAL results against the metrics defined in initial and target state
Actions (Follow Up Req’d!)
1. Invite appropriate people
for discussion @ that time.
2. Manage more closely the
agenda for week
3. Make agenda available
before event in normal
“lingo” - clarify Day 4!
4. Involve Team Leader in
Simpler/Trans. Team calls
5. Plan to Run the Process
every time - it drives the
change in one week!
What went well?
Excellent Buy in from attendees.
Clinic trial (“run the process”)
FUN WEEK!
Agreed Future Process.
Stuck to itinerary.
What helped?
Tosh’s support and insight!
What hindered?
Discussions going off track.
Transient clinic: did not find a way
To make change visible/physical.
What did not go well?
Not always one voice in the room!
Lack of Clinical Input (nursing &
Anaesthetist).
Lack of direction at times.
What are the fundamental lessons of the event and the improvement cycle?
2. Initial State 5. Solution Approach 8. Confirmed State
1. Reason for Action 4. Gap Analysis 7. Completion Plan
3. Target State 6. Rapid Experiments 9. Insights
Reflections:
Reflections:
Reflections: The throughput metric is directly correlated to income and thus captures both on one graph. The original VSA target was moderatedas it became clear that the higher target would require a third clinic.
Reflections:The Bar charts showed efficiency could jump from 55% to 83% and capacity from 6 to 8 complex Pts if Vein Mapping is moved into process flow!
Reflections: The Ease (E) and Cost (C ) column show the difficulty of implementation. A “O” signifies easy or low cost and a “X” is difficult or high cost; hence the transport solution should be the subject of another event.
Reflections: Running the rapid experiment identifiedIn the VSA gives confidence that the above are the main causes of the gap between initial and targeted state!
Root Causes: Ad hoc current process makes
Resource co-ordination impossible!
Reflections:
No GoGo No GoGo No GoGo
No GoGo No GoGo No GoGo
No GoGo No GoGo No GoGo
The process takes too long and patients are at best inconvenienced and at worst deteriorate. The trends for a, b, c & d must be understood ...
Do it!6 Pts6 PtsRun One Stop Clinic with “typical” Pt mix.
Follow up Action
Actual Effect
Anticipated Effect
Experiment
2 3 4 5 6 7 8 91
SM
Simpler
Team Members Left to Right; Steve Hart (GM),
Start Date:Current Date:End Date:
Title: Renal One Stop Clinic
Process Owner: Breeda McManus & JP Nolan
Sponsor: Zafar Chawdhery & Alistair Chesser
Facilitators: Jane Holmes & Andy Fleming
Sensei: Steve Garnett
??OnNot on callA b DEstablish “on call” translator to Rota
?OFullNo supportDAgree level required with Pt Services
O?1000% YieldA b CRedesign Pt Info. Collection process
?X010 complaints/wkA b C DRapid Redesign Event on Transport
OOYesNo auth.A B C dRegister & authorise Clinic
OO1d200 daysA B C DSet up One Stop Clinic to reduce
CEFSCurrent StateAffecting Themes
SolutionCause/Priority
30/7JP2hEnsure all docs. Prepared for first clinic.
30/7D J L1dEstablish Info. Centre to manage problems arising.
30/7DC1hConfirm Rota for August
30/7ZC1hAgree Surgical/ Anestheticprotocols.
30/7EW1hAgree Pt. Info
30/7JP4hIdentify Pts for first clinic
RAG
DueOwnerTTAction
Barts &The London
400 miles traveled by patients often using BartsTransport!
The process starts with DGH referral and ends with a date for surgery.
Vis
its
to c
linic
8
2006/07
Many visits ˜ many miles NOK Patient Morale!
X
X X
Flo
w T
ime
/d
ays
200
Typically ˜ 8 Months to get surgery!
X
2006/07
%
Acce
ss T
yp
e
58
%
42
%
Lines Def. Access
d. Throughput (Cost)
Th
rou
gh
pu
t
/we
ek
2006/07
The data was not complete enough to show trend however all conditions are bad (X Status); and targets are clear for below…
a. # Visits (Morale)
Vis
its
to c
linic
8
1
O
3
134 Pts pa
2006 Aug 07 onwards
X
X
Step Change!
b. Time to get Date (Timeliness)
Flo
w T
ime
/d
ays
O200
1 X
X
Step Change!
c. Temp v Def Access (Quality)
%
Acce
ss T
yp
e
80
%
Lines Def. Access
20%
High SMR
Th
rou
gh
pu
t
/we
ek
O12
6
3
X
X
2006 Aug 07 onwards
20/7 1/8 1/9 onwards
500 Pts paO
The cause of problems creating gap between initial & target state in themes a,b,c & d (ref box 1,2&3):
5th Why?
Another event!
IN BOX 8 WE TRACK AND SHOW THE BENEFIT/RESULTS.
THE FIRST UPDATE IS DUE 3RD AUGUST 2007 FOLLOWINGFIRST RUN OF ONE STOP CLINIC.
THE GRAPHS COPY ACROSS FROM BOX TWO AND THREE.
IF WE ARE NOT MEETING THE TARGETS WE NEED TO GOBACK TO BOX 4 TO UNDERSTAND WHY - AN EFFECTIVEINFO. CENTRE WILL EASE THIS TASK!
The VSA highlighted patients
typically visit the Renal clinic 8
times, taking 201 days to obtain a
date for surgery. Consequently 42%
of patients need temporary access
impacting SMR (113) and income.
Therefore the event themesare:
a. Too many visits: focus is to reduce # of visits to the clinic.
b. Flow Time too long: focus is to reduce time from referral to getting a date for surgery.
c. Too many have temp access: focus is to reduce % of population with temp. access.
d. Demand > Capacity: focus is to meet demand.
a. # Visits (Morale)b. Time to get Date (Timeliness)
c. Temp v Def Access (Quality)
a. Morale
c. Timed. Increased activity= £ 375K net profit pa
a. Morale b. Quality
c. Time d. Actual Benefit = £ _____
This box is “GO” when Box 8 = Box 3Monitor ACTUAL results against the metrics defined in initial and target state
Actions (Follow Up Req’d!)
1. Invite appropriate people
for discussion @ that time.
2. Manage more closely the
agenda for week
3. Make agenda available
before event in normal
“lingo” - clarify Day 4!
4. Involve Team Leader in
Simpler/Trans. Team calls
5. Plan to Run the Process
every time - it drives the
change in one week!
What went well?
Excellent Buy in from attendees.
Clinic trial (“run the process”)
FUN WEEK!
Agreed Future Process.
Stuck to itinerary.
What helped?
Tosh’s support and insight!
What hindered?
Discussions going off track.
Transient clinic: did not find a way
To make change visible/physical.
What did not go well?
Not always one voice in the room!
Lack of Clinical Input (nursing &
Anaesthetist).
Lack of direction at times.
What are the fundamental lessons of the event and the improvement cycle?
2. Initial State 5. Solution Approach 8. Confirmed State
1. Reason for Action 4. Gap Analysis 7. Completion Plan
3. Target State 6. Rapid Experiments 9. Insights
Reflections:
Reflections:
Reflections: The throughput metric is directly correlated to income and thus captures both on one graph. The original VSA target was moderatedas it became clear that the higher target would require a third clinic.
Reflections:The Bar charts showed efficiency could jump from 55% to 83% and capacity from 6 to 8 complex Pts if Vein Mapping is moved into process flow!
Reflections: The Ease (E) and Cost (C ) column show the difficulty of implementation. A “O” signifies easy or low cost and a “X” is difficult or high cost; hence the transport solution should be the subject of another event.
Reflections: Running the rapid experiment identifiedIn the VSA gives confidence that the above are the main causes of the gap between initial and targeted state!
Root Causes: Ad hoc current process makes
Resource co-ordination impossible!
Reflections:
No GoGo No GoGo No GoGo
No GoGo No GoGo No GoGo
No GoGo No GoGo No GoGo
The process takes too long and patients are at best inconvenienced and at worst deteriorate. The trends for a, b, c & d must be understood ...
Do it!6 Pts6 PtsRun One Stop Clinic with “typical” Pt mix.
Follow up Action
Actual Effect
Anticipated Effect
Experiment
2 3 4 5 6 7 8 91
SM
Simpler
Team Members Left to Right; Steve Hart (GM),
Start Date:Current Date:End Date:
Title: Renal One Stop Clinic
Process Owner: Breeda McManus & JP Nolan
Sponsor: Zafar Chawdhery & Alistair Chesser
Facilitators: Jane Holmes & Andy Fleming
Sensei: Steve Garnett
??OnNot on callA b DEstablish “on call” translator to Rota
?OFullNo supportDAgree level required with Pt Services
O?1000% YieldA b CRedesign Pt Info. Collection process
?X010 complaints/wkA b C DRapid Redesign Event on Transport
OOYesNo auth.A B C dRegister & authorise Clinic
OO1d200 daysA B C DSet up One Stop Clinic to reduce
CEFSCurrent StateAffecting Themes
SolutionCause/Priority
30/7JP2hEnsure all docs. Prepared for first clinic.
30/7D J L1dEstablish Info. Centre to manage problems arising.
30/7DC1hConfirm Rota for August
30/7ZC1hAgree Surgical/ Anestheticprotocols.
30/7EW1hAgree Pt. Info
30/7JP4hIdentify Pts for first clinic
RAG
DueOwnerTTAction
Barts &The London
400 miles traveled by patients often using BartsTransport!
The process starts with DGH referral and ends with a date for surgery.
Vis
its
to c
linic
8
2006/07
Many visits ˜ many miles NOK Patient Morale!
X
X X
Flo
w T
ime
/d
ays
200
Typically ˜ 8 Months to get surgery!
X
2006/07
%
Acce
ss T
yp
e
58
%
42
%
Lines Def. Access
d. Throughput (Cost)
Th
rou
gh
pu
t
/we
ek
2006/07
The data was not complete enough to show trend however all conditions are bad (X Status); and targets are clear for below…
a. # Visits (Morale)
Vis
its
to c
linic
8
1
O
3
134 Pts pa
2006 Aug 07 onwards
X
X
Step Change!
b. Time to get Date (Timeliness)
Flo
w T
ime
/d
ays
O200
1 X
X
Step Change!
c. Temp v Def Access (Quality)
%
Acce
ss T
yp
e
80
%
Lines Def. Access
20%
High SMR
Th
rou
gh
pu
t
/we
ek
O12
6
3
X
X
2006 Aug 07 onwards
20/7 1/8 1/9 onwards
500 Pts paO
The cause of problems creating gap between initial & target state in themes a,b,c & d (ref box 1,2&3):
5th Why?
Another event!
IN BOX 8 WE TRACK AND SHOW THE BENEFIT/RESULTS.
THE FIRST UPDATE IS DUE 3RD AUGUST 2007 FOLLOWINGFIRST RUN OF ONE STOP CLINIC.
THE GRAPHS COPY ACROSS FROM BOX TWO AND THREE.
IF WE ARE NOT MEETING THE TARGETS WE NEED TO GOBACK TO BOX 4 TO UNDERSTAND WHY - AN EFFECTIVEINFO. CENTRE WILL EASE THIS TASK!
3.Graphically Present Target Condition3.Graphically Present Target Condition• What specific outcomes are required?What specific outcomes are required?• Agree on targets to add to initial state graphsAgree on targets to add to initial state graphs• Be sure to record required target not Be sure to record required target not
what we ‘think’ we can achievewhat we ‘think’ we can achieve• Wherever possible use voice-of-the-customerWherever possible use voice-of-the-customer
Tool
TechniquesBeliefs
Simpler Business System® 11.0© Simpler Consulting, L.P. 1996-2011 ALL RIGHTS RESERVED For the Express Use of Simpler Members and Simpler Clients.
12
Box 4 – Gap Analysis
The VSA highlighted patients
typically visit the Renal clinic 8
times, taking 201 days to obtain a
date for surgery. Consequently 42%
of patients need temporary access
impacting SMR (113) and income.
Therefore the event themesare:
a. Too many visits: focus is to reduce # of visits to the clinic.
b. Flow Time too long: focus is to reduce time from referral to getting a date for surgery.
c. Too many have temp access: focus is to reduce % of population with temp. access.
d. Demand > Capacity: focus is to meet demand.
a. # Visits (Morale)b. Time to get Date (Timeliness)
c. Temp v Def Access (Quality)
a. Morale
c. Timed. Increased activity= £ 375K net profit pa
a. Morale b. Quality
c. Time d. Actual Benefit = £ _____
This box is “GO” when Box 8 = Box 3Monitor ACTUAL results against the metrics defined in initial and target state
Actions (Follow Up Req’d!)
