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  • Highland Quality Approach

    Quality in Action

    Gavin Hookway

    Senior Quality Improvement Practitioner (Lean)

    NHS Highland

  • Putting quality first to deliver Better health, Better care and Better value

  • Captures the spirit of how NHS Highland is working to improve care and outcomes for peopleand describes the way we want to

    do things here in NHS Highland

  • The Highland Quality Approach

    OUR Strategic Framework

  • Quality & Efficiency Framework

    Eliminate WASTE

    Manage VARIATION

    Eliminate HARM

    Person Centered


    We relentlessly pursue the highest quality outcomes of care

  • Method Focus Culture

  • Virginia Mason Production System (VMPS)

    Patient is always first

    Focus on highest quality & safety

    Engage all employees

    Strive for highest satisfaction levels

    Maintain a successful economic enterprise

    Based on Toyota Production System (TPS) methodologies (Lean)

  • Method Focus Culture

  • Cancer

    Patient Flow

    Patient Management System

  • Method Focus Culture

  • LEAN, SPSP, Productive series

    Tool kit, evidence based

    Remove waste + add value for all our patients

    Apply training with rigor & consistency

  • Define







    Not addressed



    y Im





    Create bundles


    observation and


    Run charts


    Kaizen RPIW PDSA

    Productive Series



    tools & solutions.

    Some bundles set


    set and given

    Not addressed

  • LEAN allows practitioners to spend more of their time caring for

    people and improves the quality of care these people receive

  • 15 RPIWs completed

    50 RPIWs planned for 2014-2015

    9 Certified Lean Leaders - Qualified

    20 Certified Lean Leaders in training

    6 Certified Lean Leader Coaches in training

    Over 1200 staff trained to Basic Awareness Level

  • Quality in Action

    Mid Argyll

    Community Mental Health

    RPIW 5th August 2013

  • RPIW Project Form

    Event Name: Mid Argyll & Bute Community Mental Health Date: 5th August 2013

    Sponsor: Deborah Jones Board Strategic Goals (linked to this process)

    Provide quality care all times Support people and communities to maximize their own health Develop precision driven services so that when people need our care they experience; timely,

    focused, effective services, that minimize the duration and frequency of contact; Ensure that every health pound spent delivers maximum health gain Specifically to develop a mental health service which aspires amongst many core principles to

    deliver care predominantly provided in the individuals community or own home and where hospital admission will be for the few.

    Current Situation:

    Small team comprising a core of 5 members supported by other specialists looking after clients from the geographic area of Mid Argyll.

    There is variation of referrals into the service There is variation in the methods used to process referrals once received in to the service Case load triage on referral through single point 1

    st and 2

    nd stage triage are manual process

    Patients allocated in accordance with need, priority, specialty and available capacity (gender preference also a consideration).

    Total case load across 5 core members, as at 12 June 2013, 131, of which 109 active and 23 on waiting list. There is variation in capacity of specialist team members to accommodate MA referrals.

    Patients placed on waiting list are not offered an appointment until relevant team members discharge from existing case load if at capacity. There is variation in waiting time for first appointment.

    Workshop Leader: Gavin Hookway / Derek Leslie

    Team Leader: Derek Leslie / Gavin Hookway

    Process Owner: Douglas Philand

    Team Members Advisory Group

    Ros Box Nicola Gillespie Geraldine Hannan John Lawson Amanda Adams-McGilp Valda Parnaby Fiona McClean Moira Harrison Tina Jordan (tbc) Social Worker (tbc) Fiona Margach Sheena Clark Kristin Gillies

    John Dreghorn David Logue Fiona Coffield Fiona Broderick Consultant Psychiatrist (tba) Cameron Stark Linda Kirkland GP (tba) Glen Heritage (AVA)

    Production Requirements/Takt Time Calculation 782 minutes

    Process Flow: RPIW Theme/Overview

    Community Mental Health Service Mid Argyll. Effective triage and case lists management to minimise number of clients waiting for first appointment and to ensure any related waiting time targets are met.

