Making King's First Choice for Patients and Staff

Making King’s First Choice for patients and staff

A Programmatic Approach to

Transformation

David J Dawson – Deputy Director of Service

Transformation

Karl Douglas – Senior Change Leader

Lean Enterprise

2nd October 2006

LOX-GNH053-20060905-PROB

Contents

• What is First Choice Programme and why did we start this journey?

• What is the philosophy of First Choice and what are some of the key enablers?

• What does some of our work look like and is it producing results?

• What have we learned and how are we reapplying the learning?

• What are some of the key questions for us (and others?) to consider in order to

become a truly Lean health organisation?


King’s is a busy teaching hospital rooted in the local community

• Major, complex university teaching hospital

• Turnover of £385 million

• 5,000 staff

• Over 900 beds

• Local emergency services

• Local, regional and national elective work

• Economically deprived & ethnically diverse local population

• Strong links to local public, patients & primary care


King’s must change if it is to cope with policy trends

Market reform

Patient care

• Quality

• Cost

• Access

Care delivery

Increasing emphasis on demand management and integrated care

4

5

Drive to increase productivity

3-fold increase in funding 98-08 – but leveling out from 2008 onwards

1

Funding issues

2

Creation of a contestable market / patient choice

3

Increasingly open and transparent regulatory environment

Market Reform

• Foundation Trust application

• Financial and performance targets

• Rising local demand

King’s Position


In 2005 the Trust invested in the First Choice King’s Programme to deliver a set of objectives

1CK objectives 1. Improve on the already

excellent quality of care

2. Make the patient

experience for King’s

patients more positive

3. Create a culture and

capability of continuous

operational and

managerial

improvement

4. Deliver a step change in

financial efficiency by

2008

1CK targets 1. Reduce ALOS

2. Comply with 18 weeks

3. Increase patient

satisfaction

4. Build team of 80

Change Agents

5. Reduce cost per spell

Change

Leaders

team

McKinsey

Service

based

teams

Marketing & branding

Convenience and

access

Environment

Communication and

care

Improvement

capability building

Cross-hospital

enabling projects

Performance

Management

Finance

processes

Service-based transformations

GM CCS Liver CH TBC


Contents


• What is the philosophy of First Choice and what are some of the key

enablers?






We have come to see that a hospital is in some ways similar to industry and that we can learn

Infrastructure

Processes

People

Materials and

products

Hospital Manufacturing Industry


We use a suite of transformation tools to balance action in three organisational dimensions

Operating

System

Management

Infrastructure

Mindsets,

Capabilities &

Behaviours

Lean Methods

Exhibit 10

We must still make value flow….

GP Referral

C/T: 10 mins

No. of GPs : 600

No. of Clinics: 4000/wk

Time/clinic: 4 hrs

Patient

Sees

Consultant

C/T: 15 mins

No. of Clincs:18/wk

Time/Clinic:3.5 hrs

Pre-

Assessm’t

C/T: 20 mins

No. of Clinics :

8/wk

Time/Clinic: 3.5 hrs

Admission

to Ward

C/T: 21.5 hrs

Capacity : 7 x 22 bed

days

X Ray

C/T: 5 mins

No. of Clincs:18/wk

Time/Clinic:3.5 hrs

Util : 65%

In-Patient

Surgery

C/T: 111 mins

Time Available: 5

x 24 hrs

C/O: 15 min

Util : 75%

Daily

Referrals

Daily

Weekly

Demand:

42

Weekly

Demand:

1000

Customers

Elective Care Population

Suppliers


Orthopaedics

- Elective

Confirmed Appt’s

Recovery

C/T: 30 mins

Time Available: 5

x 24 hrs

No. of Beds : 8

Ward Care

C/T: 4 days

Capacity : 7x 22 bed

days

Util : 93%

Patient

Sees

Consultant

F/U

C/T: 10 mins

No. of Clinics :18/wk


PatientsPatients

PatientsPatients

EPRGalaxy

PIMS

Choose

& Book

FIFO FIFO

10 min 15 min 5 min 10 min 20 min 1290 min 111 min 30 min 5760 min

3.6 days 50 days .1 days 01 days 132 days 15 days 2 days

Processing time

Lead timeFor longest stream =

7251 min = 7%202.8 days

121275 10 10 1500 90130

3150 F/U

Value Steam Map

Lean MethodsLean Methods

Exhibit 10


GP Referral

C/T: 10 mins

No. of GPs : 600


Time/clinic: 4 hrs

Patient

Sees

Consultant

C/T: 15 mins

No. of Clincs:18/wk

Time/Clinic:3.5 hrs

Pre-

Assessm’t

C/T: 20 mins

No. of Clinics :

