Initial Findings from Evaluation of Service Improvement Activity

1. Initial Findings from Evaluation of Service Improvement Activity Dr Zoe Radnor Giovanni Bucci AtoZ Business Consultancy

2. Overview • Independent evaluation assessing improvement activities that have taken place over the past 2 years. • Evaluate the impact of the activities and the readiness of the Trust to implement further improvement. • Evaluating the approach of what has been done, the process by which it has been implemented, its impact and factors which can support sustainability of improvement activity in the longer term.

3. Methods • Focused on Service Improvement Activities • Site visits over 4 weeks in January 2008 • Interviewed 18 people including clinicians, managers, nurses and, support staff • Carried out 8 Focus Groups • Site Tours of both Royal Shrewsbury and Princess Royal Hospitals • Some Trust Documents

4. Initial Findings: Perceptions and Understanding • Drivers for improvement have been turnaround and current aim to achieve Foundation Trust status • Main focus of the activity has been theatre stores, RIEs, Productive Ward • Number of Service Improvement projects have been consolidated in to 4 areas plus 18 RTT • Good understanding of the definition of Lean • “Getting rid of waste, organising and prioritising things, being efficient” • “Lean is an improvement methodology. It includes process redesign, value stream mapping, removal of waste, patient journey, continual improvement and 5S”

5. Initial Findings: Impact • Reduced level of stock/ inventory • Audits introduced • Improved service for the patient • Better discharge process • Better preparation for surgical procedures • More direct time to care for patients (productive ward) • Tidying up areas: cleanliness (5S’s) • Staff felt enthused, motivated and empowered to implement changes initially • “It is now a better place to work….There was a buzz around the ward” • “Events had a real application to day to day work of staff and inspired staff immediately after the events. However, they were not followed up on and, this motivation has since disappeared.” • Given an insight to the need to better understand the roles and relationship with other departments

6. Initial Findings: Organisational Readiness • Process mainly seen as the department/ward process not as end-to-end process • Feeling that culture moving from fire fighting to more cause and effect analysis, starting to move from financial focus to the patient • Customers often seen as the commissioners (i.e. PCT). • Patient requirement not been fully defined – ‘how are we doing rather than how do we improve’ • Recognition that it is important to understand demand and need to match with capacity but information still needed to achieve this. • SPS/ Control charts started to be introduced in some areas.

7. Initial Findings: Goods • Lots of improvement activities • Good understanding and support from Senior Management team (Board level) of the need to take Lean approach • Recognition that it is important to engage all levels of staff” • “Evolution not revolution” • “Doing with not done to” • Greater awareness and understanding of the need for efficiency • Division 1 – Lean, Division 2 – Productive Ward, Division 3 – TOC/Lean/EFQM • Seeing the change happen in real time (Productive Ward/5 S’s) • Team Briefs have been a useful to communicate service improvement activities. • Good levelof impact where there have been champions

8. Initial Findings: Issues • Uncertainty whether changes will be sustained • Not all the actions agreed at the RIE have been completed • Not all clinicians have engaged with improvement • More successful projects have clinical buy-in • Big picture not considered - the improvement activity is in pockets within the Divisions and departments • Lack of Learning opportunities • Fragmented, and even diverse activities • Each Division taking own approach • Impact/ Outcomes of Service Improvement often not known outside of the departments/ wards • Communication could be more effective all levels

9. Reflections: Areas for Improvement • Communication • Engage staff in the communication process (e.g. Ward 26) • Promote success stories • Develop a Service Improvement Strategy that is linked with overall Strategy -i.e. what do you want to achieve through the improvement activity? • Consolidate and co-ordinate the various activities across the Divisions • Develop an Improvement framework using sets of tools within it. • Leadership support and challenging • Need to give visual support of the activities – go and see • Develop a network of leaders/champions throughout the organisation • Sustainability • Need to embed an improvement culture • RIE themselves produced good outcomes but little learning or motivation is carried forward except by a few individuals • Find new ways to engage with the patients • Productive Ward is part not all of the journey

10. Are you on the right journey? • Should we be on an Improvement Journey? • Yes – the impact and the extent of the outcomes indicate that improvements have taken place for the staff and patients. • Are we on the right journey? • Yes but… need to take a whole systems view, create quality focused stable processes and embed an improvement culture through developing visible committed leaders, having clear communication at all levels in the organisation and organisational readiness • Still along way to go…. • It takes an average of 7 years to implement Lean in manufacturing organisations

11. Initial Recommendations for Continued Service Improvement • Create a Service Improvement Strategy/ Framework • Understand customer and patient requirements – manage those expectations • Create process to capture and use demand information • Map the end-to-end processes (clinical and support) • Develop local champions (at all levels) • Develop Communications Strategy