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Created by D Carr – BICS Team – September 2011 © Bolton NHS Foundation Trust 2011. All rights reserved. Not to be reproduced in whole or in part without the permission of the copyright owner
One of the most sentinel insights from lean is that of flow, and I am constantly reminded from all of the work you are doing out there to improve care for patients is that eliminating waste really makes the difference to enable flow.
For instance, in the Urgent Care Improvement value stream there are some great examples of teams working to improve flow at the moment, for example stroke, ensuring best care by admitting patients directly to ward (see article below) and also the trial of using “Blue Bay” in General Outpatients as an emergency clinical decisions unit, reducing delays, and thus enhancing flow by improving senior reviews as well as the physical environment and experience for patients.
Thanks to all staff who are supporting these teams to try new ways of working in their areas. We look forward to hearing more from these teams about how their work is going and what their reflections and learning from their work.
As part of the Urgent Care priorities for the Trust; B2 Acute Stroke and C4 Post Acute/Complex Care wards held an event to improve flow and experience for stroke patients. Evidence suggests it is better if patients who have just had a stroke go directly to the ward, ensuring they receive the most appropriate care in a timely manner. For instance, if patients are admitted to an acute stroke ward within 4 hours of arrival at A&E, all other best practice elements of care will be achieved e.g. swallow assessment, Occupational Therapy and Physiotherapy assessment. Currently only 55% of patients are admitted directly to the Acute Stroke Unit within 4 hours. The aim is to have 80% of patients spend 90% of their time on a stroke ward. The outcome of the event has been:
• To ensure daily capacity on B2 can facilitate direct admissions from A&E through the protection of stroke beds for new onset strokes
• Excellent MDT teamwork and forming relationships • For the team doing the event to meet and inform people of the agreed pathway and
escalations e.g. A and E, D1 and D2, Bed managers • Visual management and standard work to monitor capacity and the achieve direct
admissions , discharges and transfers etc • Improving daily board rounds through the implementation of rapid experiments • To establish a working group to review standard work for SINAP (stroke) data • A rapid experiment to support discharges into the community Early Supported
Discharge Team
For further information contact [email protected]
Issue: September 2011 BICS Newsletter
Using Lean for
Continuous Improvement
Special points of interest:
• Improvement News
• BICS Academy
• Sharing the Learning
• Celebrating Success
• Forthcoming events
INSIDE THIS ISSUE:
Stroke Flow Event 1
MSK Pathway 2
Medical Illustration 2
Health Records 6S 2
The Parallel 3
School Nursing 3
Laboratory Medicine 3
Policy Deployment 4
BICS Green 4
Best Practice Visit 5
Introduction to Good Clinical Practice
5
Handy Hints 6
Celebrating Success 6
Lung Cancer 2
AQuA WebEX 4
Swap Shop Event 5
FOCUS ON FLOW
STROKE FLOW EVENT
Joy Furnival
Head of Lean
Transformation
Created by D Carr – BICS Team – September 2011 © Bolton NHS Foundation Trust 2011. All rights reserved. Not to be reproduced in whole or in part without the permission of the copyright owner
Improvement News ………. Page 2
BOLTON COMMUNITY UNIT (BCU) EVENT: Integrating the musculoskeletal pathway is a Trust Level One priority for 2011/2012— initial work involved planning to make sure we’re doing the right thing at the right time. September’s event aimed to improve the post-operative intervention and discharge process for elective orthopaedic patients. A trial to assess the impact of protected beds for elective orthopaedic patients began in August allowing us time to reflect and ensure we were making the most of this opportunity.
Gateways for discharge planning were written, board round was reviewed and the target for post-operative therapy was revised. Achievements included reducing the time to therapy from 2 weeks to 1; increasing Ascribe training by 30% and initiating early MRSA testing for trauma patients so that they can use the elective orthopaedic beds in times of pressure. Longer term goals are reducing pre-operative bed days, reducing the length of stay for joint replacement patients where appropriate and reducing infection rates. For further information contact [email protected] or [email protected]
INTEGRATING THE MUSCULOSKELETAL PATHWAY
Medical Illustration provides a photography service for babies born at the Maternity Unit, from which income is re-invested into Trust services. In 2010/11 only 3.74% of the babies born were photographed - and income generation targets were not met. The department needed to tailor photography packages to suit customers, increase awareness/uptake of the service to increase income generated to the Trust. What we did • Surveyed customers and staff for improvement ideas • Redesigned photography packages to reflect different customer requirements. • Review promotional materials/locations including developing a “Bolton Babies”
portrait internet site to suit client base (e.g. e-commerce.) • Trial new process with Maternity staff providing information and ringing
department when photographer is required. Impact of the changes include: • Enhanced accessibility, tailored packages and promotions to suit customer needs • More convenient payment system • Collaborative working between departments—Improve staff Morale • Increase income generation to department and Trust as a whole.