1. Invite appropriate people
for discussion @ that time.
2. Manage more closely the
agenda for week
3. Make agenda available
before event in normal
“lingo” - clarify Day 4!
4. Involve Team Leader in
Simpler/Trans. Team calls
5. Plan to Run the Process
every time - it drives the
change in one week!
What went well?
Excellent Buy in from attendees.
Clinic trial (“run the process”)
FUN WEEK!
Agreed Future Process.
Stuck to itinerary.
What helped?
Tosh’s support and insight!
What hindered?
Discussions going off track.
Transient clinic: did not find a way
To make change visible/physical.
What did not go well?
Not always one voice in the room!
Lack of Clinical Input (nursing &
Anaesthetist).
Lack of direction at times.
What are the fundamental lessons of the event and the improvement cycle?
2. Initial State 5. Solution Approach 8. Confirmed State
1. Reason for Action 4. Gap Analysis 7. Completion Plan
3. Target State 6. Rapid Experiments 9. Insights
Reflections:
Reflections:
Reflections: The throughput metric is directly correlated to income and thus captures both on one graph. The original VSA target was moderatedas it became clear that the higher target would require a third clinic.
Reflections:The Bar charts showed efficiency could jump from 55% to 83% and capacity from 6 to 8 complex Pts if Vein Mapping is moved into process flow!
Reflections: The Ease (E) and Cost (C ) column show the difficulty of implementation. A “O” signifies easy or low cost and a “X” is difficult or high cost; hence the transport solution should be the subject of another event.
Reflections: Running the rapid experiment identifiedIn the VSA gives confidence that the above are the main causes of the gap between initial and targeted state!
Root Causes: Ad hoc current process makes
Resource co-ordination impossible!
Reflections:
No GoGo No GoGo No GoGo
No GoGo No GoGo No GoGo
No GoGo No GoGo No GoGo
The process takes too long and patients are at best inconvenienced and at worst deteriorate. The trends for a, b, c & d must be understood ...
Do it!6 Pts6 PtsRun One Stop Clinic with “typical” Pt mix.
Follow up Action
Actual Effect
Anticipated Effect
Experiment
2 3 4 5 6 7 8 91
SM
Simpler
Team Members Left to Right; Steve Hart (GM),
Start Date:Current Date:End Date:
Title: Renal One Stop Clinic
Process Owner: Breeda McManus & JP Nolan
Sponsor: Zafar Chawdhery & Alistair Chesser
Facilitators: Jane Holmes & Andy Fleming
Sensei: Steve Garnett
??OnNot on callA b DEstablish “on call” translator to Rota
?OFullNo supportDAgree level required with Pt Services
O?1000% YieldA b CRedesign Pt Info. Collection process
?X010 complaints/wkA b C DRapid Redesign Event on Transport
OOYesNo auth.A B C dRegister & authorise Clinic
OO1d200 daysA B C DSet up One Stop Clinic to reduce
CEFSCurrent StateAffecting Themes
SolutionCause/Priority
30/7JP2hEnsure all docs. Prepared for first clinic.
30/7D J L1dEstablish Info. Centre to manage problems arising.
30/7DC1hConfirm Rota for August
30/7ZC1hAgree Surgical/ Anestheticprotocols.
30/7EW1hAgree Pt. Info
30/7JP4hIdentify Pts for first clinic
RAG
DueOwnerTTAction
Barts &The London
400 miles traveled by patients often using BartsTransport!
The process starts with DGH referral and ends with a date for surgery.
Vis
its
to c
linic
8
2006/07
Many visits ˜ many miles NOK Patient Morale!
X
X X
Flo
w T
ime
/d
ays
200
Typically ˜ 8 Months to get surgery!
X
2006/07
%
Acce
ss T
yp
e
58
%
42
%
Lines Def. Access
d. Throughput (Cost)
Th
rou
gh
pu
t
/we
ek
2006/07
The data was not complete enough to show trend however all conditions are bad (X Status); and targets are clear for below…
a. # Visits (Morale)
Vis
its
to c
linic
8
1
O
3
134 Pts pa
2006 Aug 07 onwards
X
X
Step Change!
b. Time to get Date (Timeliness)
Flo
w T
ime
/d
ays
O200
1 X
X
Step Change!
c. Temp v Def Access (Quality)
%
Acce
ss T
yp
e
80
%
Lines Def. Access
20%
High SMR
Th
rou
gh
pu
t
/we
ek
O12
6
3
X
X
2006 Aug 07 onwards
20/7 1/8 1/9 onwards
500 Pts paO
The cause of problems creating gap between initial & target state in themes a,b,c & d (ref box 1,2&3):
5th Why?
Another event!
IN BOX 8 WE TRACK AND SHOW THE BENEFIT/RESULTS.
THE FIRST UPDATE IS DUE 3RD AUGUST 2007 FOLLOWINGFIRST RUN OF ONE STOP CLINIC.
THE GRAPHS COPY ACROSS FROM BOX TWO AND THREE.
IF WE ARE NOT MEETING THE TARGETS WE NEED TO GOBACK TO BOX 4 TO UNDERSTAND WHY - AN EFFECTIVEINFO. CENTRE WILL EASE THIS TASK!
The VSA highlighted patients
typically visit the Renal clinic 8
times, taking 201 days to obtain a
date for surgery. Consequently 42%
of patients need temporary access
impacting SMR (113) and income.
Therefore the event themesare:
a. Too many visits: focus is to reduce # of visits to the clinic.
b. Flow Time too long: focus is to reduce time from referral to getting a date for surgery.
c. Too many have temp access: focus is to reduce % of population with temp. access.
d. Demand > Capacity: focus is to meet demand.
a. # Visits (Morale)b. Time to get Date (Timeliness)
c. Temp v Def Access (Quality)
a. Morale
c. Timed. Increased activity= £ 375K net profit pa
a. Morale b. Quality
c. Time d. Actual Benefit = £ _____
This box is “GO” when Box 8 = Box 3Monitor ACTUAL results against the metrics defined in initial and target state
Actions (Follow Up Req’d!)
1. Invite appropriate people
for discussion @ that time.
2. Manage more closely the
agenda for week
3. Make agenda available
before event in normal
“lingo” - clarify Day 4!
4. Involve Team Leader in
Simpler/Trans. Team calls
5. Plan to Run the Process
every time - it drives the
change in one week!
What went well?
Excellent Buy in from attendees.
Clinic trial (“run the process”)
FUN WEEK!
Agreed Future Process.
Stuck to itinerary.
What helped?
Tosh’s support and insight!
What hindered?
Discussions going off track.
Transient clinic: did not find a way
To make change visible/physical.
What did not go well?
Not always one voice in the room!
Lack of Clinical Input (nursing &
Anaesthetist).
Lack of direction at times.
What are the fundamental lessons of the event and the improvement cycle?
2. Initial State 5. Solution Approach 8. Confirmed State
1. Reason for Action 4. Gap Analysis 7. Completion Plan
3. Target State 6. Rapid Experiments 9. Insights
Reflections:
Reflections:
Reflections: The throughput metric is directly correlated to income and thus captures both on one graph. The original VSA target was moderatedas it became clear that the higher target would require a third clinic.
Reflections:The Bar charts showed efficiency could jump from 55% to 83% and capacity from 6 to 8 complex Pts if Vein Mapping is moved into process flow!
Reflections: The Ease (E) and Cost (C ) column show the difficulty of implementation. A “O” signifies easy or low cost and a “X” is difficult or high cost; hence the transport solution should be the subject of another event.
Reflections: Running the rapid experiment identifiedIn the VSA gives confidence that the above are the main causes of the gap between initial and targeted state!
Root Causes: Ad hoc current process makes
Resource co-ordination impossible!
Reflections:
No GoGo No GoGo No GoGo
No GoGo No GoGo No GoGo
No GoGo No GoGo No GoGo
The process takes too long and patients are at best inconvenienced and at worst deteriorate. The trends for a, b, c & d must be understood ...
Do it!6 Pts6 PtsRun One Stop Clinic with “typical” Pt mix.
Follow up Action
Actual Effect
Anticipated Effect
Experiment
2 3 4 5 6 7 8 91
SM
Simpler
Team Members Left to Right; Steve Hart (GM),
Start Date:Current Date:End Date:
Title: Renal One Stop Clinic
Process Owner: Breeda McManus & JP Nolan
Sponsor: Zafar Chawdhery & Alistair Chesser
Facilitators: Jane Holmes & Andy Fleming
Sensei: Steve Garnett
??OnNot on callA b DEstablish “on call” translator to Rota
?OFullNo supportDAgree level required with Pt Services
O?1000% YieldA b CRedesign Pt Info. Collection process
?X010 complaints/wkA b C DRapid Redesign Event on Transport
OOYesNo auth.A B C dRegister & authorise Clinic
OO1d200 daysA B C DSet up One Stop Clinic to reduce
CEFSCurrent StateAffecting Themes
SolutionCause/Priority
30/7JP2hEnsure all docs. Prepared for first clinic.
30/7D J L1dEstablish Info. Centre to manage problems arising.
30/7DC1hConfirm Rota for August
30/7ZC1hAgree Surgical/ Anestheticprotocols.
30/7EW1hAgree Pt. Info
30/7JP4hIdentify Pts for first clinic
RAG
DueOwnerTTAction
Barts &The London
400 miles traveled by patients often using BartsTransport!
The process starts with DGH referral and ends with a date for surgery.
Vis
its
to c
linic
8
2006/07
Many visits ˜ many miles NOK Patient Morale!
X
X X
Flo
w T
ime
/d
ays
200
Typically ˜ 8 Months to get surgery!
X
2006/07
%
Acce
ss T
yp
e
58
%
42
%
Lines Def. Access
d. Throughput (Cost)
Th
rou
gh
pu
t
/we
ek
2006/07
The data was not complete enough to show trend however all conditions are bad (X Status); and targets are clear for below…
a. # Visits (Morale)
Vis
its
to c
linic
8
1
O
3
134 Pts pa
2006 Aug 07 onwards
X
X
Step Change!
b. Time to get Date (Timeliness)
Flo
w T
ime
/d
ays
O200
1 X
X
Step Change!
c. Temp v Def Access (Quality)
%
Acce
ss T
yp
e
80
%
Lines Def. Access
20%
High SMR
Th
rou
gh
pu
t
/we
ek
O12
6
3
X
X
2006 Aug 07 onwards
20/7 1/8 1/9 onwards
500 Pts paO
The cause of problems creating gap between initial & target state in themes a,b,c & d (ref box 1,2&3):
5th Why?
Another event!
IN BOX 8 WE TRACK AND SHOW THE BENEFIT/RESULTS.
THE FIRST UPDATE IS DUE 3RD AUGUST 2007 FOLLOWINGFIRST RUN OF ONE STOP CLINIC.
THE GRAPHS COPY ACROSS FROM BOX TWO AND THREE.
IF WE ARE NOT MEETING THE TARGETS WE NEED TO GOBACK TO BOX 4 TO UNDERSTAND WHY - AN EFFECTIVEINFO. CENTRE WILL EASE THIS TASK!
4.Gap Analysis4.Gap Analysis
• Identify all possible causes for the situationIdentify all possible causes for the situation
• Cause and Effect Diagrams help hereCause and Effect Diagrams help here
• Conduct investigations find ‘root cause’ Conduct investigations find ‘root cause’
• Use the 7 basic Quality Tools (ex. Pareto, Affinity Diagrams, Scatter Use the 7 basic Quality Tools (ex. Pareto, Affinity Diagrams, Scatter Diagrams, Trend, 5 Whys) Diagrams, Trend, 5 Whys)
• Use the simplest problem analysis tool that clearly shows the cause Use the simplest problem analysis tool that clearly shows the cause and effect relationshipand effect relationship
Tool
TechniquesBeliefs
Simpler Business System® 11.0© Simpler Consulting, L.P. 1996-2011 ALL RIGHTS RESERVED For the Express Use of Simpler Members and Simpler Clients.
13
Box 5 – Solution approach
The VSA highlighted patients
typically visit the Renal clinic 8
times, taking 201 days to obtain a
date for surgery. Consequently 42%
of patients need temporary access
impacting SMR (113) and income.