8/wk


Admission

to Ward

C/T: 21.5 hrs


days

X Ray

C/T: 5 mins

No. of Clincs:18/wk

Time/Clinic:3.5 hrs

Util : 65%

In-Patient

Surgery

C/T: 111 mins

Time Available: 5

x 24 hrs

C/O: 15 min

Util : 75%

Daily

Referrals

Daily

Weekly

Demand:

42

Weekly

Demand:

1000

Customers


Suppliers


Orthopaedics

- Elective

Confirmed Appt’s

Recovery

C/T: 30 mins

Time Available: 5

x 24 hrs

No. of Beds : 8

Ward Care

C/T: 4 days


days

Util : 93%

Patient

Sees

Consultant

F/U

C/T: 10 mins



PatientsPatients

PatientsPatients

EPRGalaxy

PIMS

Choose

& Book

FIFO FIFO



Processing time


7251 min = 7%202.8 days

121275 10 10 1500 90130

3150 F/U

Value Steam MapExhibit 10


GP Referral

C/T: 10 mins

No. of GPs : 600


Time/clinic: 4 hrs

Patient

Sees

Consultant

C/T: 15 mins

No. of Clincs:18/wk

Time/Clinic:3.5 hrs

Pre-

Assessm’t

C/T: 20 mins

No. of Clinics :

8/wk


Admission

to Ward

C/T: 21.5 hrs


days

X Ray

C/T: 5 mins

No. of Clincs:18/wk

Time/Clinic:3.5 hrs

Util : 65%

In-Patient

Surgery

C/T: 111 mins

Time Available: 5

x 24 hrs

C/O: 15 min

Util : 75%

Daily

Referrals

Daily

Weekly

Demand:

42

Weekly

Demand:

1000

Customers


Suppliers


Orthopaedics

- Elective

Confirmed Appt’s

Recovery

C/T: 30 mins

Time Available: 5

x 24 hrs

No. of Beds : 8

Ward Care

C/T: 4 days


days

Util : 93%

Patient

Sees

Consultant

F/U

C/T: 10 mins



PatientsPatients

PatientsPatients

EPRGalaxy

PIMS

Choose

& Book

FIFO FIFO



Processing time


7251 min = 7%202.8 days

121275 10 10 1500 90130

3150 F/U

Value Steam Map

Work

ing

Dra

ft -Last M

od

ified

7/2

8/2

005 1

2:3

2:3

5 A

M

THE CONDITIONS FOR LASTING BEHAVIOURAL CHANGE

“ . . . I have the

skills to behave in

the new way”

Capability building

“. . . the systems

reinforce the

desired change “

Aligned systems

and structure

“ . . . I see my

leaders

behaving

differently”

Role-modeling

and leadership

“. . . I know what

I need to change and

I want to do it “

Understanding

and commitment

“I will change my behaviour if . . . .” Influencing Clinicians + Mgt

Work

ing

Dra

ft -Last M

od

ified

7/2

8/2

005 1

2:3

2:3

5 A

M



skills to behave in

the new way”

Capability building


reinforce the

desired change “

Aligned systems

and structure

“ . . . I see my

leaders

behaving

differently”

Role-modeling

and leadership



I want to do it “

Understanding

and commitment

“I will change my behaviour if . . . .” Influencing

Work

ing

Dra

ft -Last M

od

ified

7/2

8/2

005 1

2:3

2:3

5 A

M



skills to behave in

the new way”

Capability building


reinforce the

desired change “

Aligned systems

and structure

“ . . . I see my

leaders

behaving

differently”

Role-modeling

and leadership



I want to do it “

Understanding

and commitment

“I will change my behaviour if . . . .” Influencing Clinicians + MgtClinicians + Mgt

/

/


We underpin the programme with enabling projects – Performance Management (1)

LOX-GNH026-200500802-MVMF

Wo

rking

Dra

ft -La

st Mo

difie

d 0

8/0

9/2

005

14

:04

:25

Exhibit 15Exhibit 15

Developing Scorecards and KPIs . . .

