Redesigning the A&E Value Stream
•
2 likes•863 views
by Marc Baker and Ian Taylor shown at the Lean Healthcare Forum on 15th October 2008 ran by the Lean Enterprise Academy
Recommended
Recommended
More Related Content
What's hot
What's hot (20)
Similar to Redesigning the A&E Value Stream
Similar to Redesigning the A&E Value Stream (20)
More from Lean Enterprise Academy
More from Lean Enterprise Academy (20)
Recently uploaded
Recently uploaded (20)
Redesigning the A&E Value Stream
- 1. Our Approach “I can’t see it” (If you can’t see it - then how can you do something to improve it) Need to visualise your problems, processes, capacity, demand….. Anything you’re trying to improve is attempting to address a problem…….. © Lean Enterprise Academy UK
- 2. What is the Problem? Why is it a Problem? How Big is the Problem? Who owns the Problem? ... but are you working on the right Problem Usually everybody's responsibility – and yet nobody's © Lean Enterprise Academy UK
- 3. 1. Initial Problem (s) Perception (Large, vague, complicated problem) 2. Clarify the problem The “Real” Problem 3. Locate Area/ Point of Cause A&E Problem LoS Problem Cost Problem Access ProblemHAI Problem LoS Problem Further down the funnel So in this example now we can SEE that Medical LoS is the BIG Problem © Lean Enterprise Academy UK
- 4. So now we’ll need to SEE what Medical Demand looks like – the size of it, the shape of it. But all patients are different!!!! – Lets SEE Chest Pain 3942 (15%) D&V 1314 (5%) Haematemesis 2628 (10%) Shortness of Breath 10512 (40%) Falls 5256 (20%) Neurological Disorder 2628 (10%) Total 26280 Count Percent C1 Count 20.0 15.0 10.0 10.0 5.0 Cum % 40.0 60.0 75.0 85.0 10512 95.0 100.0 5256 3942 2628 2628 1314 Percent 40.0 Other Neurological Disorder Haem atem esis Chest Pain Falls Shortness of Breath 30000 25000 20000 15000 10000 5000 0 100 80 60 40 20 0 Pareto Chart for Presenting Conditions © Lean Enterprise Academy UK
- 5. But all patients are different!!!! – Well lets SEE In this example it soon becomes apparent that if you map Shortness of Breath you will also capture all the process steps for the remaining presenting symptoms (with the exception of the Speech & Language Therapy process step contained within Neurological Disorder) at least 90% of demand Therefore Mapping Shortness of Breath represents your ‘biggest bang for your buck’ © Lean Enterprise Academy UK
- 6. We need to see: •Where they come from & where they go •What points can they enter the system & leave •The numbers The Demand Map for Emergency Medical patients © Lean Enterprise Academy UK
- 7. Now we need to see the Patients Journey in detail (Door to Door) P/A Capacity Working Hrs Freq Handover P/A Capacity Working Hrs Freq Nurse Obs P/A Capacity Working Hrs Freq Dr Assm’t P/A Capacity Working Hrs Freq Imaging P/A Capacity Working Hrs Freq Dr Review P/A Capacity Working Hrs Freq Spec’ Rev P/A Capacity Working Hrs Freq Nurse Obs P/A Capacity Working Hrs Freq Dr Assm’t P/A Capacity Working Hrs Freq Imaging P/A Capacity Working Hrs Freq W/Round P/A Capacity Working Hrs Freq Nurse Obs P/A Capacity Working Hrs Freq Physio P/A Capacity Working Hrs Freq W/Round P/A Capacity Working Hrs Freq Discharge GPHome Home Community Hospital A&E MAU Medical Wards What are the steps they go through (the boxes), the delays they experience (the Triangles) Important here is the data in the boxes: Plan & Actual (is there one for every box) Capacity (staff not beds - % against planned establishment) Opening Hours (24/7 or 09:00 -17:00 Mon – Fri etc) Frequency (PRN or once a dat etc) © Lean Enterprise Academy UK
- 8. 2nd add the offline activities, information flow & sceduling activities Patient Notes P/A Capacity Working Hrs Freq Handover P/A Capacity Working Hrs Freq Nurse Obs P/A Capacity Working Hrs Freq Dr Assm’t P/A Capacity Working Hrs Freq Imaging P/A Capacity Working Hrs Freq Dr Review P/A Capacity Working Hrs Freq Spec’ Rev P/A Capacity Working Hrs Freq Nurse Obs P/A Capacity Working Hrs Freq Dr Assm’t P/A Capacity Working Hrs Freq Imaging P/A Capacity Working Hrs Freq W/Round P/A Capacity Working Hrs Freq Nurse Obs P/A Capacity Working Hrs Freq Physio P/A Capacity Working Hrs Freq W/Round P/A Capacity Working Hrs Freq Discharge GPHome Home Community Hospital A&E MAU Medical Wards Bed Management Patient Data System P/A Capacity Working Hrs Freq Pathology P/A Capacity Working Hrs Freq Pharmacy P/A Capacity Working Hrs Freq DLN © Lean Enterprise Academy UK
