CAPA is Lean… Steve Kingsbury & Ann York

1. CAPA is Lean…Steve Kingsbury & Ann York

2. CAPA is Lean p198-199 Toyota mantra: ‘People + Brilliant processes = Amazing results’ Always: • Add value • Smooth flow • Pull not push Make decisions slowly, implement quickly Relentless reflection Go see for yourself

3. Add value Only 5% of NHS activity adds value!! What % in NZ? Cut waste (TIM WOOD) • Transportation-e.g have notes ready • Inventory- only have what is needed • Motion- reduce travel • Waiting-reduce and make active • Overproduction-not too many appts • Over-processing-not too many things • Defects correction- do it right first time

4. Smooth flow p 174-177 • Analyse bottlenecks • Full booking • Daily referral screening • Reduce number of queues with Core work • Segment similar needs together • Plan time for admin • Give families things to do until next step HELPFUL Habit

5. Pull don’t push • Increase pull- draw resources to the user • Flex capacity • Use full booking systems in Choice and Partnership • Specific work added, not another waiting list • Reduce push systems: • fixed appointments- urgent ‘slots’ • Avoid waiting lists

6. Toyota Production System Goal: highest value to customer, as fast as possible Continuous Improvement Product Development: 14 Principles Respect for People Foundation: Management applies and teaches lean thinking

7. Pillar 1: Respect for people • Don't trouble your customer • Includes the person after you in the production chain • Develop people then build products • Managers “Walk the talk” • They are lean themselves; eliminate waste etc • Develop teams • Team work not group work • Teams and individuals evolve their own practices and improvements

8. Pillar 2: Continuous improvement • Go see (gengi genbutsu) • Solve at the source not behind desks • Kaizen • “My work is to do my work and to improve my work” • Local experimentation • Continuous improvement • Value and waste • Perfection Challenge • Work towards flow

9. 14 principles • Some highlights.. • Use pull systems • Stop and fix problems (this means attend to issues now to save time later • Visual tools (e.g. not just printed schedule information but how to bring the processes and info to life in a visual way) • Decide slowly by consensus, implement quickly • Time boxing • Setting small and near time limits to avoid outcome delay

10. Lean Thinking • Is a set of tools and ideas that simplify the Toyota Production system • Largely miss out the first pillar of Respect for People • Effective none the less

11. Lean Principles • Specify Value: every step must add value • Would the customer pay for it? • (don't forget the customer is also your colleague after you!) • Identify the Value stream • I.e. what acts add value? • Make the Process flow • Create Pull systems • Pursue Perfection

12. Waste • Transportation • Inventory (large stock) • Motion (having to move to complete tasks) • Waiting • Over-processing • Overproduction • Defect Correction

13. Waste exercise (20 mins) • Separate in small groups of 4-5. • For each type think about your service • See if you can find waste of this type • Meet and discuss the identified wastes Longer exercise... • As a group pick some of the wastes • Go back into the small groups to think of possible solutions • Meet up again to plan!!

14. Push vs pull systems • Push • Timing of items flowing through system is based on high level commands or schedules • “Up-stream” or “Top down” commands • Or number of things provided is based upon planning • CAMHS examples? ... Fixed number new patient appointments • Pull • Capacity provided or movement of items in a system based on “down-stream” requests • Services or products are pulled to the customer by their demand • CAMHS examples? • Stock / inventory control examples • Kanban cards in TPS • Visual cards that signal a need for restocking (a pull request)

15. Exercise: is CAPA a Lean system? • Think about the CAPA system and consider which bits are pull and which are push • Think about which steps add value and eliminate waste cf traditional CAMHS