Trust/

Hospital

Care

Groups/

speciality

Team

Ca

rdia

c

Ge

ne

ral M

ed

icin

e

Dia

gn

ostic

Ca

th.

lab

Su

rge

ryW

ard

s

Top to bottom process & KPIs


Wo

rking

Dra

ft -La

st Mo

difie

d 0

8/0

9/2

005

14

:04

:25


Developing Scorecards and KPIs . . .

Trust/

Hospital

Care

Groups/

speciality

Team

Ca

rdia

c

Ge

ne

ral M

ed

icin

e

Dia

gn

ostic

Ca

th.

lab

Su

rge

ryW

ard

s

Top to bottom process & KPIs Visual QPFS ScorecardVisual QPFS Scorecard


Wo

rkin

g D

raft -

Las

t Mo

difie

d 0

8/0

9/2

005

14

:04

:25

Exhibit 0Exhibit 0

The cascade of meetings allows for problem solving and actions to be generated by the front line

Trust score-

card & report

Performance

Committee

Cardiac score-

card & report

Performance

Review

meeting with

Ops Director

Cardiac CG

Management

Team meeting

Scorecards &

reports from

each team

Surgery team

meeting

Cath lab team

meeting

Diagnostics

team meeting

Wards team

meeting

Feedback

Feedback

Feedback

Meeting Cascade


Wo

rkin

g D

raft -

Las

t Mo

difie

d 0

8/0

9/2

005

14

:04

:25

Exhibit 0Exhibit 0

The cascade of meetings allows for problem solving and actions to be generated by the front line

Trust score-

card & report

Performance

Committee

Cardiac score-

card & report

Performance

Review

meeting with

Ops Director

Cardiac CG

Management

Team meeting

Scorecards &

reports from

each team

Surgery team

meeting

Cath lab team

meeting

Diagnostics

team meeting

Wards team

meeting

Feedback

Feedback

Feedback

Meeting Cascade


Wo

rkin

g D

raft -L

as

t Mo

difie

d 0

8/0

9/2

00

5 1

4:0

4:2

5


Performance Management Roll-out across all Care Groups

• CD/GM off-

site

• Wave 1– Neuro (4 )

– Gen Med (2)

– CSDS (6)

Wave 2– Liver (5)

– Renal (1)

– Specialist

medicine (5)

– Dental (3/4)

Wave 3– Critical care &

surgery

– W omen’s

– Children’s

– Guthrie

• Care groups take

the lead to drive

implementation

• First Choice

support is focused

on

– Ensuring

appropriate

scorecards

– Establishing

processes,

meeting

structures, etc

– Coaching team

leads and CG

leadership

Key assumptionsSep Oct Nov Dec Jan Feb Mar Apr May Jun

Wave 1

Sign-offWave 2

Sign-off

Jul Aug Sep Oct Nov

Sign-off

Wave 3

Project Trust Roll Out


Wo

rkin

g D

raft -L

as

t Mo

difie

d 0

8/0

9/2

00

5 1

4:0

4:2

5


Performance Management Roll-out across all Care Groups

• CD/GM off-

site

• Wave 1– Neuro (4 )

– Gen Med (2)

– CSDS (6)

Wave 2– Liver (5)

– Renal (1)

– Specialist

medicine (5)

– Dental (3/4)

Wave 3– Critical care &

surgery

– W omen’s

– Children’s

– Guthrie

• Care groups take

the lead to drive

implementation

• First Choice

support is focused

on

– Ensuring

appropriate

scorecards

– Establishing

processes,

meeting

structures, etc

– Coaching team

leads and CG

leadership

Key assumptionsSep Oct Nov Dec Jan Feb Mar Apr May Jun

Wave 1

Sign-offWave 2

Sign-off

Jul Aug Sep Oct Nov

Sign-off

Wave 3

Project Trust Roll Out


“Shadow of the Leader” (Senn-Delaney)

We underpin the programme with enabling projects – Performance Management (2) Process Confirmation and a “Go & See” approach

Process confirmation is the

standardised way by which

managers ‘go and see’ that the

process is delivering its

target condition and where it

isn’t, understand and act on the

root causes

When, where and how

to do PC is rigorously

defined for all

managers, from CEO

to sisters

It is always done at

the shop floor, where

the care is given and

value added to the

patient

The exact standard of

working, giving care,

maintaining areas

What is process confirmation?

