Back in December, a few of us went to TEWV to see how their quality improvement system had enabled a transformation in the delivery of their mental health services.
We were shown how they do daily board rounds of all their inpatients, creating what is called the Purposeful In-Patient Admission Process (PIPA – for short). These were developed using the continuous improvement methods that many of us have learnt about at the Cumbria Production System Awareness Sessions. They measured daily activities on the wards, looked at outcomes and where there was ‘waste’, and realised that by taking 30 minutes each morning to talk through every patient together (and assigning tasks), they could save staff time and also reduce the length of time that people had to stay in hospital.
The staff were very happy with the way they worked and felt that the people they cared for were getting a much more efficient and responsive service, enabling them to recover faster and get back home sooner. We were really impressed with the way it all worked, but realised that it must have taken time and energy to get to this point.
The rest of the day was spent in understanding how they had developed their philosophy of continuous improvement and created ownership of that across all their staff. They started 8 years ago with the support of the North East Transformation System (NETS), spending time looking at the Toyota Production System in Japan, and the Virginia Mason Hospital in America. One of the most important things they felt was having ‘buy-in’ from the board and senior leadership team, beginning their training with them so they understood (and could do) what they were then asking their staff to do. The next task was to set up their Kaizen Promotion Office (KPO), providing the learning and support to ensure everyone else could access the tools they needed to apply the methods to their work.
It was truly inspiring to see how many improvement cycles had been (and were being) undertaken. Each month they reported out to the Chief Executive so he is aware of all the work that is going on, also giving the teams the opportunity to show how they are improving. The incredibly simple idea that the system is both inclusive – open and using tools and techniques known to solve problems, and for everyone – easily learned and applied with no-one excluded – just works!
So, what did I take away from the day?
- I learnt some Japanese words – my favourites Muda, meaning waste, and Kaizen, which means continuous improvement
- That things can always improve, but that we need to be given the time to observe, measure and change in order to do this
- That striving to create truly person-centred pathways of care that can deliver systematic, high quality evidence based services is everyone’s job within the NHS
- That CLIC is a big part of this journey, and we all need to be part of it
On a personal note I have committed to being a ‘kaizen warrior’, and buying a stop watch – beware ‘muda’, I’m going to eliminate you!