Therefore the event themesare:
a. Too many visits: focus is to reduce # of visits to the clinic.
b. Flow Time too long: focus is to reduce time from referral to getting a date for surgery.
c. Too many have temp access: focus is to reduce % of population with temp. access.
d. Demand > Capacity: focus is to meet demand.
a. # Visits (Morale)b. Time to get Date (Timeliness)
c. Temp v Def Access (Quality)
a. Morale
c. Timed. Increased activity= £ 375K net profit pa
a. Morale b. Quality
c. Time d. Actual Benefit = £ _____
This box is “GO” when Box 8 = Box 3Monitor ACTUAL results against the metrics defined in initial and target state
Actions (Follow Up Req’d!)
1. Invite appropriate people
for discussion @ that time.
2. Manage more closely the
agenda for week
3. Make agenda available
before event in normal
“lingo” - clarify Day 4!
4. Involve Team Leader in
Simpler/Trans. Team calls
5. Plan to Run the Process
every time - it drives the
change in one week!
What went well?
Excellent Buy in from attendees.
Clinic trial (“run the process”)
FUN WEEK!
Agreed Future Process.
Stuck to itinerary.
What helped?
Tosh’s support and insight!
What hindered?
Discussions going off track.
Transient clinic: did not find a way
To make change visible/physical.
What did not go well?
Not always one voice in the room!
Lack of Clinical Input (nursing &
Anaesthetist).
Lack of direction at times.
What are the fundamental lessons of the event and the improvement cycle?
2. Initial State 5. Solution Approach 8. Confirmed State
1. Reason for Action 4. Gap Analysis 7. Completion Plan
3. Target State 6. Rapid Experiments 9. Insights
Reflections:
Reflections:
Reflections: The throughput metric is directly correlated to income and thus captures both on one graph. The original VSA target was moderatedas it became clear that the higher target would require a third clinic.
Reflections:The Bar charts showed efficiency could jump from 55% to 83% and capacity from 6 to 8 complex Pts if Vein Mapping is moved into process flow!
Reflections: The Ease (E) and Cost (C ) column show the difficulty of implementation. A “O” signifies easy or low cost and a “X” is difficult or high cost; hence the transport solution should be the subject of another event.
Reflections: Running the rapid experiment identifiedIn the VSA gives confidence that the above are the main causes of the gap between initial and targeted state!
Root Causes: Ad hoc current process makes
Resource co-ordination impossible!
Reflections:
No GoGo No GoGo No GoGo
No GoGo No GoGo No GoGo
No GoGo No GoGo No GoGo
The process takes too long and patients are at best inconvenienced and at worst deteriorate. The trends for a, b, c & d must be understood ...
Do it!6 Pts6 PtsRun One Stop Clinic with “typical” Pt mix.
Follow up Action
Actual Effect
Anticipated Effect
Experiment
2 3 4 5 6 7 8 91
SM
Simpler
Team Members Left to Right; Steve Hart (GM),
Start Date:Current Date:End Date:
Title: Renal One Stop Clinic
Process Owner: Breeda McManus & JP Nolan
Sponsor: Zafar Chawdhery & Alistair Chesser
Facilitators: Jane Holmes & Andy Fleming
Sensei: Steve Garnett
??OnNot on callA b DEstablish “on call” translator to Rota
?OFullNo supportDAgree level required with Pt Services
O?1000% YieldA b CRedesign Pt Info. Collection process
?X010 complaints/wkA b C DRapid Redesign Event on Transport
OOYesNo auth.A B C dRegister & authorise Clinic
OO1d200 daysA B C DSet up One Stop Clinic to reduce
CEFSCurrent StateAffecting Themes
SolutionCause/Priority
30/7JP2hEnsure all docs. Prepared for first clinic.
30/7D J L1dEstablish Info. Centre to manage problems arising.
30/7DC1hConfirm Rota for August
30/7ZC1hAgree Surgical/ Anestheticprotocols.
30/7EW1hAgree Pt. Info
30/7JP4hIdentify Pts for first clinic
RAG
DueOwnerTTAction
Barts &The London
400 miles traveled by patients often using BartsTransport!
The process starts with DGH referral and ends with a date for surgery.
Vis
its
to c
linic
8
2006/07
Many visits ˜ many miles NOK Patient Morale!
X
X X
Flo
w T
ime
/d
ays
200
Typically ˜ 8 Months to get surgery!
X
2006/07
%
Acce
ss T
yp
e
58
%
42
%
Lines Def. Access
d. Throughput (Cost)
Th
rou
gh
pu
t
/we
ek
2006/07
The data was not complete enough to show trend however all conditions are bad (X Status); and targets are clear for below…
a. # Visits (Morale)
Vis
its
to c
linic
8
1
O
3
134 Pts pa
2006 Aug 07 onwards
X
X
Step Change!
b. Time to get Date (Timeliness)
Flo
w T
ime
/d
ays
O200
1 X
X
Step Change!
c. Temp v Def Access (Quality)
%
Acce
ss T
yp
e
80
%
Lines Def. Access
20%
High SMR
Th
rou
gh
pu
t
/we
ek
O12
6
3
X
X
2006 Aug 07 onwards
20/7 1/8 1/9 onwards
500 Pts paO
The cause of problems creating gap between initial & target state in themes a,b,c & d (ref box 1,2&3):
5th Why?
Another event!
IN BOX 8 WE TRACK AND SHOW THE BENEFIT/RESULTS.
THE FIRST UPDATE IS DUE 3RD AUGUST 2007 FOLLOWINGFIRST RUN OF ONE STOP CLINIC.
THE GRAPHS COPY ACROSS FROM BOX TWO AND THREE.
IF WE ARE NOT MEETING THE TARGETS WE NEED TO GOBACK TO BOX 4 TO UNDERSTAND WHY - AN EFFECTIVEINFO. CENTRE WILL EASE THIS TASK!
The VSA highlighted patients
typically visit the Renal clinic 8
times, taking 201 days to obtain a
date for surgery. Consequently 42%
of patients need temporary access
impacting SMR (113) and income.
Therefore the event themesare:
a. Too many visits: focus is to reduce # of visits to the clinic.
b. Flow Time too long: focus is to reduce time from referral to getting a date for surgery.
c. Too many have temp access: focus is to reduce % of population with temp. access.
d. Demand > Capacity: focus is to meet demand.
a. # Visits (Morale)b. Time to get Date (Timeliness)
c. Temp v Def Access (Quality)
a. Morale
c. Timed. Increased activity= £ 375K net profit pa
a. Morale b. Quality
c. Time d. Actual Benefit = £ _____
This box is “GO” when Box 8 = Box 3Monitor ACTUAL results against the metrics defined in initial and target state
Actions (Follow Up Req’d!)
1. Invite appropriate people
for discussion @ that time.
2. Manage more closely the
agenda for week
3. Make agenda available
before event in normal
“lingo” - clarify Day 4!
4. Involve Team Leader in
Simpler/Trans. Team calls
5. Plan to Run the Process
every time - it drives the
change in one week!
What went well?
Excellent Buy in from attendees.
Clinic trial (“run the process”)
FUN WEEK!
Agreed Future Process.
Stuck to itinerary.
What helped?
Tosh’s support and insight!
What hindered?
Discussions going off track.
Transient clinic: did not find a way
To make change visible/physical.
What did not go well?
Not always one voice in the room!
Lack of Clinical Input (nursing &
Anaesthetist).
Lack of direction at times.
What are the fundamental lessons of the event and the improvement cycle?
2. Initial State 5. Solution Approach 8. Confirmed State
1. Reason for Action 4. Gap Analysis 7. Completion Plan
3. Target State 6. Rapid Experiments 9. Insights
Reflections:
Reflections:
Reflections: The throughput metric is directly correlated to income and thus captures both on one graph. The original VSA target was moderatedas it became clear that the higher target would require a third clinic.
Reflections:The Bar charts showed efficiency could jump from 55% to 83% and capacity from 6 to 8 complex Pts if Vein Mapping is moved into process flow!
Reflections: The Ease (E) and Cost (C ) column show the difficulty of implementation. A “O” signifies easy or low cost and a “X” is difficult or high cost; hence the transport solution should be the subject of another event.
Reflections: Running the rapid experiment identifiedIn the VSA gives confidence that the above are the main causes of the gap between initial and targeted state!
Root Causes: Ad hoc current process makes
Resource co-ordination impossible!
Reflections:
No GoGo No GoGo No GoGo
No GoGo No GoGo No GoGo
No GoGo No GoGo No GoGo
The process takes too long and patients are at best inconvenienced and at worst deteriorate. The trends for a, b, c & d must be understood ...
Do it!6 Pts6 PtsRun One Stop Clinic with “typical” Pt mix.
Follow up Action
Actual Effect
Anticipated Effect
Experiment
2 3 4 5 6 7 8 91
SM
Simpler
Team Members Left to Right; Steve Hart (GM),
Start Date:Current Date:End Date:
Title: Renal One Stop Clinic
Process Owner: Breeda McManus & JP Nolan
Sponsor: Zafar Chawdhery & Alistair Chesser
Facilitators: Jane Holmes & Andy Fleming
Sensei: Steve Garnett
??OnNot on callA b DEstablish “on call” translator to Rota
?OFullNo supportDAgree level required with Pt Services
O?1000% YieldA b CRedesign Pt Info. Collection process
?X010 complaints/wkA b C DRapid Redesign Event on Transport
OOYesNo auth.A B C dRegister & authorise Clinic
OO1d200 daysA B C DSet up One Stop Clinic to reduce
CEFSCurrent StateAffecting Themes
SolutionCause/Priority
30/7JP2hEnsure all docs. Prepared for first clinic.
30/7D J L1dEstablish Info. Centre to manage problems arising.
30/7DC1hConfirm Rota for August
30/7ZC1hAgree Surgical/ Anestheticprotocols.
30/7EW1hAgree Pt. Info
30/7JP4hIdentify Pts for first clinic
RAG
DueOwnerTTAction
Barts &The London
400 miles traveled by patients often using BartsTransport!
The process starts with DGH referral and ends with a date for surgery.
Vis
its
to c
linic
8
2006/07
Many visits ˜ many miles NOK Patient Morale!
X
X X
Flo
w T
ime
/d
ays
200
Typically ˜ 8 Months to get surgery!
X
2006/07
%
Acce
ss T
yp
e
58
%
42
%
Lines Def. Access
d. Throughput (Cost)
Th
rou
gh
pu
t
/we
ek
2006/07
The data was not complete enough to show trend however all conditions are bad (X Status); and targets are clear for below…
a. # Visits (Morale)
Vis
its
to c
linic
8
1
O
3
134 Pts pa
2006 Aug 07 onwards
X
X
Step Change!
b. Time to get Date (Timeliness)
Flo
w T
ime
/d
ays
O200
1 X
X
Step Change!
c. Temp v Def Access (Quality)
%
Acce
ss T
yp
e
80
%
Lines Def. Access
20%
High SMR
Th
rou
gh
pu
t
/we
ek
O12
6
3
X
X
2006 Aug 07 onwards
20/7 1/8 1/9 onwards
500 Pts paO
The cause of problems creating gap between initial & target state in themes a,b,c & d (ref box 1,2&3):
5th Why?
Another event!
IN BOX 8 WE TRACK AND SHOW THE BENEFIT/RESULTS.
THE FIRST UPDATE IS DUE 3RD AUGUST 2007 FOLLOWINGFIRST RUN OF ONE STOP CLINIC.
THE GRAPHS COPY ACROSS FROM BOX TWO AND THREE.
IF WE ARE NOT MEETING THE TARGETS WE NEED TO GOBACK TO BOX 4 TO UNDERSTAND WHY - AN EFFECTIVEINFO. CENTRE WILL EASE THIS TASK!
5. Solution Approach5. Solution Approach
• Proposed countermeasures to achieve target stateProposed countermeasures to achieve target state
• How will your recommended countermeasures affect the root cause How will your recommended countermeasures affect the root cause to achieve the target?to achieve the target?
Tool
TechniquesBeliefs
Simpler Business System® 11.0© Simpler Consulting, L.P. 1996-2011 ALL RIGHTS RESERVED For the Express Use of Simpler Members and Simpler Clients.
14
Box 6 – Rapid Experiments
The VSA highlighted patients
typically visit the Renal clinic 8
times, taking 201 days to obtain a
date for surgery. Consequently 42%
of patients need temporary access
impacting SMR (113) and income.