Next steps include an Open Day to showcase the range of packages on offer and the opportunity to take pictures of Bolton babies to feature in the new display material at the Trust , for further information about this or the service please contact [email protected]
MEDICAL ILLUSTRATION—BABY PORTRAIT SERVICE
The lung cancer team recognised the need for improvement as they were not achieving the standard for patients being seen within 14 days of referral and treated within 62 days of referral. In addition some patients did not feel adequately involved in their care planning and treatment options. The team redesigned the pathway, enabling patients to receive a CT scan on the day of their first appointment so that patients who do not have cancer are
informed that same day and to speed up the diagnostic process to allow earlier referral for surgical biopsy or treatment in partner organisations if required. The new service will commence on 7th November and will be monitored to ensure delivery of the expected benefits. For further information contact [email protected] or [email protected]
RESPIRATORY—LUNG CANCER PATHWAY
Health Records held a 6S event to reorganise the store cupboard and ordering process, making stock levels easier to identify, eliminate safety risks, and reduce time wasted gaining access to the store cupboard. The team used data and their departmental knowledge to establish stock levels with a new clearly labelled flow layout, and ‘Standard Work’ created for all to adhere to. As a result of the team’s hard work, stock items are now visible, stored safely and easily accessible, reducing time spent looking for items, and allowing greater control of the ordering of stock process. For further information please contact [email protected] . Before
After
HEALTH RECORDS—6S STORE CUPBOARD
Created by D Carr – BICS Team – September 2011 © Bolton NHS Foundation Trust 2011. All rights reserved. Not to be reproduced in whole or in part without the permission of the copyright owner
Improvement News ………. Page 3
The Young People’s Health Team based at The Parallel recently started using BICS.; working through the Well Organised Working Environment (WOWE) module from Productive Community Services (PCS), using 6S to create a safe and organised working environment. The team are focusing on:
• Reviewing clinical bags contents for community drop-in sessions • Setting the office environment for flow • Standardising clinical/non clinical stock within treatment rooms • Reducing waste in the off duty and annual leave process
PCS is inherently similar to BICS as they were both developed from the lean principles of BICS as daily work, continually removing waste, valuing and respecting staff. Many BICS tools are applied in PCS modules e.g. visual management, standard work, benefits tracking, value stream mapping. For further information contact [email protected]
THE PARALLEL—WELL ORGANISED WORK ENVIRONMENT (6S)
Bolton’s School Nursing Team are continuing their improvement journey, developing visual management using the Knowing How We Are Doing (KHWAD) tool from PCS, which helps develop, implement and review measures specific to the needs of that team. The KHWAD visual management board has four areas of information:
• Improving Quality and Safety • Improving Productivity • Improving Staff Well Being • Improving Patient Experience
Team Leaders identified key points from National Child Protection Serious Case Review recommendations which related to quality and safety. The recommendations were:
• Managers required clearer understanding of staff’s safeguarding (Child Protection) workloads • Ensure staff received adequate safeguarding training • Ensure staff accessed regular management supervision of their high level Safeguarding cases.
The team did not have a clear overview of these issues and were aware that safeguarding cases were increasing; causing more pressure and stress. The team developed a visual management board to monitor team member’s caseloads, training and supervision levels. A workforce review was commissioned to assist formulating a numerical coding system which has enabled them to set safe safeguarding workload parameters for staff. This is incorporated on the board using a red, amber and green (RAG) rating system to visualise low, medium and high levels of risk for individual staff and the team as a whole.
Team leaders now have a succinct overview of workload pressures, resulting in the effective management of staff and safeguarding caseloads. Ultimately, staff feel more supported and are able to provide a better quality of service for children, young people and their families. For further information, please contact [email protected]
SCHOOL NURSING—KNOWING HOW WE ARE DOING
To ensure the continued delivery of local Laboratory Medicine services by the Trust a national challenge must be met of reducing costs by 20%. Greater Manchester commissioning consortia are tendering for GP services and without these efficiency savings the Trust will not be in a position to place a strong bid. There is a desire to improve the quality of the service and strengthen the future position by growing the customer base, and to achieve all this all teams within Lab Medicine need to be fully engaged and involved in this work to take their service into the future.
