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Presentation Presentation Presentation Transcript

  • Using Quality Improvement Tools to Deliver Better Health care
    PU 5004 - Group 6 Presentation
  • Members
    ArnabComfort
    Michael
    SantoshStella
    Victor Vishal
  • Content
    Introduction
    History
    Triggers
    Dimensions
    Principles
    Stakeholders
    Progress
    Challenges, Critique, Conclusion
  • Introduction
    Quality improvement is not only an important aspect of health care delivery; it is also used in other industries
    Quality improvement - an active, continuous process by all stakeholders (patients, tax payers, healthcare providers) to improve the quality of health care
    Different models(tools) have been developed overtime to effect quality improvement-
    TQM,BPR,FADE,PDSA,SIGMA, AND
    LEAN PRINCIPLES
     
  • History
    Conceived in the automobile industry in 1950s
     
    Popularized in automobile industries by early 1980s
     
    Introduced into the healthcare sector (U.K.USA, AUSTRALIA, EUROPEAN COUNTRIES) by 1990s
     
    Recently, in NHS, lean thinking is widely used by most hospitals. One of its early users is Royal Bolton Hospital Pathology department (August 2005)
  • Trigger
    Internal
    Increased incidence of hospital acquired infection and avoidable injuries
    Constraint in hospital capacity and space
    Excess pressure on the staff leading to low morale
    Increasing waiting list and queues
  • Trigger
    External
    • Political and public concerns
    • Economic- huge financial deficit incurred by NHS
    • Sociological
    • Legal
  • Why LEAN Management
  • What is Lean?
    It is creating a culture of value and eliminating waste in order to maximize quality of service.
  • Lean process involves :
    “…determining the value of any given process by distinguishing value-added steps from
    non-value-added steps and eliminating waste so that ultimately every step adds value to
    the process”
    (Institute for Healthcare Improvement 2005: 2)
  • The 5 Lean principles
    • - Value
    • - Value Stream
    • - Flow
    • - Pull
    • - Perfection
  • Lean thinking categories of waste and health care examples
    Correction (defects):
    Adverse drug reactions
    Readmission because of inappropriate discharge
    Waiting:
    Waiting for doctors to discharge patients
    Waiting for test results
    Transportation:
    Central equipment stores rather than ward based stores for commonly used items
  • Lean thinking categories of waste and health care examples
    Over processing:
    Asking patients for the same information
    several times
    Inventory:
    Waiting lists
    Excess stock in stockrooms
    Motion:
    Unnecessary staff movement to obtain
    information or supplies
    Overproduction
    Requesting unnecessary laboratory tests
    Keeping beds or slots free ‘just in case’
    (Adapted from NHS Institute for Innovation and Improvement: Going lean in the NHS (2007)
  • The Hierarchy of improvement
    Eliminate the non-value adding activity
    Reduce the size of non value adding activity.
    Combine it with another values adding activity.
  • Key lean management tools
    The 5S
    Sort – Remove Waste.
    Set– Set what remains in order. 1-2-3-4-5
    Shine– Keep a clean environment that allows process flow.
    Standardise- Maintain good activity standards for teams and managers.
    Sustain – Audit and improve the quality attained.
  • NHS LEAN Implementation Principle
    The NHS has come up with 6 principles that should guide the lean thinking implementation
    Philosophy as the foundation. See the whole process.
    Level out workloads. Match demand with capacity. Lean is not mean.
    Work on flowing work through values streams mapping
    Get quality right the first time. Plan customer value into your process.
    Standardise tasks. No rigidity just lean- removing non-value adding steps in the process.
    Grow lean leaders and managers. This is necessary to sustain the gains off the implementation. Lean thrives when there is strong leadership support.
  • Value stream Mapping
    The following are the steps involved in mapping out values streams in an organisation so that lean principles can be applied
    • Map the process
    • Involve those who are involved in the process Ask why the queues and delay happens
    • Look to where demand is coming from and smooth it in to the process
    • Sustain value streams
  • Analysis of Organisational change
    What is organisational Change?
    According to Patrick Dawson, “it is a new way of thinking and working”(1994).
    This is exactly what lean management is about.
  • The five dimensions to Organisational Change
    Content/ Character of Change of the change – TQM, Technological change, BPR, Cultural Change.
    Temporal Dimension – rate or pace of change.
    Scale of change – incremental or transformational.
    Political Dimension – Change contested or accepted?
    Intentionality.
  • LEAN as a tool for organisational change
    • It is cultural change, with a view for total quality management.
    • It is slow pace but its gains appears soon
    • Incremental and transformational
    • It is political accepted tool in the NHS. Steve Mason, Audit Commission during the Cranfield round Table shows its acceptance in other sectors and introduction to the NHS.
    • It is an intentional tool employed by change drivers
  • Lean management
    It is a transformational process and not a transactional one.
    It employs the processualapproach.
    It is leadership driven and fits into the Katter's view of leadership change model
    It is a leadership process that engages the bottom-up approach.
  • Progress of Change
    QI tools are being appliedin the healthcare industry in otherparts of the developed world
    Bolton Hospitals NHS
    a reduction by one third of death rates for patients having hip operations
    reduced paperwork in the trauma unit by 42 per cent and a fifty per cent reduction in the amount of space needed by the pathology department.
    Aircraft technicians from the RAF were invited to help them develop lean techniques
  • Progress of Change
    The Pathology Department of the Royal Bolton Hospital, yielded a 70% reduction in wasteful activities; 40 per cent reduction in floor space needed; up to 90 percent reductions in the times taken to do its job – all achieved with less, not more, staff and with limited capital investment.
    ~Powell et al (Feb 2009)
  • Sample collection after LEAN
    BEFORE
    AFTER
  • Stocks and Supplies
    Before LEAN
    After LEAN
  • Pharmacy after LEAN
  • Stakeholders
  • Progress of Change
    The NHS confederation/LEAN Enterprise Academy
    LEAN Healthcare Academy
    NHS Institute for Innovation and Improvement
    Lean Simulation Suitcase
    NHS Lean Implementation handbook draft
    Lean thinking plus Six Sigma.
  • Challenges
    Some challenges facing Lean have been identified (Young and Maclean 2009 )
    These are
    Evidence
    Value
    Metrics
    Resistance
  • Conclusion
    But these challenges notwithstanding, many writers and journals have expressed optimism that Lean will not only work as a strategy but achieve better service delivery if fully implemented in the NHS
  • LEAN IS NOT...
    LEAN is not Mean
    LEAN is not Cost cutting
    LEAN is not restructuring
  • Thank You !