A PowerPoint presentation detailing 'Whole Systems Rapid Improvement Events'.

1. August 2011
13/17/2015 WS RIE
Whole Systems Rapid
Improvement Events

2. Unclear problems...
Unknown solutions
3/17/2015 2WS RIE

3. ComplexSimple
Isolated
component
issue
Inter-related
systemic issues WSRIE
Organisation
issue
Change
required
The Territory for
Whole Systems RIEs
3/17/2015 3WS RIE

4. • ‘Whole system’ in one room
• Support from experienced
facilitators
• Principles to unpick complex,
systems problems
• Senior stakeholders back the
process and empower the
team
• Tight timescales creates focus
and urgency
• The approach is transferable
3/17/2015 4WS RIE
Key Features of WSRIEs

5. Workshop 1
•Understand
whole system
•Review key
processes
•Confirm main
user and service
challenges &
issues
•Immediate
improvements
Planning
Day
•Scope
•Problem and
Intention
Statements
•Plan
Preparation
•Multiple
stakeholder
interviews
•Map process
•Data collection
and analysis
Workshop 2
•Clarified purpose
•Right process
•Right team
structures
• Right culture
• Right measures
•Apply lean and
quality tools
•Immediate
improvements
Implementat
ion plan
support
•Action plan
•Change planning
• Change coaching
•Document
•Review
Process Overview
3/17/2015 5WS RIE

6. Connection
to Purpose
Savings
Shared Vision
Clarity of View
Productivity
Rapid
Results
Energy &
Enthusiasm
What results
can you expect?
Typically 15% -
20% whole
system
improvement in
efficiency and
effectiveness
3/17/2015 6WS RIE

7. WS RIE Parameters and Scope
Scope: Single service – whole organisation
Timescales: 6-12 weeks
Resources: 15 – 60 consultant days (team of 2+)
Stakeholders: 15 – 60 interviewees
Workshop 10-40 participants
Boundary conditions: Depth of analysis & impact ≈ to time, scope and
participant empowerment
Skills and resources to
facilitate:
Whole systems design, lean, group facilitation,
managing change, coaching
3/17/2015 7WS RIE

8. 1. Detailed Change Readiness audit
2. Leadership development – distributed leadership diagnostic
3. Coaching for Change – for individuals and teams
4. Project and Programme Management (PPM) – structure, templates and
training
5. Workforce Planning and Resource Management
6. Detailed OD Support – team launch, detail team-level org design, job
design, whole system performance scorecard
7. ‘Heart of the Leader’ Transformational Workshop (in collaboration with
Waverly Learning)
3/17/2015 8WS RIE
Post-RIE Implementation
Support Available

9. A Typical WS RIE
Profile & Costing
Scope Organisational unit with 40 staff across 2 sites
Timescales 8 weeks
Resources 24 consultant days
Tricordant team 1 director and 1 senior consultant
Stakeholders 35 interviewees
Workshop 25 participants
Costing £24,000 plus expenses plus VAT
Expenses £1,850 travel and hotels
Benefits
15% improvement against both efficiency and
effectiveness measures
3/17/2015 9WS RIE

10. Whole System Health Checks
• Rather than commissioning a full WS
RIE straight away some clients will
want a scoping intervention up front.
• We can offer an initial ‘Whole System
Health Check’.
• Health checks take an upfront
systemic overview of organisation.
• They review the organisational
health of the whole business and
identify priority areas and issues to
focus on through WS RIEs.
3/17/2015 WS RIE 10

11. A Typical
‘WS Health Check’ Profile & Costings
Scope Whole organisation employing 300 staff
Timescales 4 weeks
Resources 10 consultant days
Tricordant team 1 director and 1 senior consultant
Stakeholders 15 - 20 interviewees/focus groups
1 day workshop Senior management team only
Costing £10,000 plus expenses plus VAT
Expenses £950 travel and hotels
Outputs
• Whole system health check report.
• Priority issues /areas identified.
• Agreed plan for focused Whole Systems RIE(s). Cost
and target benefit defined.
3/17/2015 11WS RIE