Process confirmation

Trust Mgmt

Ward

Manager &

Matrons

G-grades

Team leader

Quarterly

Leve

l

Wards

Shift Daily Weekly Monthly

Weekly

meetings

Monthly

review

Daily

work

Brief and

debrief

Quarterly

review

Frequency


We underpin the programme with enabling projects – Improvement Capability Building

1400+ hours of

training delivered

by Change Leader

Team

Change Agents (70–90)

Change Leaders (8–10)

Executive

Institutional Capability

Improvement Capability

Improvement

organisation

design

Improvement

methodology

Formal

training

infrastructure

and materials

Coaching and individual

performance management

Ex

pli

cit

cap

ab

ilit

y-b

uil

din

g

an

d t

rac

kin

g p

roce

ss

es

Change agents

Individual Capability

Change leaders


Contents








We started our transformation journey in General Medicine where there were acute problems

Too big a problem

Permanent bed crisis

Budget – overspent

Income – threatened in other specialties

Capacity – constantly expanding

Market reform

Emergency demand – increasing

Target – 4 hours maximum time in A&E to be maintained

Control – silo mentality

Site – split across 2-sites

Trust View

Outliers – 20 to 60 per day

Cancellations - elective and tertiary work squeezed out


29%

2%

32%

10%

16%

12%

10%

14%

13%

62%

Spells Bed days

7,004 99,661

28+

8-14

3-7

≤2

LOS

(days)

100% =

15-27

* i.e., 5 day LOS reduction in 15-27 segment, 3 day LOS reduction in 8-14 segment, 1 day reduction in 3-7 segment

Source: KCH PIMS database, team analysis

• ALOS was 14.2 days

• Outliers averaged 40 per

day with min of 21 and

max of 58

• Spells with LOS > 28 days

are only 13% of total but

account for 62% of bed

days. A 10 day (15%)

reduction in LOS in this

group would reduce ALOS

by 9% to 12.9 days

• Spells with LOS between 3

and 27 days are also

important but do not by

themselves deliver the

LOS reduction target

ALOS by

group

67.9

19.9

10.7

4.4

1.0

We analysed current state rigorously and learned surprising things

Results


Management structure was diffuse and informal with few understood responsibilities

* Not line accountable

Senior management

team

Lead

Consultant Lead

Consultant Lead

Consultant Lead

Consultant (GI)

Firm Chief

(Firm C) Firm Chief

(Firm B)

Medical

Therapies

Nursing

Ops/Admin

Head of

Nursing (A&E)

Director of

Therapies

Firm Chief

(Firm A)

Matron

Matron

Matron

Administrative

Manager Outpatient

Admin Mgr Lead

Consultant

Lead

Consultant

Bowley Close

Head of

Physiotherapy

Outpatient

Serv Dev Mgr

Bed Capacity

Manager

HR

Manager*

Finance

Manager*

Business

Manager

Recruitment

Coordinator

Junior Drs Hrs

Coordinator

Assistant

Business Mgr

Key features

• No overall objectives

• Operational

accountability only with

General Manager

• No formal operational

accountability in Firm

• No formal operational

accountability in wards

• No real responsibility

for LOS at any level

• Firms & wards

specialist silos

• Dislocation between

Dr’s / Nurses / Admin /

therapies - blame

• Some areas outside

influence of senior

management

• No meeting or

information cascade

• Clear professional

lines of accountability

for nurses and

physicians

Chief Exec.

Dir. Ops

Head of

Nursing (GM) General

Manager

Dir. Med. Dir. Nsg

Clinical

Director

Operational line

accountability

Professional

accountability


We found that we could categorise medical patients in two ways and provide tailored care regimes

Accident & Emergency

Patient Streamed at

admission

Category 1 Ward

Category One Patients

Single condition presentation

Requires input from doctor, nurse and X1

therapist

Standard discharge needs

Category 2 Ward

Category Two Patients

Complex presentation with multiple

pathology

Requires input from clinical teams

Complex discharge needs


Results from General Medicine are now clear and financially important to the Trust

