Using Quality Improvement Tools to Deliver Better Health care Quality improvement tools like Lean principles aim to continuously improve healthcare quality by engaging all stakeholders to eliminate waste. Lean was introduced to healthcare in the 1990s from other industries and focuses on optimizing value streams to reduce errors, waiting times, and unnecessary processes. The NHS has implemented Lean thinking through tools like 5S, value stream mapping, and by developing lean leaders. While challenges remain around evidence, metrics, and resistance to change, Lean implementation in hospitals like Royal Bolton has significantly reduced waste, space needs and processing times, showing potential for improving healthcare delivery when fully adopted.

1. Using Quality Improvement Tools to Deliver Better Health carePU 5004 - Group 6 Presentation

2. MembersArnabComfort MichaelSantoshStella Victor Vishal

3. ContentIntroductionHistoryTriggersDimensionsPrinciplesStakeholdersProgress Challenges, Critique, Conclusion

4. 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, ANDLEAN PRINCIPLES

5. HistoryConceived 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)

6. TriggerInternal Increased incidence of hospital acquired infection and avoidable injuriesConstraint in hospital capacity and spaceExcess pressure on the staff leading to low moraleIncreasing waiting list and queues

7. TriggerExternalPolitical and public concerns

8. Economic- huge financial deficit incurred by NHS

9. Sociological

10. LegalWhy LEAN Management

11. What is Lean?It is creating a culture of value and eliminating waste in order to maximize quality of service.

12. 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)

13. The 5 Lean principles - Value

14. - Value Stream

15. - Flow

16. - Pull

17. - PerfectionLean thinking categories of waste and health care examplesCorrection (defects): Adverse drug reactions Readmission because of inappropriate dischargeWaiting: Waiting for doctors to discharge patientsWaiting for test resultsTransportation: Central equipment stores rather than ward based stores for commonly used items

18. Lean thinking categories of waste and health care examplesOver processing:Asking patients for the same informationseveral timesInventory:Waiting listsExcess stock in stockroomsMotion: Unnecessary staff movement to obtaininformation or suppliesOverproduction Requesting unnecessary laboratory testsKeeping beds or slots free ‘just in case’(Adapted from NHS Institute for Innovation and Improvement: Going lean in the NHS (2007)

19. The Hierarchy of improvementEliminate the non-value adding activityReduce the size of non value adding activity.Combine it with another values adding activity.

20. Key lean management tools The 5SSort – Remove Waste. Set– Set what remains in order. 1-2-3-4-5Shine– Keep a clean environment that allows process flow.Standardise- Maintain good activity standards for teams and managers.Sustain – Audit and improve the quality attained.

21. NHS LEAN Implementation PrincipleThe NHS has come up with 6 principles that should guide the lean thinking implementationPhilosophy 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 mappingGet 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.

22. Value stream MappingThe following are the steps involved in mapping out values streams in an organisation so that lean principles can be appliedMap the process

23. Involve those who are involved in the process Ask why the queues and delay happens

24. Look to where demand is coming from and smooth it in to the process

25. Sustain value streams Analysis of Organisational changeWhat 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.

26. 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.

27. LEAN as a tool for organisational change It is cultural change, with a view for total quality management.

28. It is slow pace but its gains appears soon

29. Incremental and transformational

30. 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.

31. It is an intentional tool employed by change driversLean 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 modelIt is a leadership process that engages the bottom-up approach.

33. Progress of ChangeQI tools are being appliedin the healthcare industry in otherparts of the developed worldBolton 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

34. Progress of ChangeThe 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)

35. Sample collection after LEAN BEFORE AFTER

36. Stocks and Supplies Before LEAN After LEAN

37. Pharmacy after LEAN

38. Stakeholders

39. Progress of ChangeThe NHS confederation/LEAN Enterprise Academy LEAN Healthcare Academy NHS Institute for Innovation and Improvement Lean Simulation SuitcaseNHS Lean Implementation handbook draftLean thinking plus Six Sigma.

40. ChallengesSome challenges facing Lean have been identified (Young and Maclean 2009 )These areEvidenceValueMetricsResistance

41. 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

42. LEAN IS NOT...LEAN is not Mean LEAN is not Cost cutting LEAN is not restructuring

43. Thank You !