104/15/2023 WS RIE

August 2011

Whole Systems Rapid Improvement Events

04/15/2023 WS RIE 2

Unclear problems...Unknown solutions

04/15/2023 WS RIE 3

ComplexSimple

Isolated component issue

Inter-related systemic issues WSRIE

Organisation issue Change

required

The Territory for Whole Systems RIEs

• ‘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

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Key Features of WSRIEs

04/15/2023 WS RIE 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

Implementation plan support• Action plan

• Change planning

• Change coaching

• Document

• Review

Process Overview

04/15/2023 WS 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

04/15/2023 WS 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

1. Detailed Change Readiness audit 2. Leadership development – distributed leadership diagnostic3. Coaching for Change – for individuals and teams4. Project and Programme Management (PPM) – structure, templates and

training 5. Workforce Planning and Resource Management6. Detailed OD Support – team launch, detail team-level org design, job

design, whole system performance scorecard7. ‘Heart of the Leader’ Transformational Workshop (in collaboration with

Waverly Learning)

04/15/2023 8WS RIE

Post-RIE Implementation Support Available

04/15/2023 WS RIE 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

Benefits15% improvement against both efficiency and effectiveness measures

04/15/2023 WS 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.

04/15/2023 WS RIE 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.

04/15/2023 WS RIE 12

Some of Tricordant’s Clients

Training Services and Facilities Management Company

Rapid improvement project lasting 6 weeks to review the operations of 1500 staff across 4 major military establishments, culminating in an intense 3 day workshop

A more empowered whole work team structure. Organisational savings over the remaining life of the contract worth £3,500.000.

Pharmaceuticals Manufacturer

Restored whole systems balance for 700 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 with the local NHS primary care trust, acute hospital and council social services to address ‘blocked beds’ and delayed transfers of care. Integration and streamlining of processes across multiple partner organisations .

Hospital official performance on delayed transfers reduced from 4.8% to 0.9% .Blocked beds reduced by 90%.Value of change worth est. £1 million p.a.

Energy Utility Service Centre

A whole systems organisation redesign of their pre-pay energy retail services. 200 staff across 3 locations.

Customer debt reductions achieved by the new organisation of £6 million over 6 months.

Major Government Departmental Agency

10,000 people across 26 regional sites. Clarified purpose for people and aligned responsibility with the means to deliver.18 month transformational project.

£40 million savings p.a. identified.

Large Acute Hospital A strategic review of operating theatres led to the implementation of collaborative management processes across surgery, anaesthetics and theatres.

Immediate financial savings and efficiency improvements of about £1.5m could be implemented sustainably.

04/15/2023 13WS RIE

Examples of Whole System Benefits

1404/15/2023 WS RIE

What Does a Whole Systems RIE Look and Feel Like?........

The whole system in the

room

04/15/2023 15WS RIE

Introductions & getting going

04/15/2023 WS RIE 16

Everyone working together

Process No

Sponsorship Process IO / Alli RO NO CommCorrespondence / Annum (FY10) IO / Alli RO NO Comm Total

Total allocated cost

($)1 Child Information, Enrolment

and CIF10.25 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 Letter1 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 Report0.1 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 Letter0 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 Ltr3 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)

04/15/2023 17WS RIE

Feeding Back the Numbers

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 1804/15/2023

Strategy

Systems Culture

PurposeAimsPlan

StrategyEthicsValues

SpiritLanguage

MotivationEthos

LeadershipEvaluation

Team working

ProcessSystems

TechnologyPeople

StructureRoles

MeasurementCommunication

ReasonHistoryOrigin

KnowledgePractices

Rituals

Identity

Strategy

Systems Culture

StrategyGoalsAimsPlan

EthicsValues

CultureSpirit

LanguageMotivation

EthosLeadershipEvaluation

Teamworking

Systems ProcessesTechnology

People StructureSkillsRoles

MeasurementCommunication

ReasonCore PurposeUniqueness

Unity History

Identity

Strategy

Systems Culture

StrategyGoalsAimsPlan

EthicsValues

CultureSpirit

LanguageMotivation

EthosLeadershipEvaluation

Teamworking

Systems ProcessesTechnology

People StructureSkillsRoles

MeasurementCommunication

ReasonCore PurposeUniqueness

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’

04/15/2023 19WS RIE

Taking an Holistic Perspective

04/15/2023 WS RIE 20

Systems Thinking

04/15/2023 21WS RIE

Mapping the Wider System

Healthy or Self-funding

Population

NHS Continuing Health Care and Funded Nursing

CarePatients

Adult Social Care Service Users

Children

MentalHealth

Patients

MAU

A&E

Acute Trust Wards

Mental Health Liason Team

Transfer Service

Transition Beds15 beds: Samford, Holmley,

Fir Trees

Shire Hill Intermediate care

CARAIntermediate 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

CarePatients

Adult Social Care Service Users

Children

MentalHealth

Patients

Learning Disability Service Users

Physical and Sensory Disability Service

Users

AACCTS

Age Concern

Families and Carers

Feb 2008

Community-based health

care

Community-based health

care

Out of Area Hospitals

Transfer Service Whole System Map

04/15/2023 22WS RIE

Charting Processes

Phone call from ward sister

Discuss patient case

Section 2 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 ??

04/15/2023 23WS RIE

Mapping the Detail of Processes

“We do not think and talk about what we see;

we see what we are able to think and talk about”

(Ed Schein)

04/15/2023 24WS RIE

Understanding the organisation

EXPERIENCES RESULTS

BELIEFS BEHAVIOURS

motivate achieve

drive

(Franklin Quest Corporation)

04/15/2023 25WS RIE

Exploring Thinking Differently

04/15/2023 26WS RIE

Facilitators playing different roles

CY Adult Hub

Outreach CY

Outreach CY

Outreach CY

Outreach CY

Adult CASH clinics

CASH Central:Complex procedures

GUM level 1&2Gynae CATS with UltrasoundIT, 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

04/15/2023 27WS RIE

Developing a vision

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Pitching and Voting

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£ Savings Emerging

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Consultants stepping back

Action Planning

04/15/2023 WS RIE 31

 

Service Support Project

Mile Stones 

Key Mile Stones 

Tasks Responsible Mobilisation  

Task No. Dates week commencing % Complete   Apr-10May-

10Jun-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                                  5.30Communications Review 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