– Patients classified by expected LOS and streamed from A&E to

designated wards

– Bespoke MDMs for longer stay patients are in effect with improved

meetings management

– A&E maximum wait of 4h sustained through daily care group review of

intake at lunchtimes in A&E

– Redesigned consultant driven on-take arrangements improved

continuity of care and aided earlier discharge of very short stay

patients

– Dulwich move executed successfully and on time

– New multi-specialty two-firm structure with linked wards organisation

structure replaced old speciality based divisions . Firm leaders – 1

consultant and 1 senior nurse

– The cascade of performance meetings is in place with revised

meeting calendar and terms of reference. Scorecards revised at CG

and Firm level to drive the identified care group improvement needs

Contributing Solutions Results

• ALOS reduced

by 20%

• Average daily

outliers down

by 59%

• 30 beds closed

• Normal winter

allocation of 15

extra beds not

used

• Savings £3.3

million and

ward closed


GP Referral

C/T: 10 mins

No. of GPs : 600


Time/clinic: 4 hrs

Patient

Sees

Consultant

C/T: 15 mins

No. of Clincs :18/wk

Time/Clinic:3.5 hrs

Pre-

Assessm’t

C/T: 20 mins

No. of Clinics :

8/wk


Admission

to Ward

C/T: 21.5 hrs


days

X Ray

C/T: 5 mins

No. of Clincs :18/wk

Time/Clinic:3.5 hrs

Util : 65%

In-Patient

Surgery

C/T: 111 mins

Time Available: 5

x 24 hrs

C/O: 15 min

Util : 75%

Daily

Referrals

Daily

Weekly

Demand:

42

Weekly

Demand:

1000

Customers


Suppliers


Orthopaedics

- Elective

Confirmed Appt’s

Recovery

C/T: 30 mins

Time Available: 5

x 24 hrs

No. of Beds : 8

Ward Care

C/T: 4 days


days

Util : 93%

Patient

Sees

Consultant

F/U

C/T: 10 mins



PatientsPatients

PatientsPatients

EPR Galaxy

PIMS

Choose

& Book

FIFO FIFO



Processing time

Lead time For longest

stream =

7251 min = 7% 202.8 days

12 1275 10 10 1500 90 130

3150 F/U

Improvements to operational performance can…

• ↑ 23% in clinic throughput (orthopaedics)

• ↑ 17% in theatre throughput (orthopaedics)

• ↓ 5% ward LOS (~6 beds, at current activity, or

stable bed-pool with activity to reach 18 weeks

target)

• ↓ 8% ICU LOS (~80 bed-days)

• ↓ 6% HDU LOS (~100 bed-days)

• ~2,700 more DS conversions, incl. 1,800 CC&S

(~15 ward bed reduction, of which 10 CC&S, at

current activity)

…deliver current activity with less resource

…or deliver more activity with same

resource* and reach the 18-weeks target

Range of

options in

between

Pre-requisites for performance improvements

• Participation and ownership of solution by surgeons and anaesthetists

• Strengthening theatre leadership by hiring a new theatre matron

• Appropriate resourcing of all workstreams with Change Agents (incl. theatre scheduling)

• Surgeon co-operation in scheduling additional patients in main theatres

In Critical Care & Surgery extensive analysis of the current state identified improvement opportunities to reach the 18-weeks target


We designed a future state …..

Key elements of the future state

1. Establishing radically different scheduling in theatres and clinics:

building lists that fully use available capacity, based on explicit,

agreed-on standard times, and delivering against those lists

2. Helping staff work more effectively, with agreed-on, staff-

developed protocols for key activities, clear roles and

responsibilities, and better workplace and equipment layout

3. Improving performance management, with clear accountability for

the end-to-end patient journey, better performance conversations

and reviews, and appropriate individual and team incentives

4. Developing a different way of working together, based on shared

valued, clear roles, a visual management system, and regular

briefing and feedback

5. Becoming the leader in innovative outpatient care over time

6. Continuing day surgery conversion at an aggressive pace

“Outcome” vision

A dramatically better patient

experience, delivered by

motivated, capable, and well-

trained staff working in high-

performing teams, at levels of

operational performance that

allow King’s to be a national

leader in innovative surgical

care and high acuity elective

care


Multi-Disciplinary focus on complex patient continuing care needs

D-1 Focus on Discharge

New processes work smarter rather than harder to ensure the patient journey is anticipated, planned for and supported by high quality care

Morning brief

Prepare for the

days

discharges

Ward Team

boards and

issue sheets Scorecards

Team problem solving

Ward & Bed

Boards

Preparation for

Theatre Ward Book Ward Boards

Multi-

Disciplinary

Meetings

TTAs, Pre-Packs & POD drugs control

Prepare for

next days

Discharges

Tracking of KPIs Process

Confirmation

Daily briefs

Performance management

5S – Workplace Organisation

Ward Rounds

Surgery

P

Patient Experience

F

Financial &

Operational Efficiency

S

Staff Development

A4

Q

Quality of Care

…………. WARDOWNER :

A4

How Are We Doing

?