12. Some of Tricordant’s
Clients
3/17/2015 12WS RIE

13. Training Services and
Facilities Management
Company
Rapidimprovement project lasting 6
weeks toreview the operations of 1500
staff across 4majormilitary
establishments,culminatinginan
intense 3day workshop
A more empowered whole work team
structure. Organisationalsavings over the
remaining life of the contract worth
£3,500.000.
Pharmaceuticals
Manufacturer
Restoredwhole systems balancefor700
staff across all organisational levels
Initial savings of £1million p.a. even before
efficiency, quality and service benefits
started to emerge.
Local Health Economy Working withthe local NHS primary
care trust,acute hospital andcouncil
social services to address ‘blockedbeds’
and delayedtransfers of care.
Integrationand streamlining of
processes across multiple partner
organisations .
Hospital official performance on delayed
transfers reduced from 4.8% to0.9% .
Blocked beds reduced by 90%.
Value of change worth est. £1million p.a.
Energy Utility Service
Centre
A whole systems organisationredesign
of their pre-pay energy retail services.
200 staff across 3locations.
Customer debt reductions achieved by the
new organisation of £6 million over6
months.
Major Government
Departmental Agency
10,000 people across 26regional sites.
Clarifiedpurpose for people and aligned
responsibilitywiththe means todeliver.
18 monthtransformational project.
£40 million savings p.a. identified.
Large Acute Hospital A strategic review of operating theatres
ledtothe implementationof
collaborative management processes
across surgery,anaesthetics and
theatres.
Immediate financial savings andefficiency
improvements of about £1.5mcould be
implemented sustainably.
3/17/2015 13WS RIE
Examples of
Whole System Benefits

14. 143/17/2015 WS RIE
What Does a Whole
Systems RIE Look and
Feel Like?........

15. The whole
system in the
room
3/17/2015 15WS RIE
Introductions &
getting going

16. 3/17/2015 WS RIE 16
Everyone
working together

17. Process No
Sponsorship Process IO / Alli RO NO Comm
Correspondence
/ Annum (FY10) IO / Alli RO NO Comm Total
Total
allocated cost
($)
1 Child Information, Enrolment
and CIF
10.25 0 24 97 121 116,709 1,196,267 0 2,801,016 11,320,773 15,318,056 1,384,547$
2 Welcome and Bonding Letter
1 0 10.75 134 144.75 66,534 66,534 0 715,241 8,915,556 9,697,331 876,509$
3 Sponsor letter to child and
small gift
0 0 17 75 92 252,647 0 0 4,294,999 18,948,525 23,243,524 2,100,903$
4 Child Progress Report
0.1 0 8.8 167 175.8 467,431 46,743 0 4,113,393 78,060,977 82,221,113 7,431,687$
5 Child Initiated Letter
0 0 10 43 53 379,911 0 0 3,799,110 16,336,173 20,135,283 1,819,960$
6 Child Spontanesous Letter
0 0 5 19 24 58,360 0 0 291,800 1,108,840 1,400,640 126,599$
7 DFCs - Monary Gifts and
Thank You Letters
5.5 0 7 42.25 49.25 557,557 3,066,564 0 3,902,899 23,556,783 30,526,246 2,759,164$
8 Spronsor Question Enquiry
and Response Letters
12.5 0 45 30 75 222,837 2,785,463 0 10,027,665 6,685,110 19,498,238 1,762,379$
9 Farewell Ltr
3 0 5 49 54 0 0 0 0 0 0 -$
Total Time Allocation (Std Mins) 7,161,570 0 29,946,122 164,932,737 202,040,430
FY10 Actual total sponsorship related costs (salaries and direct costs) $3,109,478 $3,934,153 $11,218,117 $18,261,748 $18,261,748
$ per std min $0.43 $0.13 $0.07
Allocation of Costs to Sponsorship Process (Based on Activity Based Cost Model)
Std Mins based on generic
level 2 charts Total Timings / Annum (Std Mins)
3/17/2015 17WS RIE
Feeding Back the
Numbers

18. The Tricord Organisational Model
Whole Work Team Attributes Whole Work Units
Work Cycle /
Flow Redesign
Tricord
Scoring
Organisational Build-up
Using the
Tricordant Toolsets
WS RIE 183/17/2015