Therefore the event themesare:
a. Too many visits: focus is to reduce # of visits to the clinic.
b. Flow Time too long: focus is to reduce time from referral to getting a date for surgery.
c. Too many have temp access: focus is to reduce % of population with temp. access.
d. Demand > Capacity: focus is to meet demand.
a. # Visits (Morale)b. Time to get Date (Timeliness)
c. Temp v Def Access (Quality)
a. Morale
c. Timed. Increased activity= £ 375K net profit pa
a. Morale b. Quality
c. Time d. Actual Benefit = £ _____
This box is “GO” when Box 8 = Box 3Monitor ACTUAL results against the metrics defined in initial and target state
Actions (Follow Up Req’d!)
1. Invite appropriate people
for discussion @ that time.
2. Manage more closely the
agenda for week
3. Make agenda available
before event in normal
“lingo” - clarify Day 4!
4. Involve Team Leader in
Simpler/Trans. Team calls
5. Plan to Run the Process
every time - it drives the
change in one week!
What went well?
Excellent Buy in from attendees.
Clinic trial (“run the process”)
FUN WEEK!
Agreed Future Process.
Stuck to itinerary.
What helped?
Tosh’s support and insight!
What hindered?
Discussions going off track.
Transient clinic: did not find a way
To make change visible/physical.
What did not go well?
Not always one voice in the room!
Lack of Clinical Input (nursing &
Anaesthetist).
Lack of direction at times.
What are the fundamental lessons of the event and the improvement cycle?
2. Initial State 5. Solution Approach 8. Confirmed State
1. Reason for Action 4. Gap Analysis 7. Completion Plan
3. Target State 6. Rapid Experiments 9. Insights
Reflections:
Reflections:
Reflections: The throughput metric is directly correlated to income and thus captures both on one graph. The original VSA target was moderatedas it became clear that the higher target would require a third clinic.
Reflections:The Bar charts showed efficiency could jump from 55% to 83% and capacity from 6 to 8 complex Pts if Vein Mapping is moved into process flow!
Reflections: The Ease (E) and Cost (C ) column show the difficulty of implementation. A “O” signifies easy or low cost and a “X” is difficult or high cost; hence the transport solution should be the subject of another event.
Reflections: Running the rapid experiment identifiedIn the VSA gives confidence that the above are the main causes of the gap between initial and targeted state!
Root Causes: Ad hoc current process makes
Resource co-ordination impossible!
Reflections:
No GoGo No GoGo No GoGo
No GoGo No GoGo No GoGo
No GoGo No GoGo No GoGo
The process takes too long and patients are at best inconvenienced and at worst deteriorate. The trends for a, b, c & d must be understood ...
Do it!6 Pts6 PtsRun One Stop Clinic with “typical” Pt mix.
Follow up Action
Actual Effect
Anticipated Effect
Experiment
2 3 4 5 6 7 8 91
SM
Simpler
Team Members Left to Right; Steve Hart (GM),
Start Date:Current Date:End Date:
Title: Renal One Stop Clinic
Process Owner: Breeda McManus & JP Nolan
Sponsor: Zafar Chawdhery & Alistair Chesser
Facilitators: Jane Holmes & Andy Fleming
Sensei: Steve Garnett
??OnNot on callA b DEstablish “on call” translator to Rota
?OFullNo supportDAgree level required with Pt Services
O?1000% YieldA b CRedesign Pt Info. Collection process
?X010 complaints/wkA b C DRapid Redesign Event on Transport
OOYesNo auth.A B C dRegister & authorise Clinic
OO1d200 daysA B C DSet up One Stop Clinic to reduce
CEFSCurrent StateAffecting Themes
SolutionCause/Priority
30/7JP2hEnsure all docs. Prepared for first clinic.
30/7D J L1dEstablish Info. Centre to manage problems arising.
30/7DC1hConfirm Rota for August
30/7ZC1hAgree Surgical/ Anestheticprotocols.
30/7EW1hAgree Pt. Info
30/7JP4hIdentify Pts for first clinic
RAG
DueOwnerTTAction
Barts &The London
400 miles traveled by patients often using BartsTransport!
The process starts with DGH referral and ends with a date for surgery.
Vis
its
to c
linic
8
2006/07
Many visits ˜ many miles NOK Patient Morale!
X
X X
Flo
w T
ime
/d
ays
200
Typically ˜ 8 Months to get surgery!
X
2006/07
%
Acce
ss T
yp
e
58
%
42
%
Lines Def. Access
d. Throughput (Cost)
Th
rou
gh
pu
t
/we
ek
2006/07
The data was not complete enough to show trend however all conditions are bad (X Status); and targets are clear for below…
a. # Visits (Morale)
Vis
its
to c
linic
8
1
O
3
134 Pts pa
2006 Aug 07 onwards
X
X
Step Change!
b. Time to get Date (Timeliness)
Flo
w T
ime
/d
ays
O200
1 X
X
Step Change!
c. Temp v Def Access (Quality)
%
Acce
ss T
yp
e
80
%
Lines Def. Access
20%
High SMR
Th
rou
gh
pu
t
/we
ek
O12
6
3
X
X
2006 Aug 07 onwards
20/7 1/8 1/9 onwards
500 Pts paO
The cause of problems creating gap between initial & target state in themes a,b,c & d (ref box 1,2&3):
5th Why?
Another event!
IN BOX 8 WE TRACK AND SHOW THE BENEFIT/RESULTS.
THE FIRST UPDATE IS DUE 3RD AUGUST 2007 FOLLOWINGFIRST RUN OF ONE STOP CLINIC.
THE GRAPHS COPY ACROSS FROM BOX TWO AND THREE.
IF WE ARE NOT MEETING THE TARGETS WE NEED TO GOBACK TO BOX 4 TO UNDERSTAND WHY - AN EFFECTIVEINFO. CENTRE WILL EASE THIS TASK!
The VSA highlighted patients
typically visit the Renal clinic 8
times, taking 201 days to obtain a
date for surgery. Consequently 42%
of patients need temporary access
impacting SMR (113) and income.
Therefore the event themesare:
a. Too many visits: focus is to reduce # of visits to the clinic.
b. Flow Time too long: focus is to reduce time from referral to getting a date for surgery.
c. Too many have temp access: focus is to reduce % of population with temp. access.
d. Demand > Capacity: focus is to meet demand.
a. # Visits (Morale)b. Time to get Date (Timeliness)
c. Temp v Def Access (Quality)
a. Morale
c. Timed. Increased activity= £ 375K net profit pa
a. Morale b. Quality
c. Time d. Actual Benefit = £ _____
This box is “GO” when Box 8 = Box 3Monitor ACTUAL results against the metrics defined in initial and target state
Actions (Follow Up Req’d!)
1. Invite appropriate people
for discussion @ that time.
2. Manage more closely the
agenda for week
3. Make agenda available
before event in normal
“lingo” - clarify Day 4!
4. Involve Team Leader in
Simpler/Trans. Team calls
5. Plan to Run the Process
every time - it drives the
change in one week!
What went well?
Excellent Buy in from attendees.
Clinic trial (“run the process”)
FUN WEEK!
Agreed Future Process.
Stuck to itinerary.
What helped?
Tosh’s support and insight!
What hindered?
Discussions going off track.
Transient clinic: did not find a way
To make change visible/physical.
What did not go well?
Not always one voice in the room!
Lack of Clinical Input (nursing &
Anaesthetist).
Lack of direction at times.
What are the fundamental lessons of the event and the improvement cycle?
2. Initial State 5. Solution Approach 8. Confirmed State
1. Reason for Action 4. Gap Analysis 7. Completion Plan
3. Target State 6. Rapid Experiments 9. Insights
Reflections:
Reflections:
Reflections: The throughput metric is directly correlated to income and thus captures both on one graph. The original VSA target was moderatedas it became clear that the higher target would require a third clinic.
Reflections:The Bar charts showed efficiency could jump from 55% to 83% and capacity from 6 to 8 complex Pts if Vein Mapping is moved into process flow!
Reflections: The Ease (E) and Cost (C ) column show the difficulty of implementation. A “O” signifies easy or low cost and a “X” is difficult or high cost; hence the transport solution should be the subject of another event.
Reflections: Running the rapid experiment identifiedIn the VSA gives confidence that the above are the main causes of the gap between initial and targeted state!
Root Causes: Ad hoc current process makes
Resource co-ordination impossible!
Reflections:
No GoGo No GoGo No GoGo
No GoGo No GoGo No GoGo
No GoGo No GoGo No GoGo
The process takes too long and patients are at best inconvenienced and at worst deteriorate. The trends for a, b, c & d must be understood ...
Do it!6 Pts6 PtsRun One Stop Clinic with “typical” Pt mix.
Follow up Action
Actual Effect
Anticipated Effect
Experiment
2 3 4 5 6 7 8 91
SM
Simpler
Team Members Left to Right; Steve Hart (GM),
Start Date:Current Date:End Date:
Title: Renal One Stop Clinic
Process Owner: Breeda McManus & JP Nolan
Sponsor: Zafar Chawdhery & Alistair Chesser
Facilitators: Jane Holmes & Andy Fleming
Sensei: Steve Garnett
??OnNot on callA b DEstablish “on call” translator to Rota
?OFullNo supportDAgree level required with Pt Services
O?1000% YieldA b CRedesign Pt Info. Collection process
?X010 complaints/wkA b C DRapid Redesign Event on Transport
OOYesNo auth.A B C dRegister & authorise Clinic
OO1d200 daysA B C DSet up One Stop Clinic to reduce
CEFSCurrent StateAffecting Themes
SolutionCause/Priority
30/7JP2hEnsure all docs. Prepared for first clinic.
30/7D J L1dEstablish Info. Centre to manage problems arising.
30/7DC1hConfirm Rota for August
30/7ZC1hAgree Surgical/ Anestheticprotocols.
30/7EW1hAgree Pt. Info
30/7JP4hIdentify Pts for first clinic
RAG
DueOwnerTTAction
Barts &The London
400 miles traveled by patients often using BartsTransport!
The process starts with DGH referral and ends with a date for surgery.
Vis
its
to c
linic
8
2006/07
Many visits ˜ many miles NOK Patient Morale!
X
X X
Flo
w T
ime
/d
ays
200
Typically ˜ 8 Months to get surgery!
X
2006/07
%
Acce
ss T
yp
e
58
%
42
%
Lines Def. Access
d. Throughput (Cost)
Th
rou
gh
pu
t
/we
ek
2006/07
The data was not complete enough to show trend however all conditions are bad (X Status); and targets are clear for below…
a. # Visits (Morale)
Vis
its
to c
linic
8
1
O
3
134 Pts pa
2006 Aug 07 onwards
X
X
Step Change!
b. Time to get Date (Timeliness)
Flo
w T
ime
/d
ays
O200
1 X
X
Step Change!
c. Temp v Def Access (Quality)
%
Acce
ss T
yp
e
80
%
Lines Def. Access
20%
High SMR
Th
rou
gh
pu
t
/we
ek
O12
6
3
X
X
2006 Aug 07 onwards
20/7 1/8 1/9 onwards
500 Pts paO
The cause of problems creating gap between initial & target state in themes a,b,c & d (ref box 1,2&3):
5th Why?
Another event!
IN BOX 8 WE TRACK AND SHOW THE BENEFIT/RESULTS.
THE FIRST UPDATE IS DUE 3RD AUGUST 2007 FOLLOWINGFIRST RUN OF ONE STOP CLINIC.
THE GRAPHS COPY ACROSS FROM BOX TWO AND THREE.
IF WE ARE NOT MEETING THE TARGETS WE NEED TO GOBACK TO BOX 4 TO UNDERSTAND WHY - AN EFFECTIVEINFO. CENTRE WILL EASE THIS TASK!
6. Rapid Experiments6. Rapid Experiments
• Validation of the hypothesisValidation of the hypothesis
• What happened when we tried stuff?What happened when we tried stuff?
- - Did it work?Did it work?
- Conclusion? - Conclusion?
Tool
TechniquesBeliefs
Simpler Business System® 11.0© Simpler Consulting, L.P. 1996-2011 ALL RIGHTS RESERVED For the Express Use of Simpler Members and Simpler Clients.
15
Box 7 – Completion Plan
The VSA highlighted patients
typically visit the Renal clinic 8
times, taking 201 days to obtain a
date for surgery. Consequently 42%
of patients need temporary access
impacting SMR (113) and income.