Work Stream

KPI

A4

Work Stream

KPI

Work Stream

KPI

A4

Work Stream

KPI

Work Stream

KPI

4

5

6

7

8

9

10

11

1213

1415161718

1920

21

22

23

24

25

26

27

31 1 23

2829

30

QUALITY OF CARE

Ward : ___________

Month : ________

21 2223

24

25

26

27

2829

3031

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

PA TIEN T EX PER IEN C E

W ard : ___________

M onth : ________

1

2

3

4

5

6

7

8

9

10

31

30

29

28

27

22

21

20

19

11

FINANC IAL & OPERATIO NAL EFFICIENC Y

W ard : _ __________

Month : _ _______

26 25

23 24

18 17 16

15

12 13 14

S T AF F CAP ABIL IT Y

W a rd : _ _ _ _ _ _ _ __ _ _

M o n th : _ _ _ _ _ __ _

1

10

9

8765

4

3

211

12

13

1415

1617

1819

20

21

22

23

24

2526 27

28

29

30

31

P atien ts F it For D ischargeW ard : __________

Month : _________

W a rd D isch arg es T im esW ard : __________

M onth : _________

K ey : E x te r na l D is c har ge D is c harge Lounge

S kills D evelopm entW ard : __________

Sis ter : __________

T e a m B o a rd C o n firm a tio nW ard : __________

Year : __________

Process

Confirmation

EXECUTIVE SUMMARY – Wards 25 Jul ‘05

Programme tracki ng a gainst pl an

Emerging iss ues and deci sions

Change reques ts

Outlook for nex t month

Progress on be nefi ts realisa tion

Risks

Work Stream

KPI

Q u a li ty o f C a reW a rd : _ _ _ _ _ _ _ _ _ _

M o n th : _ _ _ _ _ _ _ _ _

No

. o

f In

cid

en

ts o

f P

re

ss

ure

So

re

s

Work Stream

KPI

Q u a li ty o f C a reW ard : __________

M onth : _________

No

. o

f In

cid

en

ts o

f A

cq

uir

ed

In

fec

tio

n

S kills D evelo p m en tW ard : __________

Sis ter : __________

STANDARDS

MANUAL

- WARDS

WARDS


Patients to be

discharged identified

the day before

discharge

TTAs written by ward

pharmacist and

confirmed by doctors

Setting a standard for 11:00 am discharges brings new focus & discipline to ward processes

CC&S: Ward Discharge Times (includes patients unfit for discharge before 11:00am)

0

50

100

150

200

250

300

350

400

450

6-7 7-8 8-9 9-10 10-11 11-12 12-13 13-14 14-15 15-16 16-17 17-18 18-19 19-20 20-21 21-22 22-23

Discharge Time

No

. o

f P

ati

en

ts

Q1 05 Q2 05 Q4 05 Q1 06 Q2 06

CURRENT - 63%

of discharges

before 11:00am (for those patients “fit

for discharge”)

2005 - 94% of

discharges after

11:00am


Multi-disciplinary working is structured, consistent, pre-emptive and action orientated

Complex cases with special

needs on discharge identified

on admission and continuously

assessed through structured

MDM process

• Attendance by a named link

Social Workers

• Effective Social Services

relationships established with

training from them re: referrals

• Early identification and

preparation of patients to be

discussed

• Clear ownership

• Short structured approach with

effective issue capture and follow

up

• Link to ward visual management

systems, team board & briefings

No. of Patients On Ward Who Are Medically

Fit for Discharge or Transfer

0

10

20

30

40

50

60

70

80

90

100

26-Sep17-O

ct

07-Nov

28-Nov

19-Dec

09-Jan30-Jan

20-Feb13-M

ar

03-Apr

24-Apr

15-May

5-Jun26-Jun

17-Jul

No. o

f Bed

Day

s Los

t / W

eek /

Ward

Tw ining Brunel

M Whiting Cotton

Lister TARGET Bed Days/w eek

3% Bed Usage due

to Discharge Delays

against previous 8%

No. of Patients who are medically fit for Discharge or Transfer

No

. o

f b

ed

Days L

ost

/ W

eek / W

ard

CC&S - Bed Days Saved due to 1st Choice Activity (assuming previous 2 day inpatient stays)

