The Model for Improvement

1. The Model for Improvement Introducing Process Mapping

2. Key Messages • Service User focus • ‘Look Up’ : Think Whole Systems • Focus on solutions : Be Positive • Establish your baseline (Process Maps) • Take small steps - test your ideas & solutions (PDSAs)

3. What is a process? • Definition : a process is a series of connected steps or actions to achieve an outcome • Scope: it has a first step and a last step • Patient processes cross organisational, departmental and professional boundaries • There are usually constraints and or bottlenecks • It can be mapped to different levels of detail

4. Patient processes cross many boundaries • 30 - 70% of work • doesn’t add value for patient • up to 50% of process steps involve a “handoff”, leading to error, duplication or delay • no one is accountable for the patient’s “end to end” experience • job roles tend to be narrow and fragmented organisational/departmental boundaries OUT PT INPT ADMIN Soc S CMHT GP process Out patient appointment process Diagnostic process Whole Patient Journey (ICP)

5. What is process redesign? • Fundamental rethinking of the way that services are delivered to patients • Focus on implementation • Something that is anxiety provoking • Techniques from many sources: • process redesign/re-engineering • theory of constraints • quality management • psychology of change

6. Key principles for redesign • Define and really understand the current service user process • Redesign the service user process • Understand the demand for treatment and care then match capacity to demand

7. Redesign- areas for action Eliminate: • Delays • Unnecessary steps/duplication • Hand offs • Steps that don’t add value • Bottlenecks • Complicated processes- with many unnecessary steps • 30-70% of the process doesn’t add any value to the service user

8. Pareto principle • Italian economist Vilfredo Pareto (1848-1923) • 20% of the causes, inputs or efforts lead to 80% of the results, outputs or rewards (80% of your work is often taken with 20% of the clients)

9. Tools for helping define patient groups • Runners • share common characteristics • high volume • fast throughput • highly predictable • “standardised” patient routes • up to 90% pre-scheduled • Specials • “customised” • lower volume • predictable • share some steps but require • extra steps • standardised patient routes • can be pre-scheduled • Strangers • low volume, unique requirements • unpredictable demand patterns • route unpredictable and complex • throughput time tends to be longer

10. The Model for Improvement Introducing PDSA

11. It is not rocket science! • Just think • Nursing Process • Basic Management Theory • Problem Solving Techniques

13. Why test before implementing a change? • increases belief that change will result in improvement - minimise resistance on implementation • gives time to tweak the change & iron out snags • ensure sensitivity to conditions in local environment • evaluate costs and knock on effects of change • a change is permanent - high expectation to see improvement • PDSA can stop pointless arguments

14. Test can fail - why? • not executed well • support processes inadequate • idea was wrong • not ‘focused’ enough • Collect data during the DO phase to help differentiate reasons so solutions can be found……….

15. Principles for measurement We need • to keep measurement simple • to seek usefulness, not perfection, in measurement • a balanced set of measures that reflect goals, and aims • Write down definitions of measures • measure small, representative samples • build measurement into daily work • create a measurement thinking team • Back em up with testimonies!

16. So remember, when embarking on redesign…. • You must know where you are now. • You must know where you want to get to. • You must decide on when you are getting there. • You must know when the goal has been reached. • You can think of the next goal to attain. • What are the consequences of doing nothing?

17. “The impact of being able to see how well the teams are doing with the improved process often provides incentive for further improvement.”