Therefore the event themesare:
a. Too many visits: focus is to reduce # of visits to the clinic.
b. Flow Time too long: focus is to reduce time from referral to getting a date for surgery.
c. Too many have temp access: focus is to reduce % of population with temp. access.
d. Demand > Capacity: focus is to meet demand.
a. # Visits (Morale)b. Time to get Date (Timeliness)
c. Temp v Def Access (Quality)
a. Morale
c. Timed. Increased activity= £ 375K net profit pa
a. Morale b. Quality
c. Time d. Actual Benefit = £ _____
This box is “GO” when Box 8 = Box 3Monitor ACTUAL results against the metrics defined in initial and target state
Actions (Follow Up Req’d!)
1. Invite appropriate people
for discussion @ that time.
2. Manage more closely the
agenda for week
3. Make agenda available
before event in normal
“lingo” - clarify Day 4!
4. Involve Team Leader in
Simpler/Trans. Team calls
5. Plan to Run the Process
every time - it drives the
change in one week!
What went well?
Excellent Buy in from attendees.
Clinic trial (“run the process”)
FUN WEEK!
Agreed Future Process.
Stuck to itinerary.
What helped?
Tosh’s support and insight!
What hindered?
Discussions going off track.
Transient clinic: did not find a way
To make change visible/physical.
What did not go well?
Not always one voice in the room!
Lack of Clinical Input (nursing &
Anaesthetist).
Lack of direction at times.
What are the fundamental lessons of the event and the improvement cycle?
2. Initial State 5. Solution Approach 8. Confirmed State
1. Reason for Action 4. Gap Analysis 7. Completion Plan
3. Target State 6. Rapid Experiments 9. Insights
Reflections:
Reflections:
Reflections: The throughput metric is directly correlated to income and thus captures both on one graph. The original VSA target was moderatedas it became clear that the higher target would require a third clinic.
Reflections:The Bar charts showed efficiency could jump from 55% to 83% and capacity from 6 to 8 complex Pts if Vein Mapping is moved into process flow!
Reflections: The Ease (E) and Cost (C ) column show the difficulty of implementation. A “O” signifies easy or low cost and a “X” is difficult or high cost; hence the transport solution should be the subject of another event.
Reflections: Running the rapid experiment identifiedIn the VSA gives confidence that the above are the main causes of the gap between initial and targeted state!
Root Causes: Ad hoc current process makes
Resource co-ordination impossible!
Reflections:
No GoGo No GoGo No GoGo
No GoGo No GoGo No GoGo
No GoGo No GoGo No GoGo
The process takes too long and patients are at best inconvenienced and at worst deteriorate. The trends for a, b, c & d must be understood ...
Do it!6 Pts6 PtsRun One Stop Clinic with “typical” Pt mix.
Follow up Action
Actual Effect
Anticipated Effect
Experiment
2 3 4 5 6 7 8 91
SM
Simpler
Team Members Left to Right; Steve Hart (GM),
Start Date:Current Date:End Date:
Title: Renal One Stop Clinic
Process Owner: Breeda McManus & JP Nolan
Sponsor: Zafar Chawdhery & Alistair Chesser
Facilitators: Jane Holmes & Andy Fleming
Sensei: Steve Garnett
??OnNot on callA b DEstablish “on call” translator to Rota
?OFullNo supportDAgree level required with Pt Services
O?1000% YieldA b CRedesign Pt Info. Collection process
?X010 complaints/wkA b C DRapid Redesign Event on Transport
OOYesNo auth.A B C dRegister & authorise Clinic
OO1d200 daysA B C DSet up One Stop Clinic to reduce
CEFSCurrent StateAffecting Themes
SolutionCause/Priority
30/7JP2hEnsure all docs. Prepared for first clinic.
30/7D J L1dEstablish Info. Centre to manage problems arising.
30/7DC1hConfirm Rota for August
30/7ZC1hAgree Surgical/ Anestheticprotocols.
30/7EW1hAgree Pt. Info
30/7JP4hIdentify Pts for first clinic
RAG
DueOwnerTTAction
Barts &The London
400 miles traveled by patients often using BartsTransport!
The process starts with DGH referral and ends with a date for surgery.
Vis
its
to c
linic
8
2006/07
Many visits ˜ many miles NOK Patient Morale!
X
X X
Flo
w T
ime
/d
ays
200
Typically ˜ 8 Months to get surgery!
X
2006/07
%
Acce
ss T
yp
e
58
%
42
%
Lines Def. Access
d. Throughput (Cost)
Th
rou
gh
pu
t
/we
ek
2006/07
The data was not complete enough to show trend however all conditions are bad (X Status); and targets are clear for below…
a. # Visits (Morale)
Vis
its
to c
linic
8
1
O
3
134 Pts pa
2006 Aug 07 onwards
X
X
Step Change!
b. Time to get Date (Timeliness)
Flo
w T
ime
/d
ays
O200
1 X
X
Step Change!
c. Temp v Def Access (Quality)
%
Acce
ss T
yp
e
80
%
Lines Def. Access
20%
High SMR
Th
rou
gh
pu
t
/we
ek
O12
6
3
X
X
2006 Aug 07 onwards
20/7 1/8 1/9 onwards
500 Pts paO
The cause of problems creating gap between initial & target state in themes a,b,c & d (ref box 1,2&3):
5th Why?
Another event!
IN BOX 8 WE TRACK AND SHOW THE BENEFIT/RESULTS.
THE FIRST UPDATE IS DUE 3RD AUGUST 2007 FOLLOWINGFIRST RUN OF ONE STOP CLINIC.
THE GRAPHS COPY ACROSS FROM BOX TWO AND THREE.
IF WE ARE NOT MEETING THE TARGETS WE NEED TO GOBACK TO BOX 4 TO UNDERSTAND WHY - AN EFFECTIVEINFO. CENTRE WILL EASE THIS TASK!
The VSA highlighted patients
typically visit the Renal clinic 8
times, taking 201 days to obtain a
date for surgery. Consequently 42%
of patients need temporary access
impacting SMR (113) and income.
Therefore the event themesare:
a. Too many visits: focus is to reduce # of visits to the clinic.
b. Flow Time too long: focus is to reduce time from referral to getting a date for surgery.
c. Too many have temp access: focus is to reduce % of population with temp. access.
d. Demand > Capacity: focus is to meet demand.
a. # Visits (Morale)b. Time to get Date (Timeliness)
c. Temp v Def Access (Quality)
a. Morale
c. Timed. Increased activity= £ 375K net profit pa
a. Morale b. Quality
c. Time d. Actual Benefit = £ _____
This box is “GO” when Box 8 = Box 3Monitor ACTUAL results against the metrics defined in initial and target state
Actions (Follow Up Req’d!)
1. Invite appropriate people
for discussion @ that time.
2. Manage more closely the
agenda for week
3. Make agenda available
before event in normal
“lingo” - clarify Day 4!
4. Involve Team Leader in
Simpler/Trans. Team calls
5. Plan to Run the Process
every time - it drives the
change in one week!
What went well?
Excellent Buy in from attendees.
Clinic trial (“run the process”)
FUN WEEK!
Agreed Future Process.
Stuck to itinerary.
What helped?
Tosh’s support and insight!
What hindered?
Discussions going off track.
Transient clinic: did not find a way
To make change visible/physical.
What did not go well?
Not always one voice in the room!
Lack of Clinical Input (nursing &
Anaesthetist).
Lack of direction at times.
What are the fundamental lessons of the event and the improvement cycle?
2. Initial State 5. Solution Approach 8. Confirmed State
1. Reason for Action 4. Gap Analysis 7. Completion Plan
3. Target State 6. Rapid Experiments 9. Insights
Reflections:
Reflections:
Reflections: The throughput metric is directly correlated to income and thus captures both on one graph. The original VSA target was moderatedas it became clear that the higher target would require a third clinic.
Reflections:The Bar charts showed efficiency could jump from 55% to 83% and capacity from 6 to 8 complex Pts if Vein Mapping is moved into process flow!
Reflections: The Ease (E) and Cost (C ) column show the difficulty of implementation. A “O” signifies easy or low cost and a “X” is difficult or high cost; hence the transport solution should be the subject of another event.
Reflections: Running the rapid experiment identifiedIn the VSA gives confidence that the above are the main causes of the gap between initial and targeted state!
Root Causes: Ad hoc current process makes
Resource co-ordination impossible!
Reflections:
No GoGo No GoGo No GoGo
No GoGo No GoGo No GoGo
No GoGo No GoGo No GoGo
The process takes too long and patients are at best inconvenienced and at worst deteriorate. The trends for a, b, c & d must be understood ...
Do it!6 Pts6 PtsRun One Stop Clinic with “typical” Pt mix.
Follow up Action
Actual Effect
Anticipated Effect
Experiment
2 3 4 5 6 7 8 91
SM
Simpler
Team Members Left to Right; Steve Hart (GM),
Start Date:Current Date:End Date:
Title: Renal One Stop Clinic
Process Owner: Breeda McManus & JP Nolan
Sponsor: Zafar Chawdhery & Alistair Chesser
Facilitators: Jane Holmes & Andy Fleming
Sensei: Steve Garnett
??OnNot on callA b DEstablish “on call” translator to Rota
?OFullNo supportDAgree level required with Pt Services
O?1000% YieldA b CRedesign Pt Info. Collection process
?X010 complaints/wkA b C DRapid Redesign Event on Transport
OOYesNo auth.A B C dRegister & authorise Clinic
OO1d200 daysA B C DSet up One Stop Clinic to reduce
CEFSCurrent StateAffecting Themes
SolutionCause/Priority
30/7JP2hEnsure all docs. Prepared for first clinic.
30/7D J L1dEstablish Info. Centre to manage problems arising.
30/7DC1hConfirm Rota for August
30/7ZC1hAgree Surgical/ Anestheticprotocols.
30/7EW1hAgree Pt. Info
30/7JP4hIdentify Pts for first clinic
RAG
DueOwnerTTAction
Barts &The London
400 miles traveled by patients often using BartsTransport!
The process starts with DGH referral and ends with a date for surgery.
Vis
its
to c
linic
8
2006/07
Many visits ˜ many miles NOK Patient Morale!
X
X X
Flo
w T
ime
/d
ays
200
Typically ˜ 8 Months to get surgery!
X
2006/07
%
Acce
ss T
yp
e
58
%
42
%
Lines Def. Access
d. Throughput (Cost)
Th
rou
gh
pu
t
/we
ek
2006/07
The data was not complete enough to show trend however all conditions are bad (X Status); and targets are clear for below…
a. # Visits (Morale)
Vis
its
to c
linic
8
1
O
3
134 Pts pa
2006 Aug 07 onwards
X
X
Step Change!
b. Time to get Date (Timeliness)
Flo
w T
ime
/d
ays
O200
1 X
X
Step Change!
c. Temp v Def Access (Quality)
%
Acce
ss T
yp
e
80
%
Lines Def. Access
20%
High SMR
Th
rou
gh
pu
t
/we
ek
O12
6
3
X
X
2006 Aug 07 onwards
20/7 1/8 1/9 onwards
500 Pts paO
The cause of problems creating gap between initial & target state in themes a,b,c & d (ref box 1,2&3):
5th Why?
Another event!
IN BOX 8 WE TRACK AND SHOW THE BENEFIT/RESULTS.
THE FIRST UPDATE IS DUE 3RD AUGUST 2007 FOLLOWINGFIRST RUN OF ONE STOP CLINIC.
THE GRAPHS COPY ACROSS FROM BOX TWO AND THREE.
IF WE ARE NOT MEETING THE TARGETS WE NEED TO GOBACK TO BOX 4 TO UNDERSTAND WHY - AN EFFECTIVEINFO. CENTRE WILL EASE THIS TASK!
7. Completion Plans7. Completion Plans
• List Activities by Projects, Events, Do-its, and stop-itsList Activities by Projects, Events, Do-its, and stop-its
• List ‘Who and When’ and track progressList ‘Who and When’ and track progress
Tool
TechniquesBeliefs
Simpler Business System® 11.0© Simpler Consulting, L.P. 1996-2011 ALL RIGHTS RESERVED For the Express Use of Simpler Members and Simpler Clients.
16
Box 8 – Confirmed State
The VSA highlighted patients
typically visit the Renal clinic 8
times, taking 201 days to obtain a
date for surgery. Consequently 42%
of patients need temporary access
impacting SMR (113) and income.
