Highland Quality Approach

Quality in Action

Gavin Hookway

Senior Quality Improvement Practitioner (Lean)

NHS Highland

Putting quality first to deliver Better health, Better care and Better value

Captures the spirit of how NHS Highland is working to improve care and outcomes for people…and describes the way we want to

“do things here in NHS Highland”

The Highland Quality Approach

OUR Strategic Framework

Quality & Efficiency Framework

Eliminate WASTE

Manage VARIATION

Eliminate HARM

Person Centered

QUALITY

We relentlessly pursue the highest quality outcomes of care

Method Focus Culture

Virginia Mason Production System (VMPS)

Patient is always first

Focus on highest quality & safety

Engage all employees

Strive for highest satisfaction levels

Maintain a successful economic enterprise

Based on Toyota Production System (TPS) methodologies (Lean)

Method Focus Culture

Cancer

Patient Flow

Patient Management System

Method Focus Culture

LEAN, SPSP, Productive series

Tool kit, evidence based

Remove waste + add value for all our patients

Apply training with rigor & consistency

Define

Sustain

Improve

Analyse

Measure

SPSP

LEAN

Not addressed

Qu

alit

y Im

pro

vem

en

t

Create bundles

through

observation and

rigour

Run charts

PDSA

Kaizen RPIW PDSA

Productive Series

PDSA

Standardised

tools & solutions.

Some bundles set

Bundles

set and given

Not addressed

LEAN allows practitioners to spend more of their time caring for

people and improves the quality of care these people receive

15 RPIW’s completed

50 RPIW’s planned for 2014-2015

9 Certified Lean Leaders - Qualified

20 Certified Lean Leaders in training

6 Certified Lean Leader Coaches in training

Over 1200 staff trained to Basic Awareness Level

Quality in Action

Mid Argyll

Community Mental Health

RPIW – 5th August 2013

RPIW Project Form

Event Name: Mid Argyll & Bute Community Mental Health Date: 5th August 2013

Sponsor: Deborah Jones Board Strategic Goals (linked to this process)

Provide quality care all times Support people and communities to maximize their own health Develop precision driven services so that when people need our care they experience; timely,

focused, effective services, that minimize the duration and frequency of contact; Ensure that every health pound spent delivers maximum health gain Specifically to develop a mental health service which aspires amongst many core principles to

deliver care predominantly provided in the individuals community or own home and where hospital admission will be for the few.

Current Situation:

Small team comprising a core of 5 members supported by other specialists looking after clients from the geographic area of Mid Argyll.

There is variation of referrals into the service There is variation in the methods used to process referrals once received in to the service Case load triage on referral through single point – 1

st and 2

nd stage triage are manual process

Patients allocated in accordance with need, priority, specialty and available capacity (gender preference also a consideration).

Total case load across 5 core members, as at 12 June 2013, 131, of which 109 active and 23 on waiting list. There is variation in capacity of specialist team members to accommodate MA referrals.

Patients placed on waiting list are not offered an appointment until relevant team member’s discharge from existing case load if at capacity. There is variation in waiting time for first appointment.

Workshop Leader: Gavin Hookway / Derek Leslie

Team Leader: Derek Leslie / Gavin Hookway

Process Owner: Douglas Philand

Team Members Advisory Group

Ros Box Nicola Gillespie Geraldine Hannan John Lawson Amanda Adams-McGilp Valda Parnaby Fiona McClean Moira Harrison Tina Jordan (tbc) Social Worker (tbc) Fiona Margach Sheena Clark Kristin Gillies

John Dreghorn David Logue Fiona Coffield Fiona Broderick Consultant Psychiatrist (tba) Cameron Stark Linda Kirkland GP (tba) Glen Heritage (AVA)

Production Requirements/Takt Time Calculation 782 minutes

Process Flow: RPIW Theme/Overview

Community Mental Health Service – Mid Argyll. Effective triage and case lists management to minimise number of clients waiting for first appointment and to ensure any related waiting time targets are met.

RPIW Targets/Boundaries

Start point on receipt of referral to department.

End point is patient discharge or onward referral.