19. Strategy
Systems Culture
Purpose
Aims
Plan
Strategy
Ethics
Values
Spirit
Language
Motivation
Ethos
Leadership
Evaluation
Team working
Process
Systems
Technology
People Structure
Roles
Measurement
Communication
Reason
History
Origin
Knowledge
Practices
Rituals
Identity
Strategy
Systems Culture
Strategy
Goals
Aims
Plan
Ethics
Values
Culture
Spirit
Language
Motivation
Ethos
Leadership
Evaluation
Teamworking
Systems
Processes
Technology
People Structure
Skills
Roles
Measurement
Communication
Reason
Core Purpose
Uniqueness
Unity
History
Identity
Strategy
Systems Culture
Strategy
Goals
Aims
Plan
Ethics
Values
Culture
Spirit
Language
Motivation
Ethos
Leadership
Evaluation
Teamworking
Systems
Processes
Technology
People Structure
Skills
Roles
Measurement
Communication
Reason
Core Purpose
Uniqueness
Unity
History
Identity
Strategy
· No clear strategy
· Changing patient demographic & lifestyles
resulting in increased demand for PCOS
service
· Aims to manage demand of orthopaedic
referrals to Secondary care; provide
orthopaedic assessment & management in
Primary care; triage GP referrals to
appropriate service or assess and treat if
possible by OPS/GPSI
· 18 week challenge
· Values: openness, equality, professionalism,
accessibility
· Guidelines & ethics: Healthcare commission
stds, GPSI guidelines, Chartered Society of
Physiotherapy Stds of Practice, Warrington
PCT policy
Identity
· To ensure appropriate referrals are sent to
the relevant service.
· Provide the best service for the patient
· PCOS is a relatively new development,
previously GP’s referred directly to various
care providers e.g. secondary care
· Highly skilled/specialised PCOS staff
· GPSI & OPS partnership
· Future demerger of CSU from PCT
Systems
· Lorenzo PAS used for booking patients –
some frustration as lost control of diary
· Letter/fax based referrals
· Lack of information on referrals at times
· No give in the system CPD is limited or
lacking
· Limited access to diagnostics (x-ray via
backdoor)
· Supervision system not working
· PCOS to deal with 60% or referrals to ensure
viability
· Demand exceeding capacity
· Minimal time to do admin
· PCOS clinics in the community but away from
Wolves building
· Communication across the pathway is poor
· GP’s playing the system to get their patients
seen quickly i.e. sending dual referrals
· Measurements: no. of referrals, outcomes of
paper triage, no. of assessments/Fups
undertaken, Appointment slots, current
capacity 60 appointments/wk
Culture
· Direction from senior management unclear
· Little or no communication with
commissioners or with other services in the
orthopaedics pathway
· Changing PCT demands, unsupported
managers & lack of communication =
frustrated managers
· Poor relations with commissioners & GP’s
· Relatively good clinical individual & team
motivation, while leadership team motivation
is lower
· Reactive management style due to changing
pct demands
· Believe a significant change is needed to
really improve the service
· Waiting list reduction initiatives are not
sustainable
· Audit info: waiting times, outcomes of paper
triage & assessment, record keeping, patient
questionnaires, evidence of cpd/portfolio,
clinical audit, staff appraisals, cancellations/
DNA’
3/17/2015 19WS RIE
Taking an Holistic
Perspective

20. 3/17/2015 WS RIE 20
Systems Thinking

21. 3/17/2015 21WS RIE
Mapping the
Wider System
Healthy or Self-
funding
Population
NHS Continuing
Health Care and
Funded Nursing
Care
Patients
Adult Social Care
Service Users
Children
Mental
Health
Patients
MAU
A&E
Acute Trust
Wards
Mental Health
Liason Team
Transfer
Service
Transition Beds
15 beds: Samford, Holmley,
Fir Trees
Shire Hill
Intermediate care
CARA
Intermediate Care
Stroke Unit
‘The Lakes’
Fast Track palliative
Care
Learning Disability
Service Users
Physical and Sensory
Disability Service
Users
Healthy or Self-
funding
Population
NHS Continuing
Health Care and
Funded Nursing
Care
Patients
Adult Social Care
Service Users
Children
Mental
Health
Patients
Learning Disability
Service Users
Physical and Sensory
Disability Service
Users
AACCTS
Age
Concern
Families and Carers
Feb2008
Community-
based health
care
Community-
based health
care
Out of Area
Hospitals
Transfer Service Whole System Map

