Service Improvement Tools and Techniques 17/06/2011 Service Improvement Tool Key Aims Resources Available Example A Powys-specific example has been provided where available Driver Diagrams To logically illustrate the components of the issue, including: aims, drivers for the project, and interventions needed to complete the project. 1000Lives+ Tools for Improvement 1 – How to Improve: the guide for reliable and sustained improvement. April 2010. Available at: www.1000livesplus.wales.nhs.uk and on the PtHB 1000Lives+ intranet page. 1000Lives+ The Quality Improvement Guide. March 2011. Available at: www.1000livesplus.wales.nhs.uk Source: Powys Teaching Health Board, 1000Lives+, Dr Brendan Lloyd, 11/05/2010 Service Improvement Officer Page 1
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Service Improvement Tools and Techniques 17/06/2011
Service Improvement Tool
Key Aims Resources Available Example A Powys-specific example has been provided where available
Driver Diagrams
To logically illustrate the components of the issue, including: aims, drivers for the project, and interventions needed to complete the project.
1000Lives+ Tools for Improvement 1 –How to Improve: the guide for reliable and sustained improvement. April 2010. Available at: www.1000livesplus.wales.nhs.uk and on the PtHB 1000Lives+ intranet page. 1000Lives+ The Quality Improvement Guide. March 2011. Available at: www.1000livesplus.wales.nhs.uk
Source: Powys Teaching Health Board, 1000Lives+, Dr Brendan Lloyd, 11/05/2010
Service Improvement Tools and Techniques 17/06/2011
Service Improvement Tool
Key Aims Resources Available Example A Powys-specific example has been provided where available
PDSA Cycles a.k.a. PDCA Cycles, Deming Cycle
Plan-Do-Study-Act: a system which allows the planning, implementation and continual monitoring of change through a repeated cycle.
1000Lives+ Tools for Improvement 1 –How to Improve: the guide for reliable and sustained improvement. April 2010. Available at: www.1000livesplus.wales.nhs.uk and on the PtHB 1000Lives+ intranet page. 1000Lives+ The Quality Improvement Guide. March 2011. Available at: www.1000livesplus.wales.nhs.uk Leveraging Lean in Healthcare. Protzman, Mayzell, MD, Kerpchar. 2011. Productivity Press. Available from the Library Service, PtHB. A Toolkit for Change. Bird and Cumming. 2007. National Leadership and Innovation Agency for Healthcare. Llanharan. Available from the NLIAH Learning Laboratory.
Source: 1000Lives+ Tools for Improvement 1 –How to Improve: the guide for reliable and sustained improvement. Page 22.
Service Improvement Tools and Techniques 17/06/2011
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Achievement
M edian
Percentage of OT sessions that were delivered
Service Improvement Tool
Key Aims Resources Available Example A Powys-specific example has been provided where available
Run Charts A graph to illustrate changes in data comparable to the median value over time.
1000Lives+ Tools for Improvement 1 –How to Improve: the guide for reliable and sustained improvement. April 2010. Available at: www.1000livesplus.wales.nhs.uk and on the PtHB 1000Lives+ intranet page.
Powys Example: a run chart used as part of the Stroke Collaborative to monitor Occupational Therapy sessions delivered.
Service Improvement Tools and Techniques 17/06/2011
Service Improvement Tool
Key Aims Resources Available Example A Powys-specific example has been provided where available
Statistical Process Control Chart
A graph which shows changes in data over time comparable against the mean value and upper and lower control limits. Any value approaching or falling outside of the acceptable variation limits provides evidence for an intervention to improve the service.
1000Lives+ Tools for Improvement 1 –How to Improve: the guide for reliable and sustained improvement. April 2010. Available at: www.1000livesplus.wales.nhs.uk and on the PtHB 1000Lives+ intranet page. Lean for Practitioners Eaton. 2008. Ecademy Press. Penryn. Available from the Library Service, PtHB and NLIAH Learning Laboratory. Statistical Process Control. NHS Institute for Innovation and Improvement. www.institute.nhs.uk A Toolkit for Change. Bird and Cumming. 2007. National Leadership and Innovation Agency for Healthcare. Llanharan. Available from the NLIAH Learning Laboratory.
Source: 1000Lives+ How to Guide 1 How to Improve The guide for reliable and sustained improvement. Page 23.