Impact of workload management on team capacity. RPIW Measures Reduce numbers on the waiting list – reduce from 23 to 0 (zero) Reduce waiting time for patient from referral to first appointment – max 12 week wait

Ensure demand is in balance with available capacity. Improve quality of care given to all patients.

Revision: Version 3 – 24/07/2013

Receipt of Referral

1st Stage

Triage

2nd

Stage Triage referral

Outcome of 2

nd Stage

Triage

1st

AppointmentBooked

1st

AppointmentAttended

Patient Discharged from Service

Target Progress Report

Team Name: Community Mental Health Team Date: 24 July 2013

Department: Mid Argyll TAKT Time: (include calculation)112500mins /144 patients = 782 minutes

Product/Process Summary: From Receipt of Referral to point that Patient is given first appointment

Team Leader: Derek Leslie Sub-Team Leader:

Workshop Leader:Gavin Hookway Process Owner: Douglas Philand

KPO Coach (if applicable): Keith Appleby

Metric (units of measurement) Baseline Target

Day 2 Day 3 Day 4 Final 30 days mm/dd/yy

60 days mm/dd/yy

90 days mm/dd/yy

12 months mm/dd/yy

% Change

Space (square feet)

Inventory (£s)

Staff Walking Distance (feet) Travel

Parts Travel Distance (Minutes) 14 (>= 50%)

Lead Time (Weeks) 52 (>= 50%)

Work in Process (WIP) (units observed in the

process) 132

Standard Work In Process (SWIP) (lead

time/takt time); target SWIP should be target lead time/takt time

149 72

Quality (defects)(%) Referrals via SCI 97% 100%

Productivity Gain (FTEs – see target metric

definitions for formula to calculate baseline)

Environmental, Health & Safety (5S) (levels 1

thru 5) – specify for physical space or virtual space 1 Level 4

Set-up Reduction (minutes)

Remarks:

128,526 (53 Weeks)

40,961 (17 Weeks)

34

Standard Process Description: NAME referral receipt to offer of appointment

Quality Check Safety Precaution Standard WIP

Notes:- Add notes about related policies or any acceptable exceptions in sequence of steps

Who Must Adopt This Process: team leader or deputy and administration

Takt Time:

GOAL: List key quality and lean targets

STEP Add

Quality, Safety or

WIP symbols

as needed

OPERATOR List role

responsible for each task

TASK DESCRIPTION

TOOLS/SUPPLIES REQUIRED

Fill in as needed to explain use of a specific tool or

supply Add photos if valuable to provide clear instructions

CYCLE TIME Amt of

processing time to

complete each step

1. Admin

Retrieve twice daily log into SCI using login process checking the referral received

Computer with access to both SCI and Helix

2.

Admin

Copy the SCI referral into helix “this will need to be confirmed by information” this will result in the referral being activated on Helix Copy and email referral to team manager or deputy

As above and outlook access for email to manager or deputy

3.

Team manager

Team manager will need to open referral received from administrator using the 1-2 triage 3-4 triage tools complete the referral triage process Email confirmation of completed triage back to team administration for 2-3-4 And to Fiona Margach for level 1

Computer and outlook Triage tools level 1-2 Triage tools level 3-4 “need laminated copies of the triage tool for staff completing action remotely”

4.

Admin

Access team outlook diaries and for 3-4 client check available assessment appointments

Computer Clinician diary appointments

5. admin Completion of referral letter re client appointment:-

Level 2 letter is an opt in letter completed

Template letters 2-3-4

Standard Process Description

NAME referral receipt to offer of appointment

Standard Process Description:

Diary Management

Quality Check Safety Precaution Standard WIP

Notes:

Who Must Adopt This Process: All team members

Takt Time:

GOAL: List key quality and lean targets STEP

OPER-ATOR

TASK DESCRIPTION

TOOLS/SUPPLIES REQUIRED

CYCLE TIME

1. All Each team member should give full access to their diary to other members of the team by:-

In Outlook Calendar click on share my calendar

In dialogue box click add, select the team member from the drop down list, change the permission level to editor, check that create items, read items, edit items All and delete items All are ticked

Continue until all members of the team have been selected

2. All Any appointment that has personal identifiable information should be marked as ‘Private’ to conform to Information Governance requirements, any appointment marked as private can only be read, opened or changed by the owner. To mark an appointment as private, select the appointment, right click with the mouse and select private, a picture of a key will be displayed in the diary entry.

