making kings first choice for patients and staff a programmatic approach to transformation david j...

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 Enterprise2nd 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 objectives1. Improve on the already

excellent quality of care2. 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 targets1. Reduce ALOS2. Comply with 18 weeks3. Increase patient

satisfaction4. Build team of 80

Change Agents5. 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 LiverCH TBC


Contents







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

HospitalManufacturing 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 minsNo. of GPs :

600No. 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 timeLead time

For 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


600No. 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


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



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





121275 10 10 1500 90130

3150 F/U

Value Steam MapExhibit 10


GP Referral


600No. 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


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



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





121275 10 10 1500 90130

3150 F/U

Value Steam Map

Exhibit 2

TODAY

POP Action PLan

FIRST CHOICE – OVERVIEW OF PROJECT PROGRESS – 05 Jun 2006 red yellow green

Status vs. plan

Status vs. outputs

Phase 3 – CC&s Women’s & Children

Sustained implementationEyes o’pts

Pain & Urol

Academy developmentChange Agents

Phase 2

ImplementationRevised solution

Initial solution

Analysis

Mar AprFeb

2006

May Jun Jul Aug Sept Oct

HPB & Vas

Implementation of Marketing Pan

Phase 2 – L&R Dental Spec Med

Ph 1

LOS & W/E discharges

Change Agents

Phase 1

General medicine

Critical care & surgery



Performance management

Children’s services

Project

Preparation & Strategy

Jan

Project Method

Exhibit 11

LOS % < 4 hours

80

82

84

86

88

90

92

94

96

98

100

01-

Apr

-04

14-

Apr

-04

27-

Apr

-04

10-

May

-04

23-

May

-04

05-

Jun

-04

18-

Jun

-04

01-

Jul-

04

14-

Jul-

04

27-

Jul-

04

09-

Aug

-04

22-

Aug

-04

04-

Sep

-04

17-

Sep

-04

30-

Sep

-04

13-

Oct-

04

26-

Oct-

04

08-

Nov

-04

21-

Nov

-04

04-

Dec

-04

17-

Dec

-04

30-

Dec

-04

date

=mea n

Nicola Le e te

97 9897 9797

SPC FOR ATTENDANCES LENGTH OF STAY UNDER 4 HOURS IN A&E Process KPIs

Exhibit 2

TODAY

POP Action PLan


Status vs. plan

Status vs. outputs



Pain & Urol


Phase 2


Initial solution

Analysis

Mar AprFeb

2006


HPB & Vas



Ph 1


Change Agents

Phase 1

General medicine






Project


Jan

Project MethodExhibit 2

TODAY

POP Action PLan


Status vs. plan

Status vs. outputs



Pain & Urol


Phase 2


Initial solution

Analysis

Mar AprFeb

2006


HPB & Vas



Ph 1


Change Agents

Phase 1

General medicine






Project


Jan

Project Method

Exhibit 11

LOS % < 4 hours

80

82

84

86

88

90

92

94

96

98

100

01-

Apr

-04

14-

Apr

-04

27-

Apr

-04

10-

May

-04

23-

May

-04

05-

Jun

-04

18-

Jun

-04

01-

Jul-

04

14-

Jul-

04

27-

Jul-

04

09-

Aug

-04

22-

Aug

-04

04-

Sep

-04

17-

Sep

-04

30-

Sep

-04

13-

Oct-

04

26-

Oct-

04

08-

Nov

-04

21-

Nov

-04

04-

Dec

-04

17-

Dec

-04

30-

Dec

-04

date

=mea n

Nicola Le e te

97 9897 9797


Exhibit 11

LOS % < 4 hours

80

82

84

86

88

90

92

94

96

98

100

01-

Apr

-04

14-

Apr

-04

27-

Apr

-04

10-

May

-04

23-

May

-04

05-

Jun

-04

18-

Jun

-04

01-

Jul-

04

14-

Jul-

04

27-

Jul-

04

09-

Aug

-04

22-

Aug

-04

04-

Sep

-04

17-

Sep

-04

30-

Sep

-04

13-

Oct-

04

26-

Oct-

04

08-

Nov

-04

21-

Nov

-04

04-

Dec

-04

17-

Dec

-04

30-

Dec

-04

date

=mea n

Nicola Le e te

97 9897 9797


Working

Draft -

Last Mod

ified 7/28/2005 12:32:35 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 andI want to do it “