During the week a Vertical Value Stream Map was created to manage the action plan which came from the future state created by the team. Based on customer feedback the focus is on ten streams of improvement which together will create the savings and quality improvement required; these include placing the biomedical scientist in the patient value stream to support decision making, and improving flow in all aspects of the service from transport of samples to result delivery. As a Value Stream Analysis this piece of work will continue past the usual 90day mark with all results being delivered by August 2012. For further information contact [email protected]
LABORATORY MEDICINE—SECURING THE FUTURE
Created by D Carr – BICS Team – September 2011 © Bolton NHS Foundation Trust 2011. All rights reserved. Not to be reproduced in whole or in part without the permission of the copyright owner
POLICY DEPLOYMENT AWARENESS TRAINING
Page 5 BICS Academy
Green Level Certification Training
Confused by Policy Deployment? Don’t know you’re L3s from your elbow? Then come along the Policy Deployment Awareness sessions to find out more! Policy Deployment is the method the Integrated Trust uses to set its stretch annual objectives and ensure they filter up and down the organisation and to ensure departments are aware of how they contribute to the delivery of corporate goals.
Who is it for? The training is awareness level, so is suitable for anyone to attend, but is particularly relevant to Department Managers, Clinical Leaders and those who are involved in the setting of Departmental objectives. Dates available are: • 9th November 9-12, Musgrave House, Royal Bolton Hospital • 22nd November 1:00—4:00, Room 1&2, Crompton Health Centre • 16th December 9:00—12:00, Musgrave House, Royal Bolton Hospital Dates in 2012 will be arranged; alternatively we can deliver bespoke training and help you with the development of your departmental objectives for 2011/12. To book a place contact [email protected], further information about Policy Deployment can be found via this link: Policy Deployment
Due to demand we are pleased to announce additional Green Level Awareness sessions based both in the community and hospital.
Additional sessions based in the community are at Pikes Lane Centre, Training Room 1 on the following dates: • 31st October or 21st November (both 9:30 – 12:30)
Additional session based at the hospital are in the BICS Department, Musgrave House: • 15th December (1:00—4:00)
Please note: if you have already attended BICS Green Level or EQIP Awareness you do not need to attend this session again, unless you wish to do so as a refresher.
Click on Green Dates 2011 for alternative sessions . To book a place contact [email protected] RCN UPDATE BICS Green and Bronze sessions have been re-accredited with the Royal College of Nursing for a further year, confirming the relevance of these courses to nursing and clinical continuing professional development. Green counts as 3 hours study and Bronze as 18 hours study towards your accreditation. If you’re still not sure about the sessions here are a couple of recent comments from participants:
“Fantastic course, taught and delivered very well. Learnt a lot regarding change and will take it back to my workplace and recommend Green training.”
“It was a very good and rewarding three days. The interaction between the facilitator and the team was good also between the team members themselves.” - Bronze
AQuA are developing future WebEx series for their ‘Safer care’ portfolio. Proposed sessions are around Medication Safety and Productivity. Forthcoming session:
Medicine reconciliation - 24th October, 9:00am—10:00am Proposed future topics are:
• Errors/Plotting the dots • Better Care, Better value indicators • National prescribing Centre • Antibiotic stewardship • Formularity
Pre-register for any of the WebEx series by clicking on Click here to register now. Select the date and title of the WebEx you wish to attend, click register and follow the instructions.
NEW SAFER CARE FREE WEBEX SERIES
GREEN LEVEL AWARENESS—ADDITIONAL SESSIONS
Created by D Carr – BICS Team – September 2011 © Bolton NHS Foundation Trust 2011. All rights reserved. Not to be reproduced in whole or in part without the permission of the copyright owner
BEST PRACTICE VISIT—UNIPART Page 5 BICS Academy
The purpose of the visit was to gain a deeper understanding of how lean methodology and continuous improvement is embedded into the organisational culture of the Unipart Group. The Unipart Group is a leading third party logistics provider and a consultant in operational excellence; operating across a range of markets including automotive, leisure, marine, manufacturing, mobile telecoms, rail, retail and technology.
Pre-1987 Unipart was known as “Britain’s worst factory”, since then it has worked hard to embed values and principles into everything they do, the principles reinforced their commitment to engaging people at every level of the organisation, to enhance and support relationships with their clients and suppliers, and to eliminate waste from their processes.
The team from Bolton saw examples of how these principles successfully promote lean thinking referred to as the Unipart Way “ I was amazed at how smooth and calm all the work areas were. The communication cells were fantastic—they were transparent to anyone including customers and they were owned by the workforce. I thinks there are many things we can learn from this visit which will help us visualise and communicate our work, progress and success better and to a wider patient and staff audience.”
