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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
04/15/2023 4WS RIE
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
04/15/2023 28WS RIE
Pitching and Voting
04/15/2023 WS RIE 29
£ Savings Emerging
04/15/2023 30WS RIE
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