0

500

1000

1500

2000

2500

3000

Oct-05 Nov-05 Dec-05 Jan-06 Feb-06 Mar-06 Apr-06 May-06 Jun-06 Jul-06 Aug-06 Sep-06 Oct-06

Be

d D

ay

s

Bed Days Saved due to Discharge of "Fit for Discharge" Patients CC&S Bed Days Saved due to DSU Conversions

TOTAL CC&S Bed Days saved due to 1st Choice Activity Linear (TOTAL CC&S Bed Days saved due to 1st Choice Activity)


Regular review of visual process information by front-line managers and their teams places them at the heart of improvement

1 Ward Team Board clearly visualising

performance v target

2 Daily Briefing linked to team KPIs

and issues raised

3 Issues listed on specific sheet and

responsibilities assigned

Tasks emerging from issues carried

out within deadline agreed

5 Improved KPIs thanks to structured

issue logging, follow up and review

1

2

3 4

4 Linked to CC&S Nerve Centre for

work stream and Care Group

reviews

5

Improved Ward Team

communication

through daily briefing

and Team Boards

6 Process confirmation to ensure

engagement, coaching and direct

feedback, on the wards

Regular and structured review at

ground level

6


OPERATION

DISCHARGE

We are always asking – “Is there a clear standard for the process ?”


Contents








Key Enablers

• Executive drive and support has to be consistent and focused on delivery

• Up front quantified strategic context is key to structuring and prioritising

effective transformation

• Care group organisational structures clearly linked to objectives and

performance management is a key enabler to allow managers to drive

transformation and make it part of day-to-day life – people need to be in place

before, not after 1CK

• The leadership and engagement of clinicians transforms impact – things

happen

• The introduction of flexible working to cope with natural variation and maximise

value added time is key to breaking through current disabling process rigidities

• Care Group teams must have capacity and capability made available in order

for change to be self sustaining (e.g., analytical skills). The energy and drive of

middle managers can take the programme so far, however, front line management

is key to delivering day-to-day and require development

• The consequences of not achieving / non-compliance or recognition for

achieving / exceeding agreed objectives should be more explicit and enacted

• Specific 1st Choice communications at programme and team levels spreads

knowledge, gets engagement and liberates ideas.

1CK is meeting KPIs and is delivering some results, particularly where supported by key enablers. The programme is learning and new themes are emerging that should shape our direction …


Contents





• What are some of the key questions for us (and others?) to consider in order

to become a truly Lean health organisation?


There are key questions to resolve as we continue forward: For discussion

Does the transformation

journey really have to be so

long and arduous?

How do medical staff really

become excited and central to

the change effort?

Pioneers aren’t enough –

can frontline managers

sustain success? Toyota Production System

Highest Quality

Respect for

People

Flexible ProductionResponse

basedon market

Elimination of

Waste

For customer

•Quality

•Highest Value

•Shortest lead-time

For the Member

•Work Satisfaction

•Job Security

•Fair Treatment

For the Company

•Market Flexibility

•Profit (cost reduction)

•Long Term Prosperity

Flexible

Motivated

Members

Standardisation

Maintenance of

Standards

Continuous Improvement

Just In Time

Goals

Outcomes

Autonomation

Toyota Production System

Highest Quality

Respect for

People

Flexible ProductionResponse

basedon market

Elimination of

Waste

For customer

•Quality

•Highest Value

•Shortest lead-time

For the Member

•Work Satisfaction

•Job Security

•Fair Treatment

For the Company

•Market Flexibility

•Profit (cost reduction)

•Long Term Prosperity

Flexible

Motivated

Members

Standardisation

Maintenance of

Standards

Continuous Improvement

Just In Time

Goals

Outcomes

Autonomation

What else do we need to

do to become a truly Lean

hospital?

Education

Making King's First Choice for Patients and Staff