Transformation and Toyota

1. Transformation and Toyota Tom Downes MB BS, MRCP, MBA, MPH (Harvard) Sheffield Teaching Hospitals The Health Foundation IHI QI Fellow 31st May 2012

3. General Aim The Cumberland Initiative aims to transform the quality and cost of NHS care delivery through simulation, modelling and systems thinking.

4. Specific Aim A stretching target is our 20:20 Vision. We aim to deliver an extra million quality adjusted life years (QALYs) from the current £100 billion spent annually on the NHS (an extra £20 billion of value from existing expenditure at £20,000/QALY). Additionally, we would hope to save 20 per cent of the current annual NHS budget: £20 billion.

5. A patient story Painful hand Discharge Surgery IV antibiotics Oral antibiotics

6. A patient story Workaround admission Wound redressed Antibiotics late Painful hand Discharge Surgery 3 hours to access IV antibiotics Wound examined Antibiotics late Oral antibiotics

7. A patient story Workaround admission Staph / Strep mop Wound redressed Second operation Antibiotics late Painful hand Discharge Surgery 3 hours to access IV antibiotics Wound examined Antibiotics late Calls unanswered Oral antibiotics

8. A patient story Workaround admission Staph / Strep mop Wound redressed Second operation Antibiotics late No antibiotics Painful hand Discharge Surgery 3 hours to access IV antibiotics Wound examined Antibiotics late Calls unanswered Oral antibiotics No anitbiotics

9. Within 2 weeks two adults died of identical strain of streptococcal infection

10. Successful outcome: due to fantastic individuals despite the system If ‘ideal’ systematic had been care delivered: Would patient satisfaction have been higher? Would length of stay have been shorter? Would second operation have been necessary? Were the two deaths avoidable?

14. PDSA tests of moving from ‘post take’ to ‘on take’

17. ‘Improvement in health care is 20% technical and 80% human’ Marjorie Godfrey The Dartmouth Institute

18. Tom.Downes@sth.nhs.uk@sheffielddoc