22. 3/17/2015 WS RIE 22
Charting Processes

23. Phone call from
ward sister
Discuss patient
case
Section2
accepted
Redirect to other
services
Contact
assessment form
completed
Decision on
who is to
process case
Routing criterea
Record in referral
book
Pre-existing
patient with
social
services?
Retrieve case
file notes from
LA
Enter case onto
Swift system
No
Yes
Yes Courier
Intray for social
allocated social
worker
Daily duty
social worker
asigns
unallocated
work
Social worker
opens case to
themselves
(signs)
Separate forms
Enters
allocated social
worker and
date on Swift
yellow
Study contact
assessment
Gather information
· Ward notes?
· L.A. case notes
· Speak to patient
· Speak to carers/family
· Speak to ward staff
· Attend MDT
· Speak to tharapist
· Speak to specialist workers
· etc
Decide upon
care plan and
funding source
Screen for LA
eligibility criterea
LA funding
criterea
CHC assessment
if complex case
CHC Assessment
forms
Discuss with
manager
Discharge
planning meeting
Care planning
meeting
Write up care plan
and decisions
Record formal
’Care Plan’ doc
Family choose
of nursing
home Transitional bed
manager
assessment
Record outcome
and log
Ward sisters
prepare for
discharge
E.g. medicines
Agree
discharge date
Assistant team
manager for audit
Patient discharged
and transferred
· Social worker
· Patient
· Family/carer
· OT, etc
Is a bed
available?
Close case to social
worker and open to
new case owner on
Swift
Wait
busineess
support
Patient safe under
community care
Section 5 ??
3/17/2015 23WS RIE
Mapping the Detail
of Processes

24. “We do not think and talk
about what we see;
we see what we are able to
think and talk about”
(Ed Schein)
3/17/2015 24WS RIE
Understanding the
organisation

25. EXPERIENCES RESULTS
BELIEFS BEHAVIOURS
motivate achieve
drive
(Franklin Quest Corporation)
3/17/2015 25WS RIE
Exploring Thinking
Differently

26. 3/17/2015 26WS RIE
Facilitators playing
different roles

27. CY Adult Hub
Outreach CY
Outreach CY
Outreach CY
Outreach CY
Adult CASH clinics
CASH Central:
Complex procedures
GUM level 1&2
Gynae CATS with Ultrasound
IT, Central booking & admin
Staff base Supported outreach to
high risk groups:
Homeless, disabled,
Gay & lesbians,
Asylum seekers
Ethnic MinoritiesTraining & support to GP
practices, school nursing,
other services etc
Links with FT GUM service
& chlamydia screening
centre
Remodelled Staff &
skill mix with
enhanced skills incl
GUM level 1/2
Adult CASH clinics
Adult CASH clinics
Adult CASH clinics
3/17/2015 27WS RIE
Developing a vision

28. 3/17/2015 28WS RIE
Pitching and Voting

29. 3/17/2015 WS RIE 29
£ Savings Emerging

30. 3/17/2015 30WS RIE
Consultants
stepping back

31. Action Planning
3/17/2015 WS RIE 31
Service Support Project
Mile Stones
Key Mile Stones
Tasks Responsible Mobilisation
Task No. Dates week commencing % Complete
Apr-10
May-10
Jun-10
Jul-10
Aug-10
Sep-10
Oct-10
Nov-10
Dec-10
Jan-11
Feb-11
Mar-11
Apr-11
May-11
Jun-11
Jul-11
May-11
onward
1.00Project Management System 0
1.10Complete Training 0
1.20Pilot on HE Tracker 0
1.30Taylor Process 0
1.40Process Sign Off 0
1.50Process Launch 0
1.50Project Management System Review 0
1.00Quick Hits 0
1.10Request to SMT to resolve staff password change access 0 24
1.30Mac Engineer 2 days a week with Palatine based engineers 0 24
1.40Investigate models of PDA 0 24
1.50Maintenance of Loop PCs 0 24
1.50Quick Hits Review 0 28
2.00Restructure 0
2.10Organisation Design - Sign off 0
2.20Job Descriptions 0
2.30Formal Restructuring Process 0
2.50Allocate People into Teams 0
2.60Appoint Permanent Team Leader 0
2.70Launch Service Support Team 0
3.00Service Desk Systems and Software 0
3.10Purchase service desk software - Quick Hit 0 24
3.10Service Desk Project planning & Implementation 0
3.10Service desk Project Reviews 0
4.00Physical Layout and Estates 0
4.10Agree Locations and layout 0
4.20Detailed Design 0
4.30Business Case 0
4.40Sign Off 0
4.50Implementation 0
4.60Opening Ceremony 0
4.00Resource Planning 0
4.10Process Design 0
Process Implementation
4.20Process Review 0
5.00Communications Strategy & Implementation 0
5.10Develop Strategy & Plan 0
5.20Implement FAQ's 0
5.20Implement fuller plan 0
5.30CommunicationsReview 0
6.00Staff Training and Development 0
6.20Learning Resources Training 0
6.30Incident team Training - Customer Services 0 6/7
6.40Incident team Training - Technical Solutions 0
6.50Team leaders - Intensive Management Training/Coaching 0
6.60Review 0
4.00Change Management 0
4.10Announce Formal Restructure 0
4.20Consultantion 0
4.30Zero Agenda Meetings 0
4.40Team Meetings 0
0