Therefore the event themesare:
a. Too many visits: focus is to reduce # of visits to the clinic.
b. Flow Time too long: focus is to reduce time from referral to getting a date for surgery.
c. Too many have temp access: focus is to reduce % of population with temp. access.
d. Demand > Capacity: focus is to meet demand.
a. # Visits (Morale)b. Time to get Date (Timeliness)
c. Temp v Def Access (Quality)
a. Morale
c. Timed. Increased activity= £ 375K net profit pa
a. Morale b. Quality
c. Time d. Actual Benefit = £ _____
This box is “GO” when Box 8 = Box 3Monitor ACTUAL results against the metrics defined in initial and target state
Actions (Follow Up Req’d!)
1. Invite appropriate people
for discussion @ that time.
2. Manage more closely the
agenda for week
3. Make agenda available
before event in normal
“lingo” - clarify Day 4!
4. Involve Team Leader in
Simpler/Trans. Team calls
5. Plan to Run the Process
every time - it drives the
change in one week!
What went well?
Excellent Buy in from attendees.
Clinic trial (“run the process”)
FUN WEEK!
Agreed Future Process.
Stuck to itinerary.
What helped?
Tosh’s support and insight!
What hindered?
Discussions going off track.
Transient clinic: did not find a way
To make change visible/physical.
What did not go well?
Not always one voice in the room!
Lack of Clinical Input (nursing &
Anaesthetist).
Lack of direction at times.
What are the fundamental lessons of the event and the improvement cycle?
2. Initial State 5. Solution Approach 8. Confirmed State
1. Reason for Action 4. Gap Analysis 7. Completion Plan
3. Target State 6. Rapid Experiments 9. Insights
Reflections:
Reflections:
Reflections: The throughput metric is directly correlated to income and thus captures both on one graph. The original VSA target was moderatedas it became clear that the higher target would require a third clinic.
Reflections:The Bar charts showed efficiency could jump from 55% to 83% and capacity from 6 to 8 complex Pts if Vein Mapping is moved into process flow!
Reflections: The Ease (E) and Cost (C ) column show the difficulty of implementation. A “O” signifies easy or low cost and a “X” is difficult or high cost; hence the transport solution should be the subject of another event.
Reflections: Running the rapid experiment identifiedIn the VSA gives confidence that the above are the main causes of the gap between initial and targeted state!
Root Causes: Ad hoc current process makes
Resource co-ordination impossible!
Reflections:
No GoGo No GoGo No GoGo
No GoGo No GoGo No GoGo
No GoGo No GoGo No GoGo
The process takes too long and patients are at best inconvenienced and at worst deteriorate. The trends for a, b, c & d must be understood ...
Do it!6 Pts6 PtsRun One Stop Clinic with “typical” Pt mix.
Follow up Action
Actual Effect
Anticipated Effect
Experiment
2 3 4 5 6 7 8 91
SM
Simpler
Team Members Left to Right; Steve Hart (GM),
Start Date:Current Date:End Date:
Title: Renal One Stop Clinic
Process Owner: Breeda McManus & JP Nolan
Sponsor: Zafar Chawdhery & Alistair Chesser
Facilitators: Jane Holmes & Andy Fleming
Sensei: Steve Garnett
??OnNot on callA b DEstablish “on call” translator to Rota
?OFullNo supportDAgree level required with Pt Services
O?1000% YieldA b CRedesign Pt Info. Collection process
?X010 complaints/wkA b C DRapid Redesign Event on Transport
OOYesNo auth.A B C dRegister & authorise Clinic
OO1d200 daysA B C DSet up One Stop Clinic to reduce
CEFSCurrent StateAffecting Themes
SolutionCause/Priority
30/7JP2hEnsure all docs. Prepared for first clinic.
30/7D J L1dEstablish Info. Centre to manage problems arising.
30/7DC1hConfirm Rota for August
30/7ZC1hAgree Surgical/ Anestheticprotocols.
30/7EW1hAgree Pt. Info
30/7JP4hIdentify Pts for first clinic
RAG
DueOwnerTTAction
Barts &The London
400 miles traveled by patients often using BartsTransport!
The process starts with DGH referral and ends with a date for surgery.
Vis
its
to c
linic
8
2006/07
Many visits ˜ many miles NOK Patient Morale!
X
X X
Flo
w T
ime
/d
ays
200
Typically ˜ 8 Months to get surgery!
X
2006/07
%
Acce
ss T
yp
e
58
%
42
%
Lines Def. Access
d. Throughput (Cost)
Th
rou
gh
pu
t
/we
ek
2006/07
The data was not complete enough to show trend however all conditions are bad (X Status); and targets are clear for below…
a. # Visits (Morale)
Vis
its
to c
linic
8
1
O
3
134 Pts pa
2006 Aug 07 onwards
X
X
Step Change!
b. Time to get Date (Timeliness)
Flo
w T
ime
/d
ays
O200
1 X
X
Step Change!
c. Temp v Def Access (Quality)
%
Acce
ss T
yp
e
80
%
Lines Def. Access
20%
High SMR
Th
rou
gh
pu
t
/we
ek
O12
6
3
X
X
2006 Aug 07 onwards
20/7 1/8 1/9 onwards
500 Pts paO
The cause of problems creating gap between initial & target state in themes a,b,c & d (ref box 1,2&3):
5th Why?
Another event!
IN BOX 8 WE TRACK AND SHOW THE BENEFIT/RESULTS.
THE FIRST UPDATE IS DUE 3RD AUGUST 2007 FOLLOWINGFIRST RUN OF ONE STOP CLINIC.
THE GRAPHS COPY ACROSS FROM BOX TWO AND THREE.
IF WE ARE NOT MEETING THE TARGETS WE NEED TO GOBACK TO BOX 4 TO UNDERSTAND WHY - AN EFFECTIVEINFO. CENTRE WILL EASE THIS TASK!
The VSA highlighted patients
typically visit the Renal clinic 8
times, taking 201 days to obtain a
date for surgery. Consequently 42%
of patients need temporary access
impacting SMR (113) and income.
Therefore the event themesare:
a. Too many visits: focus is to reduce # of visits to the clinic.
b. Flow Time too long: focus is to reduce time from referral to getting a date for surgery.
c. Too many have temp access: focus is to reduce % of population with temp. access.
d. Demand > Capacity: focus is to meet demand.
a. # Visits (Morale)b. Time to get Date (Timeliness)
c. Temp v Def Access (Quality)
a. Morale
c. Timed. Increased activity= £ 375K net profit pa
a. Morale b. Quality
c. Time d. Actual Benefit = £ _____
This box is “GO” when Box 8 = Box 3Monitor ACTUAL results against the metrics defined in initial and target state
Actions (Follow Up Req’d!)
1. Invite appropriate people
for discussion @ that time.
2. Manage more closely the
agenda for week
3. Make agenda available
before event in normal
“lingo” - clarify Day 4!
4. Involve Team Leader in
Simpler/Trans. Team calls
5. Plan to Run the Process
every time - it drives the
change in one week!
What went well?
Excellent Buy in from attendees.
Clinic trial (“run the process”)
FUN WEEK!
Agreed Future Process.
Stuck to itinerary.
What helped?
Tosh’s support and insight!
What hindered?
Discussions going off track.
Transient clinic: did not find a way
To make change visible/physical.
What did not go well?
Not always one voice in the room!
Lack of Clinical Input (nursing &
Anaesthetist).
Lack of direction at times.
What are the fundamental lessons of the event and the improvement cycle?
2. Initial State 5. Solution Approach 8. Confirmed State
1. Reason for Action 4. Gap Analysis 7. Completion Plan
3. Target State 6. Rapid Experiments 9. Insights
Reflections:
Reflections:
Reflections: The throughput metric is directly correlated to income and thus captures both on one graph. The original VSA target was moderatedas it became clear that the higher target would require a third clinic.
Reflections:The Bar charts showed efficiency could jump from 55% to 83% and capacity from 6 to 8 complex Pts if Vein Mapping is moved into process flow!
Reflections: The Ease (E) and Cost (C ) column show the difficulty of implementation. A “O” signifies easy or low cost and a “X” is difficult or high cost; hence the transport solution should be the subject of another event.
Reflections: Running the rapid experiment identifiedIn the VSA gives confidence that the above are the main causes of the gap between initial and targeted state!
Root Causes: Ad hoc current process makes
Resource co-ordination impossible!
Reflections:
No GoGo No GoGo No GoGo
No GoGo No GoGo No GoGo
No GoGo No GoGo No GoGo
The process takes too long and patients are at best inconvenienced and at worst deteriorate. The trends for a, b, c & d must be understood ...
Do it!6 Pts6 PtsRun One Stop Clinic with “typical” Pt mix.
Follow up Action
Actual Effect
Anticipated Effect
Experiment
2 3 4 5 6 7 8 91
SM
Simpler
Team Members Left to Right; Steve Hart (GM),
Start Date:Current Date:End Date:
Title: Renal One Stop Clinic
Process Owner: Breeda McManus & JP Nolan
Sponsor: Zafar Chawdhery & Alistair Chesser
Facilitators: Jane Holmes & Andy Fleming
Sensei: Steve Garnett
??OnNot on callA b DEstablish “on call” translator to Rota
?OFullNo supportDAgree level required with Pt Services
O?1000% YieldA b CRedesign Pt Info. Collection process
?X010 complaints/wkA b C DRapid Redesign Event on Transport
OOYesNo auth.A B C dRegister & authorise Clinic
OO1d200 daysA B C DSet up One Stop Clinic to reduce
CEFSCurrent StateAffecting Themes
SolutionCause/Priority
30/7JP2hEnsure all docs. Prepared for first clinic.
30/7D J L1dEstablish Info. Centre to manage problems arising.
30/7DC1hConfirm Rota for August
30/7ZC1hAgree Surgical/ Anestheticprotocols.
30/7EW1hAgree Pt. Info
30/7JP4hIdentify Pts for first clinic
RAG
DueOwnerTTAction
Barts &The London
400 miles traveled by patients often using BartsTransport!
The process starts with DGH referral and ends with a date for surgery.
Vis
its
to c
linic
8
2006/07
Many visits ˜ many miles NOK Patient Morale!
X
X X
Flo
w T
ime
/d
ays
200
Typically ˜ 8 Months to get surgery!
X
2006/07
%
Acce
ss T
yp
e
58
%
42
%
Lines Def. Access
d. Throughput (Cost)
Th
rou
gh
pu
t
/we
ek
2006/07
The data was not complete enough to show trend however all conditions are bad (X Status); and targets are clear for below…
a. # Visits (Morale)
Vis
its
to c
linic
8
1
O
3
134 Pts pa
2006 Aug 07 onwards
X
X
Step Change!
b. Time to get Date (Timeliness)
Flo
w T
ime
/d
ays
O200
1 X
X
Step Change!
c. Temp v Def Access (Quality)
%
Acce
ss T
yp
e
80
%
Lines Def. Access
20%
High SMR
Th
rou
gh
pu
t
/we
ek
O12
6
3
X
X
2006 Aug 07 onwards
20/7 1/8 1/9 onwards
500 Pts paO
The cause of problems creating gap between initial & target state in themes a,b,c & d (ref box 1,2&3):
5th Why?
Another event!
IN BOX 8 WE TRACK AND SHOW THE BENEFIT/RESULTS.
THE FIRST UPDATE IS DUE 3RD AUGUST 2007 FOLLOWINGFIRST RUN OF ONE STOP CLINIC.
THE GRAPHS COPY ACROSS FROM BOX TWO AND THREE.
IF WE ARE NOT MEETING THE TARGETS WE NEED TO GOBACK TO BOX 4 TO UNDERSTAND WHY - AN EFFECTIVEINFO. CENTRE WILL EASE THIS TASK!
8. Confirmed State8. Confirmed State
• What are the indicators (metrics) of performance or progressWhat are the indicators (metrics) of performance or progress
• Relates all the way back to target condition. Relates all the way back to target condition.
• Have we achieved and closed the gap?Have we achieved and closed the gap?
• Does box 8 = box 3Does box 8 = box 3
Tool
TechniquesBeliefs
Simpler Business System® 11.0© Simpler Consulting, L.P. 1996-2011 ALL RIGHTS RESERVED For the Express Use of Simpler Members and Simpler Clients.
17
Box 9 – Insights
The VSA highlighted patients
typically visit the Renal clinic 8
times, taking 201 days to obtain a
date for surgery. Consequently 42%
of patients need temporary access
impacting SMR (113) and income.