- 9. Finally add the Timelines at the bottom – Process Steps & Delays (& add them up) Patient Notes P/A Capacity Working Hrs Freq Handover P/A Capacity Working Hrs Freq Nurse Obs P/A Capacity Working Hrs Freq Dr Assm’t P/A Capacity Working Hrs Freq Imaging P/A Capacity Working Hrs Freq Dr Review P/A Capacity Working Hrs Freq Spec’ Rev P/A Capacity Working Hrs Freq Nurse Obs P/A Capacity Working Hrs Freq Dr Assm’t P/A Capacity Working Hrs Freq Imaging P/A Capacity Working Hrs Freq W/Round P/A Capacity Working Hrs Freq Nurse Obs P/A Capacity Working Hrs Freq Physio P/A Capacity Working Hrs Freq W/Round P/A Capacity Working Hrs Freq Discharge GPHome Home Community Hospital A&E MAU Medical Wards 20 10 20 13 22 10 20 10 43 6 35 7 15 9 120 12 480 15 1080 8 360 5 4320 12 1440 8 1440 15 WT = 9415 PT = 175 Bed Management Patient Data System P/A Capacity Working Hrs Freq Pathology P/A Capacity Working Hrs Freq Pharmacy P/A Capacity Working Hrs Freq DLN Complex!!! Remember this is just one patient’s journey. Imagine if we overlaid all the patient’s journeys on top of this © Lean Enterprise Academy UK
- 10. Typical NHS Mgmt approach – Squeeze the Boxes Why - Because they can’t see the Triangles Value adding 5% Non value adding 60% Start here insteadNecessary but non value adding 35% © Lean Enterprise Academy UK
- 11. Value Stream Map is a Snapshot Purpose: Answer the questions: – Were are we now? – Where do we need to go? – What are the obstacles in our path? © Lean Enterprise Academy UK
- 12. Root Cause Analysis For the presence of the Triangles: •Lack of Patient Planning •Lack of Capacity Planning (Staff) •Opening Hours not Synchronised •Lack of Real Time Management Data . What the Data Boxes Tell Us: © Lean Enterprise Academy UK
- 13. Current state problems............ • Visual management is weak: standards are ‘invisible’ • Information flow is chaotic: no coherent system • Ops Mgmt is weak: Line managers don’t know their problem areas & expected ‘functional’ groups(HR, Quality, Bed Management) to solve their problems • Division/Department meetings are long & dull • Problem solving is sporadic & ineffective: no standard approach. • Little evidence of staff involvement: Day job..... Our Observations: © Lean Enterprise Academy UK
- 14. Why not just go to Improvements? • We see many ‘Current State’ maps……… • We’ve done a lot of Science to just relegate it to an ‘aide memoir’ for brainstorming. • Signals & Noise…………. © Lean Enterprise Academy UK
- 15. Process, obviously needs Re-designing but……. Stability 1st Then Re-design So what is stability & how do you get it……. © Lean Enterprise Academy UK
- 16. What is a Stable Process? •Every step and connection is: Capable – a good outcome every time. Available – ready whenever needed. Adequate – just enough capacity. Note: Capability x Availability x Adequate = Stability. Why is it so important? To tell you whether any changes made are effective? So how do we get Stability? © Lean Enterprise Academy UK
- 17. ……Through Operations Management Operations management is the field of science that focuses on the provision of services, and involves the responsibility of ensuring that operations are efficient and effective. It is the management of resources, the distribution of services to patients, and the analysis of data . Definition: Operations management provides the Stability & Measures required to provide a platform that will enable Safe Experimentation (Re-design) © Lean Enterprise Academy UK
- 18. Key Components of Operations Management • The Scientific Method: PDCA • Management Process: Visual • Alignment: Clear goals & R&Rs • Management Timeframes • Structured Problem Solving: © Lean Enterprise Academy UK
- 19. P lan D o A ct C heck Now Grasp the Current State The Abnormality is Obvious Gap EffectCauses The Possible Causes EffectCauses The Possible Causes EffectCauses The Possible Causes for Gap Pareto Graph Highest Priority Pareto Graph Highest Priority Pareto Graph Highest Priority Action Plan No. WhoAction Action Plan No. WhoAction Plan Target Operations Management - The Scientific Approach © Lean Enterprise Academy UK
- 20. What does Operations Management give you • Focus: shared understanding of our critical few goals • Alignment: ensuring all activities are necessary, sufficient and are focussed on our few common goals • Quick response: identify problems quickly and fix them © Lean Enterprise Academy UK
- 21. To Summarise • Defining the Problem • Sizing the Problem • Visualising the Current State • Setting Target Condition • Root Cause Analysis • Proposed Countermeasures. But.......... © Lean Enterprise Academy UK
- 22. How will you get agreement from everybody else to do this???? Who, currently, has the time to do this????....... Do you???? If you agree that this is the right approach, what current activities can/will you de-select to give you time to do it © Lean Enterprise Academy UK