3.

All All appointments including planning time for events should be booked in the Outlook calendar as soon as they are received using the following colours:-

None Annual leave/flexi assessment

Standard Process Description

Diary Management

Mid Argyll CMHT SBAR/B

S

SITUATION This is ________________________________

Calling from ____________________________

Regarding patient ________________________

I am bringing this person to the meeting because:

B BACKGROUND Is ____ year old Male / Female Referred by _________________ for ___________________________ History of service(s) involvement / Other professionals involved: PHQ9 _________________________________

CORE / Risk Scores _______________________

Their Goals ______________________________

Symptoms (brief) Impact on Life:

A ASSESSMENT Key Issues are:

R RECOMMENDATION My question to the team is:

D Decision (Team) Who: By When:

5S

Standard Process Description: NAME communication cell management

Quality Check Safety Precaution Standard WIP

Notes:- Add notes about related policies or any acceptable exceptions in sequence of steps

Who Must Adopt This Process: team manager and team members

Takt Time: 5 min daily

GOAL: List key quality and lean targets

STEP Add

Quality, Safety or

WIP symbols

as needed

OPERATOR List role

responsible for each task

TASK DESCRIPTION

TOOLS/SUPPLIES REQUIRED

Fill in as needed to explain use of a specific tool or

supply Add photos if valuable to provide clear instructions

CYCLE TIME Amt of

processing time to

complete each step

1. Team manager and team members

Agree the key issues for discussion at the communication cell – daily briefing NB: may want to consider the following:-

Number referrals received previous 24hour period

Number referrals allocated for assessment previous 24 hour period

Case load management white board VCB

Waiting list position treatment

Team Value stream map Target progress sheet

pre 30, 60, 90day PDSA re-measures and target metrics

NB this is the element of how are we doing

Referral information Assessment information Case management Waiting list information Computer Helix information SCY information

2.

Team manager and team admin

Update the referral received previous 24 hours and referrals allocated for assessment (metric update) Check progress against RPIW target metrics Check clinical staff have updated to case load information

Visual control board Project form Future state VSM Target progress report sheet

3.

Team

Walk the wall “brief staff attending the 9am meeting” NB

Speaker phone for staff phoning or webex

Standard Process Description

NAME Communication Cell Management

Target Progress Report

Team Name: Community Mental Health Team Date: 24 July 2013

Department: Mid Argyll TAKT Time: (include calculation)112500mins /144 patients = 782 minutes

Product/Process Summary: From Receipt of Referral to point that Patient is given first appointment

Team Leader: Derek Leslie Sub-Team Leader:

Workshop Leader:Gavin Hookway Process Owner: Douglas Philand

KPO Coach (if applicable): Keith Appleby

Metric (units of measurement) Baseline Target

Day 2 Day 3 Day 4 Final 30 days mm/dd/yy

60 days mm/dd/yy

90 days mm/dd/yy

12 months mm/dd/yy

% Change

Space (square feet)

Inventory (£s)

Staff Walking Distance (feet) Travel

Parts Travel Distance (Minutes) 14 (>= 50%) 14 14 0%

Lead Time (Weeks) Lead Ref to Discharge

Lead Time (Weeks) Ref to Allocation of First Appt

52 34

(>= 50%) 22 11mins

22 9mins

+58% +1102%

Work in Process (WIP) (units observed in the

process) 132 146 146 -9%

Standard Work In Process (SWIP) (lead

time/takt time); target SWIP should be target lead time/takt time

149 72 67 67 +65%

Quality (defects)(%) Referrals via SCI 97% 100%

Productivity Gain (FTEs – see target metric

definitions for formula to calculate baseline)

Environmental, Health & Safety (5S) (levels 1

thru 5) – specify for physical space or virtual space 1 Level 4 1 2 +25%

Set-up Reduction (minutes)

Remarks:

30 Day Report Out

60 Day Report Out

90 Day Report Out

365 Day Report Out

Thankyou Any Questions?