Service Improvement Tools and Techniques 17/06/2011
Service Improvement Tool
Key Aims Resources Available Example A Powys-specific example has been provided where available
Value Stream Mapping- Lean Thinking
To visually identify value-added time for the patient and wastes within a given process.
Making Hospitals Work. Baker, Taylor and Mitchell. May 2009. Lean Enterprise Academy Ltd. Available from the Library Service, PtHB and NLIAH Learning Laboratory. Lean for Practitioners Eaton. 2008. Ecademy Press. Penryn. Available from the Library Service, PtHB and NLIAH Learning Laboratory. Sustaining Lean Healthcare. Eaton & Phillips. 2008. Ecademy Press. Penryn. Available from the Library Service, PtHB and NLIAH Learning Laboratory. Leveraging Lean in Healthcare. Protzman, Mayzell, MD, Kerpchar. 2011. Productivity Press. Available from the Library Service, PtHB. Value Stream Mapping. NHS Institute for Innovation and Improvement. www.institute.nhs.uk
Source: current state value stream map: Brecon cataracts project.
Service Improvement Tools and Techniques 17/06/2011
Service Improvement Tool
Key Aims Resources Available Example A Powys-specific example has been provided where available
Root Cause Analysis- Lean Thinking 5 Whys 5Ws and 2Hs
Determining the cause of a problem can usually be achieved by asking ‘why’ 5 times. Asks ‘why’ for each of: who, what, where, when, why, how and how much- it aims to find the roots of the problem and provide the basis for solving the problem
Lean for Practitioners Eaton. 2008. Ecademy Press. Penryn. Available from the Library Service, PtHB and NLIAH Learning Laboratory. Leveraging Lean in Healthcare. Protzman, Mayzell, MD, Kerpchar. 2011. Productivity Press. Available from the Library Service, PtHB. Root Cause Analysis Using 5 Whys. NHS Institute for Innovation and Improvement. www.institute.nhs.uk
Service Improvement Tools and Techniques 17/06/2011
Service Improvement Tool
Key Aims Resources Available Example A Powys-specific example has been provided where available
A3 Reports A framework to summarise key events of a service improvement project on a single piece of A3 paper. It features the background, current state, analysis of the problem, the target state, and outline of the plan for change and often lists responsibilities.
Making Hospitals Work. Baker, Taylor and Mitchell. May 2009. Lean Enterprise Academy Ltd. Available from the Library Service, PtHB and NLIAH Learning Laboratory. Leveraging Lean in Healthcare. Protzman, Mayzell, MD, Kerpchar. 2011. Productivity Press. Available from the Library Service, PtHB. A3 Problem Solving for Healthcare: a practical method for eliminating waste. Jimmerson. 2007. Healthcare Performance Press. New York. Available from the NLIAH Learning Laboratory.
5S To effectively organise the working environment against five standards: sort, set, shine, standardise and sustain.
Lean for Practitioners Eaton. 2008. Ecademy Press. Penryn. Available from the Library Service, PtHB and NLIAH Learning Laboratory. Sustaining Lean Healthcare. Eaton & Phillips. 2008. Ecademy Press. Penryn. Available from the Library Service, PtHB and NLIAH Learning Laboratory.
Powys example: “Well Organised Ward Model” Transforming Care project, Llanidloes Hospital. The 5s Process:
Service Improvement Tools and Techniques 17/06/2011
Service Improvement Tool
Key Aims Resources Available Example A Powys-specific example has been provided where available
Making Hospitals Work. Baker, Taylor and Mitchell. May 2009. Lean Enterprise Academy Ltd. Available from the Library Service, PtHB and NLIAH Learning Laboratory. Leveraging Lean in Healthcare. Protzman, Mayzell, MD, Kerpchar. 2011. Productivity Press. Available from the Library Service, PtHB Sort and Shine. NHS Institute for Innovation and Improvement. www.institute.nhs.uk
Fishbone Diagrams a.k.a. cause and effect diagrams
A diagram which is designed to help identify all the possible causes of an issue- similar to brainstorming but structured to point towards the problem.
Making Hospitals Work. Baker, Taylor and Mitchell. May 2009. Lean Enterprise Academy Ltd. Available from the Library Service, PtHB and NLIAH Learning Laboratory. Lean for Practitioners Eaton. 2008. Ecademy Press. Penryn. Available from the Library Service, PtHB and NLIAH Learning Laboratory. Cause and Effect. NHS Institute for Innovation and Improvement.