Therefore the event themesare:
a. Too many visits: focus is to reduce # of visits to the clinic.
b. Flow Time too long: focus is to reduce time from referral to getting a date for surgery.
c. Too many have temp access: focus is to reduce % of population with temp. access.
d. Demand > Capacity: focus is to meet demand.
a. # Visits (Morale)b. Time to get Date (Timeliness)
c. Temp v Def Access (Quality)
a. Morale
c. Timed. Increased activity= £ 375K net profit pa
a. Morale b. Quality
c. Time d. Actual Benefit = £ _____
This box is “GO” when Box 8 = Box 3Monitor ACTUAL results against the metrics defined in initial and target state
Actions (Follow Up Req’d!)
1. Invite appropriate people
for discussion @ that time.
2. Manage more closely the
agenda for week
3. Make agenda available
before event in normal
“lingo” - clarify Day 4!
4. Involve Team Leader in
Simpler/Trans. Team calls
5. Plan to Run the Process
every time - it drives the
change in one week!
What went well?
Excellent Buy in from attendees.
Clinic trial (“run the process”)
FUN WEEK!
Agreed Future Process.
Stuck to itinerary.
What helped?
Tosh’s support and insight!
What hindered?
Discussions going off track.
Transient clinic: did not find a way
To make change visible/physical.
What did not go well?
Not always one voice in the room!
Lack of Clinical Input (nursing &
Anaesthetist).
Lack of direction at times.
What are the fundamental lessons of the event and the improvement cycle?
2. Initial State 5. Solution Approach 8. Confirmed State
1. Reason for Action 4. Gap Analysis 7. Completion Plan
3. Target State 6. Rapid Experiments 9. Insights
Reflections:
Reflections:
Reflections: The throughput metric is directly correlated to income and thus captures both on one graph. The original VSA target was moderatedas it became clear that the higher target would require a third clinic.
Reflections:The Bar charts showed efficiency could jump from 55% to 83% and capacity from 6 to 8 complex Pts if Vein Mapping is moved into process flow!
Reflections: The Ease (E) and Cost (C ) column show the difficulty of implementation. A “O” signifies easy or low cost and a “X” is difficult or high cost; hence the transport solution should be the subject of another event.
Reflections: Running the rapid experiment identifiedIn the VSA gives confidence that the above are the main causes of the gap between initial and targeted state!
Root Causes: Ad hoc current process makes
Resource co-ordination impossible!
Reflections:
No GoGo No GoGo No GoGo
No GoGo No GoGo No GoGo
No GoGo No GoGo No GoGo
The process takes too long and patients are at best inconvenienced and at worst deteriorate. The trends for a, b, c & d must be understood ...
Do it!6 Pts6 PtsRun One Stop Clinic with “typical” Pt mix.
Follow up Action
Actual Effect
Anticipated Effect
Experiment
2 3 4 5 6 7 8 91
SM
Simpler
Team Members Left to Right; Steve Hart (GM),
Start Date:Current Date:End Date:
Title: Renal One Stop Clinic
Process Owner: Breeda McManus & JP Nolan
Sponsor: Zafar Chawdhery & Alistair Chesser
Facilitators: Jane Holmes & Andy Fleming
Sensei: Steve Garnett
??OnNot on callA b DEstablish “on call” translator to Rota
?OFullNo supportDAgree level required with Pt Services
O?1000% YieldA b CRedesign Pt Info. Collection process
?X010 complaints/wkA b C DRapid Redesign Event on Transport
OOYesNo auth.A B C dRegister & authorise Clinic
OO1d200 daysA B C DSet up One Stop Clinic to reduce
CEFSCurrent StateAffecting Themes
SolutionCause/Priority
30/7JP2hEnsure all docs. Prepared for first clinic.
30/7D J L1dEstablish Info. Centre to manage problems arising.
30/7DC1hConfirm Rota for August
30/7ZC1hAgree Surgical/ Anestheticprotocols.
30/7EW1hAgree Pt. Info
30/7JP4hIdentify Pts for first clinic
RAG
DueOwnerTTAction
Barts &The London
400 miles traveled by patients often using BartsTransport!
The process starts with DGH referral and ends with a date for surgery.
Vis
its
to c
linic
8
2006/07
Many visits ˜ many miles NOK Patient Morale!
X
X X
Flo
w T
ime
/d
ays
200
Typically ˜ 8 Months to get surgery!
X
2006/07
%
Acce
ss T
yp
e
58
%
42
%
Lines Def. Access
d. Throughput (Cost)
Th
rou
gh
pu
t
/we
ek
2006/07
The data was not complete enough to show trend however all conditions are bad (X Status); and targets are clear for below…
a. # Visits (Morale)
Vis
its
to c
linic
8
1
O
3
134 Pts pa
2006 Aug 07 onwards
X
X
Step Change!
b. Time to get Date (Timeliness)
Flo
w T
ime
/d
ays
O200
1 X
X
Step Change!
c. Temp v Def Access (Quality)
%
Acce
ss T
yp
e
80
%
Lines Def. Access
20%
High SMR
Th
rou
gh
pu
t
/we
ek
O12
6
3
X
X
2006 Aug 07 onwards
20/7 1/8 1/9 onwards
500 Pts paO
The cause of problems creating gap between initial & target state in themes a,b,c & d (ref box 1,2&3):
5th Why?
Another event!
IN BOX 8 WE TRACK AND SHOW THE BENEFIT/RESULTS.
THE FIRST UPDATE IS DUE 3RD AUGUST 2007 FOLLOWINGFIRST RUN OF ONE STOP CLINIC.
THE GRAPHS COPY ACROSS FROM BOX TWO AND THREE.
IF WE ARE NOT MEETING THE TARGETS WE NEED TO GOBACK TO BOX 4 TO UNDERSTAND WHY - AN EFFECTIVEINFO. CENTRE WILL EASE THIS TASK!
The VSA highlighted patients
typically visit the Renal clinic 8
times, taking 201 days to obtain a
date for surgery. Consequently 42%
of patients need temporary access
impacting SMR (113) and income.
Therefore the event themesare:
a. Too many visits: focus is to reduce # of visits to the clinic.
b. Flow Time too long: focus is to reduce time from referral to getting a date for surgery.
c. Too many have temp access: focus is to reduce % of population with temp. access.
d. Demand > Capacity: focus is to meet demand.
a. # Visits (Morale)b. Time to get Date (Timeliness)
c. Temp v Def Access (Quality)
a. Morale
c. Timed. Increased activity= £ 375K net profit pa
a. Morale b. Quality
c. Time d. Actual Benefit = £ _____
This box is “GO” when Box 8 = Box 3Monitor ACTUAL results against the metrics defined in initial and target state
Actions (Follow Up Req’d!)
1. Invite appropriate people
for discussion @ that time.
2. Manage more closely the
agenda for week
3. Make agenda available
before event in normal
“lingo” - clarify Day 4!
4. Involve Team Leader in
Simpler/Trans. Team calls
5. Plan to Run the Process
every time - it drives the
change in one week!
What went well?
Excellent Buy in from attendees.
Clinic trial (“run the process”)
FUN WEEK!
Agreed Future Process.
Stuck to itinerary.
What helped?
Tosh’s support and insight!
What hindered?
Discussions going off track.
Transient clinic: did not find a way
To make change visible/physical.
What did not go well?
Not always one voice in the room!
Lack of Clinical Input (nursing &
Anaesthetist).
Lack of direction at times.
What are the fundamental lessons of the event and the improvement cycle?
2. Initial State 5. Solution Approach 8. Confirmed State
1. Reason for Action 4. Gap Analysis 7. Completion Plan
3. Target State 6. Rapid Experiments 9. Insights
Reflections:
Reflections:
Reflections: The throughput metric is directly correlated to income and thus captures both on one graph. The original VSA target was moderatedas it became clear that the higher target would require a third clinic.
Reflections:The Bar charts showed efficiency could jump from 55% to 83% and capacity from 6 to 8 complex Pts if Vein Mapping is moved into process flow!
Reflections: The Ease (E) and Cost (C ) column show the difficulty of implementation. A “O” signifies easy or low cost and a “X” is difficult or high cost; hence the transport solution should be the subject of another event.
Reflections: Running the rapid experiment identifiedIn the VSA gives confidence that the above are the main causes of the gap between initial and targeted state!
Root Causes: Ad hoc current process makes
Resource co-ordination impossible!
Reflections:
No GoGo No GoGo No GoGo
No GoGo No GoGo No GoGo
No GoGo No GoGo No GoGo
The process takes too long and patients are at best inconvenienced and at worst deteriorate. The trends for a, b, c & d must be understood ...
Do it!6 Pts6 PtsRun One Stop Clinic with “typical” Pt mix.
Follow up Action
Actual Effect
Anticipated Effect
Experiment
2 3 4 5 6 7 8 91
SM
Simpler
Team Members Left to Right; Steve Hart (GM),
Start Date:Current Date:End Date:
Title: Renal One Stop Clinic
Process Owner: Breeda McManus & JP Nolan
Sponsor: Zafar Chawdhery & Alistair Chesser
Facilitators: Jane Holmes & Andy Fleming
Sensei: Steve Garnett
??OnNot on callA b DEstablish “on call” translator to Rota
?OFullNo supportDAgree level required with Pt Services
O?1000% YieldA b CRedesign Pt Info. Collection process
?X010 complaints/wkA b C DRapid Redesign Event on Transport
OOYesNo auth.A B C dRegister & authorise Clinic
OO1d200 daysA B C DSet up One Stop Clinic to reduce
CEFSCurrent StateAffecting Themes
SolutionCause/Priority
30/7JP2hEnsure all docs. Prepared for first clinic.
30/7D J L1dEstablish Info. Centre to manage problems arising.
30/7DC1hConfirm Rota for August
30/7ZC1hAgree Surgical/ Anestheticprotocols.
30/7EW1hAgree Pt. Info
30/7JP4hIdentify Pts for first clinic
RAG
DueOwnerTTAction
Barts &The London
400 miles traveled by patients often using BartsTransport!
The process starts with DGH referral and ends with a date for surgery.
Vis
its
to c
linic
8
2006/07
Many visits ˜ many miles NOK Patient Morale!
X
X X
Flo
w T
ime
/d
ays
200
Typically ˜ 8 Months to get surgery!
X
2006/07
%
Acce
ss T
yp
e
58
%
42
%
Lines Def. Access
d. Throughput (Cost)
Th
rou
gh
pu
t
/we
ek
2006/07
The data was not complete enough to show trend however all conditions are bad (X Status); and targets are clear for below…
a. # Visits (Morale)
Vis
its
to c
linic
8
1
O
3
134 Pts pa
2006 Aug 07 onwards
X
X
Step Change!
b. Time to get Date (Timeliness)
Flo
w T
ime
/d
ays
O200
1 X
X
Step Change!
c. Temp v Def Access (Quality)
%
Acce
ss T
yp
e
80
%
Lines Def. Access
20%
High SMR
Th
rou
gh
pu
t
/we
ek
O12
6
3
X
X
2006 Aug 07 onwards
20/7 1/8 1/9 onwards
500 Pts paO
The cause of problems creating gap between initial & target state in themes a,b,c & d (ref box 1,2&3):
5th Why?
Another event!
IN BOX 8 WE TRACK AND SHOW THE BENEFIT/RESULTS.
THE FIRST UPDATE IS DUE 3RD AUGUST 2007 FOLLOWINGFIRST RUN OF ONE STOP CLINIC.
THE GRAPHS COPY ACROSS FROM BOX TWO AND THREE.
IF WE ARE NOT MEETING THE TARGETS WE NEED TO GOBACK TO BOX 4 TO UNDERSTAND WHY - AN EFFECTIVEINFO. CENTRE WILL EASE THIS TASK!
9. Insights9. Insights
• Capture and share learningCapture and share learning
• Lessons Learned / breakthroughs / reflectionsLessons Learned / breakthroughs / reflections
• What new things have we learned?What new things have we learned?
Tool
TechniquesBeliefs
Simpler Business System® 11.0© Simpler Consulting, L.P. 1996-2011 ALL RIGHTS RESERVED For the Express Use of Simpler Members and Simpler Clients.
18
A3 Link to the Activity Improvement Cycle
Not just an event report: standard work for prep, execution and sustainmentNot just an event report: standard work for prep, execution and sustainment
Prep PhasePrep Phase Execution PhaseExecution PhaseSustainment PhaseSustainment Phase
Formally Launch C
ycle
Formally Launch C
ycle
Set up A
3 Header
Set up A
3 Header
Com
plete A3 B
oxes 1, 2 & 3
Com
plete A3 B
oxes 1, 2 & 3
SP
ON
SO
R A
GR
EE
S TO
PR
OC
EE
D?