    RPIW Targets/Boundaries

    Start point on receipt of referral to department.

    End point is patient discharge or onward referral.

    Impact of workload management on team capacity. RPIW Measures Reduce numbers on the waiting list reduce from 23 to 0 (zero) Reduce waiting time for patient from referral to first appointment max 12 week wait

    Ensure demand is in balance with available capacity. Improve quality of care given to all patients.

    Revision: Version 3 24/07/2013

    Receipt of Referral

    1st Stage



    Stage Triage referral

    Outcome of 2

    nd Stage






    Patient Discharged from Service

  • Target Progress Report

    Team Name: Community Mental Health Team Date: 24 July 2013

    Department: Mid Argyll TAKT Time: (include calculation)112500mins /144 patients = 782 minutes

    Product/Process Summary: From Receipt of Referral to point that Patient is given first appointment

    Team Leader: Derek Leslie Sub-Team Leader:

    Workshop Leader:Gavin Hookway Process Owner: Douglas Philand

    KPO Coach (if applicable): Keith Appleby

    Metric (units of measurement) Baseline Target

    Day 2 Day 3 Day 4 Final 30 days mm/dd/yy

    60 days mm/dd/yy

    90 days mm/dd/yy

    12 months mm/dd/yy

    % Change

    Space (square feet)

    Inventory (s)

    Staff Walking Distance (feet) Travel

    Parts Travel Distance (Minutes) 14 (>= 50%)

    Lead Time (Weeks) 52 (>= 50%)

    Work in Process (WIP) (units observed in the process)


    Standard Work In Process (SWIP) (lead time/takt time); target SWIP should be target lead time/takt time

    149 72

    Quality (defects)(%) Referrals via SCI 97% 100%

    Productivity Gain (FTEs see target metric definitions for formula to calculate baseline)

    Environmental, Health & Safety (5S) (levels 1 thru 5) specify for physical space or virtual space

    1 Level 4

    Set-up Reduction (minutes)


  • 128,526 (53 Weeks)

    40,961 (17 Weeks)

  • 34

  • Standard Process Description: NAME referral receipt to offer of appointment

    Quality Check Safety Precaution Standard WIP

    Notes:- Add notes about related policies or any acceptable exceptions in sequence of steps

    Who Must Adopt This Process: team leader or deputy and administration

    Takt Time:

    GOAL: List key quality and lean targets

    STEP Add

    Quality, Safety or

    WIP symbols

    as needed

    OPERATOR List role

    responsible for each task



    Fill in as needed to explain use of a specific tool or

    supply Add photos if valuable to provide clear instructions

    CYCLE TIME Amt of

    processing time to

    complete each step

    1. Admin

    Retrieve twice daily log into SCI using login process checking the referral received

    Computer with access to both SCI and Helix



    Copy the SCI referral into helix this will need to be confirmed by information this will result in the referral being activated on Helix Copy and email referral to team manager or deputy

    As above and outlook access for email to manager or deputy


    Team manager

    Team manager will need to open referral received from administrator using the 1-2 triage 3-4 triage tools complete the referral triage process Email confirmation of completed triage back to team administration for 2-3-4 And to Fiona Margach for level 1

    Computer and outlook Triage tools level 1-2 Triage tools level 3-4 need laminated copies of the triage tool for staff completing action remotely



    Access team outlook diaries and for 3-4 client check available assessment appointments

    Computer Clinician diary appointments

    5. admin Completion of referral letter re client appointment:-

    Level 2 letter is an opt in letter completed

    Template letters 2-3-4

    Standard Process Description

    NAME referral receipt to offer of appointment

  • Standard Process Description:

    Diary Management

    Quality Check Safety Precaution Standard WIP


    Who Must Adopt This Process: All team members

    Takt Time:

    GOAL: List key quality and lean targets STEP





    1. All Each team member should give fu


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