Source: Cause and Effect (fishbone). www.improvingnhsscotland.scot.nhs.uk (accessed
SET Tidy: give each item a
clearly labelled, specific location
STANDARDISE Set responsibilities so this becomes routine
Service Improvement Tools and Techniques 17/06/2011
Service Improvement Tool
Key Aims Resources Available Example A Powys-specific example has been provided where available
www.institute.nhs.uk A Toolkit for Change. Bird and Cumming. 2007. National Leadership and Innovation Agency for Healthcare. Llanharan. Available from the NLIAH Learning Laboratory.
23/03/2011)
Pareto Analysis
Uses the 80/20 rule – 80% of the problems are usually only caused by 20% of the activity. Pareto analysis helps to identify where to focus improvement efforts via a relative frequency graph.
Lean for Practitioners Eaton. 2008. Ecademy Press. Penryn. Available from the Library Service, PtHB and NLIAH Learning Laboratory. Pareto NHS Institute for Innovation and Improvement. www.institute.nhs.uk A Toolkit for Change. Bird and Cumming. 2007. National Leadership and Innovation Agency for Healthcare. Llanharan. Available from the NLIAH Learning Laboratory.
Service Improvement Tools and Techniques 17/06/2011
Service Improvement Tool
Key Aims Resources Available Example A Powys-specific example has been provided where available
Check-Plan-Do - Systems Thinking
A three step process for managing change, which revolves around understanding the process and the systems which it feeds into, and the systems which feed into the process. Measurables should be derived from understanding the process.
Systems Thinking in the Public Sector. Seddon. 2008. Triarchy Press. UK. www.systemsthinking.co.uk
Source: Managing Change –Systems Thinking for Service Organisations. Vanguard. 2009. (accessed 23/03/11) www.systemsthinking.co.uk
Powys Quality Improvement Faculty Wiki
An online resource for discussion of service improvement projects and techniques, listing key publications relating to
Prevention of Venous Thromboembolism Wiki Page http://qualityimprovementfaculty.pbworks.com/w/page/36481723/Prevention-of-Venous-Thromboembolism (accessed 03/05/2011)
Service Improvement Tools and Techniques 17/06/2011
Service Improvement Tool
Key Aims Resources Available Example A Powys-specific example has been provided where available
quality improvement.
Service Improvement Officer Page 11
Service Improvement Tools and Techniques 17/06/2011
Service Improvement Tool
Key Aims Resources Available Example A Powys-specific example has been provided where available
Funnel Charts A graph used to identify outliers between defined statistical limits.
Association of Public Health Observatories Website, Tools page: http://www.apho.org.uk/default.aspx?RID=39403 Analytical Tools for Public Heath: Funnel Plot for Rates (including directly standardised rates). Analytical Tools for Public Health: Funnel Plot for Count Data. Analytical Tools for Public Health: Funnel Plot for Proportions and Percentages.
Example Funnel Chart used in the management of hypertension.
Service Improvement Tools and Techniques 17/06/2011
Service Improvement Tool
Key Aims Resources Available Example A Powys-specific example has been provided where available
Setting the Direction: Maturity Matrix
A Self Assessment tool for the development of 5 key areas of Setting the Direction. Each of PtHB’s Localities report on progress to the Setting the Direction Board using this matrix.
(one for each of the 5 key areas) Setting the Direction: Health Board Assessment – Examples of Evidence for Performance:
Communication Hubs Hospital Interface Chronic Conditions Management Localities Community Resource Teams
Setting the Direction Matrix Template for Self Assessment- locality specific.
Extract from Setting the Direction Health Board Assessment – Examples of Evidence for Performance: Communication Hubs.
Service Improvement Officer Page 13
Service Improvement Tools and Techniques 17/06/2011
Service Improvement Officer Page 14
Service Improvement Tool
Key Aims Resources Available Example A Powys-specific example has been provided where available
WHO Safer Surgery Checklists
A checklist devised by WHO to be used for every patient undergoing a surgical procedure, which has been shown to have reduced complications.
1000Lives Plus: How to Guide 4: Reducing Surgical Complications http://www.wales.nhs.uk/sites3/page.cfm?orgid=781&pid=35738 National Patient Safety Agency: http://www.nrls.npsa.nhs.uk/resources/clinical-specialty/surgery/?entryid45=59860
For further information, please contact Nathalie Thomas, Service Improvement Officer [email protected] Thank you.