Understanding

and commitment

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

Working

Draft -

Last Mod

ified 7/28/2005 12:32:35 A

M



Capability building






Understanding

and commitment

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

Working

Draft -

Last Mod

ified 7/28/2005 12:32:35 A

M



Capability building






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

dified

08/0

9/20

05 1

4:0

4:25

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

ost

icC

ath

. la

bS

urg

ery

Wa

rds


Wo

rking

Dra

ft -La

st Mo

dified

08/0

9/20

05 1

4:0

4:25


Developing Scorecards and KPIs . . .

Trust/ Hospital

Care Groups/ speciality

Team

Ca

rdia

c

Ge

ne

ral M

ed

icin

e

Dia

gn

ost

icC

ath

. la

bS

urg

ery

Wa

rds

Visual QPFS ScorecardVisual QPFS Scorecard


Wo

rking

Dra

ft -L

ast M

od

ified

08

/09

/20

05 1

4:04

: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


Wo

rking

Dra

ft -L

ast M

od

ified

08

/09

/20

05 1

4:04

: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


Wo

rking

Dra

ft -La

st 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

rking

Dra

ft -La

st 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 itstarget 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

Le

ve

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

Exp

lici

t ca

pab

ilit

y-b

uil

din

g

and

tra

ckin

g p

roce

sses

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 ConsultantLead

ConsultantLead ConsultantLead

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)

MatronMatron

Matron

Administrative Manager

Outpatient Admin MgrLead

Consultant

Lead Consultant

Bowley Close

Head of Physiotherapy

Outpatient Serv Dev Mgr

Bed Capacity Manager

HRManager*

Finance Manager*

Business Manager

Recruitment Coordinator

Junior Drs Hrs Coordinator

AssistantBusiness 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 SolutionsResults

• 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


600No. 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


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




For longest stream

= 7251 min = 7%202.8 days

121275 10 10 1500 90130

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 BoardsMulti-

Disciplinary Meetings

TTAs, Pre-Packs & POD drugs control

Prepare for next days Discharges

Tracking of KPIsProcess Confirmation

Daily briefs


5S – Workplace Organisation

Ward Rounds

Surgery

9

42

51

79

Target = 80%

9

42

51

79

Target = 80%

P Patient Experience

F Financial &

Operational Efficiency

S Staff Development

A4

QQuality of Care

…………. WARD OWNER :

A4

How Are We Doing ?

Work Stream KPI

A4

Work Stream KPI

Work Stream KPI

A4

Work Stream KPI

Work Stream KPI

45

6

7

8

9

10

1112

131415161718

1920

21

22

23

24

25

2627

31 1 23

2829 30

Q U A L IT Y O F C A R E

W a r d : ___________

M o n th : ________

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

P A T IE N T E X P E R IE N C E

W a r d : ___________

M o n th : ________

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

. of P

atie

nts

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

3% Bed Usage due to Discharge Delays against previous 8%

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

No

. of

bed

Day

s L

ost

/ W

eek

/ War

d

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

0

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Bed

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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

34

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







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

FlexibleMotivatedMembers

Standardisation

Maintenance of Standards

Continuous Improvement

Ju

st In

Tim

e

Goals

Outcomes

Au

ton

om

atio

n

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

FlexibleMotivatedMembers

Standardisation

Maintenance of Standards

Continuous Improvement

Ju

st In

Tim

e

Goals

Outcomes

Au

ton

om

atio

nWhat else do we need to do to become a truly

Lean hospital?

making kings first choice for patients and staff a programmatic approach to transformation david j...

Documents

prob kings

choice programme

choice kings programme

care improvement capability

prob contents

patients primary care

prob shadow

step change