SP
ON
SO
R A
GR
EE
S TO
PR
OC
EE
D?
Confirm
Team
Confirm
TeamTrain Team
Train Team
SE
NS
EI R
EV
IEW
SE
NS
EI R
EV
IEW
SE
NS
EI R
EV
IEW
SE
NS
EI R
EV
IEW
Com
plete A3 B
oxes 4 & 5
Com
plete A3 B
oxes 4 & 5
Com
plete A3 B
oxes 6
Com
plete A3 B
oxes 6
Com
plete A3 B
oxes 7
Com
plete A3 B
oxes 7
Com
plete A3 B
oxes 8 & 9
Com
plete A3 B
oxes 8 & 9
Update TP
OC
/Mission V
SA
Update TP
OC
/Mission V
SA
Review
/Update B
ox 7, 8 & 9
Review
/Update B
ox 7, 8 & 9
SE
NS
EI R
EV
IEW
SE
NS
EI R
EV
IEW
SENSEI REVIEW SENSEI REVIEW
SP
ON
SO
R S
IGN
OFF
SP
ON
SO
R S
IGN
OFF
& P
ULS
E
& P
ULS
E
-3-3 -2-2 -1-1
Team Leveling R
eview
Team Leveling R
eviewD1D1 D2D2 D3D3 D4D4 D5D5
Out brief using A
3
Out brief using A
3
WIP
slot
WIP
slot
available?
available?
Tool
TechniquesBeliefs
Simpler Business System® 11.0© Simpler Consulting, L.P. 1996-2011 ALL RIGHTS RESERVED For the Express Use of Simpler Members and Simpler Clients.
19
A3’s as a Management Process(example)
EnterpriseTPOC
CVSAA3
CashOneVSA A3
Wealth VSA A3
MortgageVSA A3
RIE 1 A3 RIE 2 A3 RIE 3 A3 RIE 1 A3 RIE 2 A3 RIE 3 A3 RIE 1 A3 RIE 2 A3 RIE 3 A3
Unit TrustVSA A3
RIE A3 RIE A3 RIE A3
LocationTPOC
A3
EVSAA3
DivisionalTPOC
A3
Owned by MDUpdated 6 Monthly with Simpler
Owned by AKUpdated monthly with BJUpdated quarterly with Sensei
Owned by “Process Owner”Updated monthly with BJ
Owned by “Process Owner”Updated weekly with Lean Team
1
2
3
4
NB: All A3’s live andused to drive improvementuntil target conditions aremet
Event complete Target met
Tool
TechniquesBeliefs
Simpler Business System® 11.0© Simpler Consulting, L.P. 1996-2011 ALL RIGHTS RESERVED For the Express Use of Simpler Members and Simpler Clients.
20
A3 Example – Enterprise OEDP
1: REASONS FOR ACTION 4: GAP ANALYSIS 7: COMPLETION PLAN# Action
1) 1 Dates set for OEDP/Mission Cont review (for all of 11)2 Define OpEx Leaders for the Sectors
2) 3 Define Corporate Core Team4 Finalize Box 8 Metrics
3) 5 Define VSM Leaders and PSO Leaders6 Master schedule of 1:1 review s w ith Sensei
4) 7 Redeploy policy recommendations to ELT8 Develop and roll out full communciation plan
5) 9 Develop and roll out rew ard and recognition plan10 Review dates for Sector OEDP
6) 11 Build Sector Mission Control rooms 2: INITIAL STATE * Analysis based on total IR Enterprise 12 Build Sector benefit tracker
7) 13 Get Sector OpEx resources in placeOTR Productivity COPQ 14 Define Steering Teams/EFA alignment
8) 15 Initiate Sector OEDP review s16 Develop know ledge management system
9) 17 Build Enterprise Mission Control and Benefit Tracker18 Fix f low /template/timing/MBR19 Design counter measure process20 OpEx aw areness training
8: CONFIRMED STATE
Revenue vs Plan EE Engagement Cycle RG
Human Development
OE FT (w ell below 1%)Reflection:
3: TARGET STATE:*** A3 agreed to be bounded by 19 selected Value Streams ***
True North Metrics:Human Development
-Create Capable Infrastructure Full Time in OE = 1%1/3 of FT = Hi Pot Employees
-Corporate EE Survey (VSM Sites) Improve Score by 3 points 5: SOLUTION APPROACHQuality #
Warranty / Scrap / Concession $'s Reduce by 30%(By Revenue)
DeliveryPast Due Days Reduce by 50%
Past Due Aging Reduce 50% from 95th percentile 9: INSIGHTSCost
Productivity (SG&A, L & OH) +20% (Realized)(Be careful on MTL Productivity)
GrowthReduce Flow Time Decrease by 50%
Shipments vs. Plan Above plan 6: RAPID EXPERIMENTSMilestones: #
1) Leadership Immersion Plan 100% comp. by 12/31/112) RIE's Hit Box 3 = Box 8 in 30 Days 50% of RIE's Conducted
3) Define SMS Process Defined by End of Feb '11(Mission Cont. Room / MBR / Utilization)
4) IR People w ho have led 3 events w here 50 People by 12/31/2011(Box 3 = Box 8 in 30 Days)
Guidelines / Coaching RIE? Discipline and ProcessWatch Leadership & assmt. - Model BehaviorStandard Work for Leadership and Processes
Huge Opportunity, Big Change Challenge, QDC Balance has large impact to people's behavior, No reason to measure VS's Differently, Cements how
pow erful std w ork w ill be for IR, Don't Look at Metrics from customer eyes
VOC
OpEx
MA/TW
DM/HR
By creating the OP EX program, Deliver / Support the PD
20%
RIE Effectivity 50%N/A VSM,OE
N/A -50% 15%
KPI
Revenue vs P lan 100%
31-MarRS/DM 31-Mar
Scott/Dan 15-FebRW/CFO 15-Feb
31-JanOpEx/SLT 31-Jan
RR/DM 31-Jan
OpEx 31-JanOpEx 31-Jan
31-JanRR 31-Jan
OpEx 31-Jan
RR/OpEx 15-JanTW/MA 24-JanPB/DM 31-Jan
MA/TW 7-JanRR/DM 7-JanOpEx 15-Jan
Ow ner Comp Date R/GRR 15-Jan
S Pres 31-Dec
© Simpler Consulting, L.P. 1996-2010 All Rights Reserved. (w w w .simpler.com)
9 3Do a full review of Goal Deployment process by end/Jan by ST
Determine effectiveness of initial implementation of goal
Create Standard Work recipe card for Senior Leaders and OpEx Core Team and VSM/Team
Determine the schedules and responsiblities for Op Ex
RR/OpEx
What w ent w ell Opportunities for ImprovementMust be completed by cross functional teamsMust not use “Plant or Site” must use value streamGives us vocabulary common across the enterpriseThis process will drive us forward - - field
We will get better at this with practice
Need consistency of terminology within A3
Give Core Team autonomy to create names / terminologyDefine how C.T reduction translates into benefitsNeed CFO participation in this process L & global leaders
8 2Do a full review of A3 process by end-Feb by CS sector
Determine effectiveness of initial implementation of A3 process
7 1Redeploy policy pilot in Clarksville by Feb /15 MA/TW/KS
Determine the degree of acceptance w ith the w orkforce
Sheet Realised
6Define Experiment Anticipated Effect Actual Effect Organizational Learning
What w ent w ell Opportunities for ImprovementComplexity of A3 and how do we balance resources to meet goalsGood exposure to A3 thinkingGreat methodology for jump starting a big programBig opportunity to leverage the “belts” in the organizationFelt more connection as a team on this effort
Focus quality as the key improvementHow to capture the empowerment of this process and communicate to organizaton5 5 Set std schedule for 1:1 meetings w ith Sensei
Begin coaching process to grow leadership competency
RR/ELT
4 4
3 G 3 Build the Communication and Education Plan and ProcessCreate vision for Op Ex Deployment and Impact
PB/RS/DMPersonal Learning
2 G 2Create Enabling Infrastructure - Core Team, Steering Team, Program Management, Mission Control, Benefits Tracker
Create the infrastucture for execution
RR/SLT
MA/TW/DM
1 G 1
Statement RealisedIncome Identif ied
Schedule & Complete 4 Sector OEDP Create solution approaches for each of the 19 Value
2 3 4 5 8 9 10
Balance Identif ied
11 126 7
M Lam
ach, M A
vedon, T W
yman, D
Tierlink, J C
onover, K
Sultana, B
Ware, T
Eckersley, D
Vaughn, D
Thoren, M
M
ajocha, D M
cDonnell, K
Sieverding, M
Hafer
Andons Theme Expected Improvement Ow ner
Benefits Tracker 1
SMS P rocess N/A
63%
1% 1%0.3%
-15% -20%
1/qtrN/A All
4.9%
Te
am
Me
mb
ers:
EE Survey 62% 65%
Quality COP Q 4.2% -30%
Delivery P ast Due Days TBD -50%
N/A
CycleGrowth
P ast Due Aging TBD -50%
Cost P roductivity
2. Create & Execute 2011 OpEx Enterprise Plan3 Deploy a Progressive, Diverse & Inclusive culture
By building our Continuous Improvement Capabiltiy
The intent of this OEDP is to influence strategies …
1. Customer Driven Grow th PlanThe organization’s key improvement priorities are…
Fix Flow / Template / Timing of MBRCountermeasure Process
Redeploy Policy
Clien
t sign
-off:
Top 5 - 10 Business and Transformation Root Causes
Resource Planning (OpEx, VS Ldrs, PDM, Core TeamProgram Master Schedule
Engagement and Immersion, Dictatorship
Review Date: Jan 07/11 Revision: 06
OEDP Owner: Todd Wyman Current Date: 1/6/2011 Sensei: Hafer / SieverdingDescription: Operating Excellence Deployment Plan
Site/Location: Davidson, NC Start Date: 12/20/2010
VSM
VSM
62%62% 62%
ACTUAL/TARGET
TNM Metric FY 10Target J T F T M T A T
HD Full Time OE N/A 1%
Leader Eng'mt
0%
100%
25%
100%
IR Competency N/A 50 0 0 0 0 0 5
All
OE
100% 100% 100% 100%
VSM
VSM
VSM
SLT
0.3%
0% 100%
J T A T
0%
0%
0%
5%
0%
100%
0%
0%
0%
0%
5%
0%
100%
S T O T N T D TOwner
VSM,CT
CB
M T J T
0.3%
62%
1%
62%
25%
-6%
-10%
-10%
10%
10%
100%
-15%
-25%
-25%
15%
25%
100%
-9% -12%
-15% -20%
10% 10%
20%
100%
100%
-3%
-5%
-5%
10%
5%
100%
100%
10% 25%
100%
10
1%
63%
-18%
-30%
-30%
15%
30%
100%
50%
100%
15
1%
63%
50% 50%
100%
20
1%
64%
-24%
-40%
-40%
20%
40%
100%
50%
100%
25
1%
64%
-21%
-35%
-35%
15%
35%
100%
100%
50%
100%
35
1%
65%
-30%
-50%
-50%
20%
50%
100%
100%
50%
100%
50
1%
64%
-27%
-45%
-45%
20%
45%
100%
3 Simpler Business System® 11.0 ©1996-2010 Simpler Consulting, L.P. All Rights Reserved
Ingersoll Rand Value Streams - Scope
EmployeesFully Engaged
Customers who want IR
Shareholders want to invest
No Baseline for the 19 Value
Streams
All 19 Value Streams Started
By First OEDP Review
0.6
0.61
0.62
0.63
0.64
0.65
0.66
2008 2009 2010
2500
3000
3500
4000
4500
5000
Q1-
08
Q2-
08
Q3-
08
Q4-
08
Q1-
09
Q2-
09
Q3-
09
Q4-
09
Q1-
10
Q2-
10
Q3-
10
Q4-
10
AOP Actual
0
0.02
0.04
0.06
0.08
Q1-
08Q
2-08
Q3-
08Q
4-08
Q1-
09Q
2-09
Q3-
09Q
4-09
Q1-
10Q
2-10
Q3-
10Q
4-10
**
Tool
TechniquesBeliefs
Simpler Business System® 11.0© Simpler Consulting, L.P. 1996-2011 ALL RIGHTS RESERVED For the Express Use of Simpler Members and Simpler Clients.
21
Did we cover everything By the end of this module we will have covered……. The A3 thinking approach The 9 steps required through a worked example Shown other example A3’s Have we answered your questions Good
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