The Unipart Way has become the company’s selling point within the marketplace, offering customers a chance to do business with an organisation that will not only meet their needs but one that will continually seek to improve the service they offer. For information about forthcoming best practice visits contact [email protected]
8th November 2011, 9am-4.30pm BICS event room 1, Royal Bolton Hospital
This course provides an introduction to Good Clinical Practice (GCP) and the EU Directives, UK Regulations and Research Governance Framework requirements covering clinical trials and other NIHR Portfolio studies conducted within the NHS. Aim of session: The aim being that participants know how to practice excellent GCP when they return to their workplace to ensure that the rights, safety and well-being of patients are always protected. Participants will have a demonstrable understanding of the background and practical implications of GCP. This understanding is intended to be a foundation for action about translating principles into practice and give participants the confidence to take a proactive role in improving processes and standards within their own work area. The course is aimed at staff involved in the conduct of studies once they have been accepted onto the NIHR Portfolio.
Book your place online at: http://learning.nihr.ac.uk/Register.aspx or contact: [email protected] for further details
INTRODUCTION TO GOOD CLINICAL PRACTICE (GCP): A practical guide to ethical and scientific quality standards in clinical research
NHS Northwest hosted a Swap Shop event to share good practice and innovations in Human Resource Management, employment practice, organisational development and Workforce Strategy. The event consisted of exhibition stands showcasing great work from across the region and the opportunity to attend various workshops to learn about best practice. Bolton NHS Foundation Trust had a stall to showcase our work on ‘Engagement and Improvement in an integrated Organisation’, which was hosted jointly by the OD and BICS Team. For further information, please contact [email protected] or [email protected]
NHS NORTHWEST SWAP SHOP EVENT—SEPTEMBER 2011
Created by D Carr – BICS Team – September 2011 © Bolton NHS Foundation Trust 2011. All rights reserved. Not to be reproduced in whole or in part without the permission of the copyright owner
SHARING THE LEARNING: Page 6
Congratulations to our Outpatients and Districting Nursing Teams who won the
Efficiency in Administrative and Clerical Services Award at the inaugural HSJ Efficiency Awards for the Streamlining of Outpatients’ Admin & Clerical Services and the creation of a Centralised Booking Service for District Nurses. Well done also to the Strategic Review Team who were runners up in the “Communicating Efficiency” category.
All teams concerned have demonstrated not only tremendous efficiencies but significant quality improvements too by keeping patients at the heart of everything they do.
Nursing Times Awards: Good luck to those who have been short-listed in the Nursing Times Awards:
• Noreen Ryan - Nurse prescribing in CAMHS • Respiratory Nursing Team - Improving care and service
by respiratory nurse specialists • Michaela Bowden, Nursing Times’ Nurse of the Year The winners will be announced in November.
Health Service Journal Awards: Further congratulations to the Workforce Team who have been short-listed in the HSJ Awards for their work on Staff Engagement and the Diabetic Team for their evidence based, redesign of diabetic foot screening services in Bolton, short-listed in the Managing Long Term Conditions category.
Good luck to all teams!
Events that took place in September
Medical Illustration
Post-operative Intervention & Discharge
Laboratory Medicine B2/C4 Flow
Respiratory Cancer Pathway Urgent Care Rapid
Experiment—Blue Bay MSK Capacity & Demand
Take a look at our case study page
on our intranet site for more information on these events.
Forthcoming Events
The following events will take place in October
MSK Pathway
Neo-natal
Audiology
Complex Care
Watch this space for more
information
Next BICS Outbrief
21st October in the Lecture Theatre, RBH
12.00 pm
Everyone welcome!
Also featuring feedbacks from:
Palliative Therapy—patient status at a glance
For more information about this, any of our events or about BICS in
general, contact us or refer to our intranet site:
Contact details: [email protected]
01204 390482 (ext 5482)
Website:
“Bolton Improving Care System”
HANDY HINTS - 6S AUDIT SHEET
Each month we will be running a handy hints section that may be of use to some departments when they improve their area. In August the BICS Team held a documentation event, review and integrate documents from both improvement teams, one of which was the 6S Audit Sheet. The audit has been altered to include 4 additional questions:
The new template can be accessed via the following link on our intranet page: 6S Audit Sheet For more handy hints take a look at the Shared Learning website . You can get to the site via the Trust Intranet, by using the Trust Information Menu and selecting the Shared Learning option If you have an idea to share or to find out more email the BICS Team at [email protected] .
CELEBRATING SUCCESS: HSJ AWARDS
SHORTLIST SENSATIONS:
Respiratory Nursing Team
The winning teams!
