process excellence at bolton nhs foundation trust case study

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  • 1. Process Excellence at Bolton NHS Foundation Trust - PEX Network Case StudyProcess Excellenceat Bolton NHS Foundation TrustProcess Excellence Network Case Study2012 Europe Process Excellence Award WinnerWinner Best Process Improvement Programme1|Page
  • 2. Process Excellence at Bolton NHS Foundation Trust - PEX Network Case StudyCASE STUDY: BOLTON NHS FOUNDATION TRUSTINSIGHT FROM EUROPEAN AWARD WINNING BEST MATURE PROCESSIMPROVEMENT PROGRAMMECONTEXT & PROGRAMME OVERVIEWIn 2004, the former Bolton Hospitals NHS Trust,now Bolton NHS Foundation Trust, was facingchallenges faced by many healthcare organizations address the challenges and make sure thatacross the United Kingdom: high rates of mortality, examples of best practice were infections, financial difficulty, and staffdissatisfaction. Introduced in 2005, the Bolton Improving Care System (BICS), a process improvement programmeDespite examples of good practice in certain areas based on Lean principles, aimed to change that.of service, there was no coherent system to Under the leadership of the then-Chief Executive David Fillingham, and after a year of trying Lean in a number of areas, BICS was established to improve patient care by reducing wasteful Bolton NHS Foundation processes in the system (e.g. duplication, errors and work-round solutions) in order to provide safe Trust Snapshot and high quality services. Since its inception, BICS has resulted in major improvements for the Trust including reduced 2011/12 270m turnover mortality rates, shorter stays for patients and many other initiatives which have ultimately saved Circa 1,000,000 patient lives. contacts per annum For their work and results achieved to date the 6,000 + staff Trust won PEX Networks 2012 European award for Best Mature Business Process Excellence Busy emergency service, Programme (running for longer than 2 years), a 110k attendances pan-European award judged on operational and business results as well as clarity in execution Approximately 750 acute throughout and sustainability of change. beds Offers community, secondary and some specialist services2|Page
  • 3. Process Excellence at Bolton NHS Foundation Trust - PEX Network Case StudyAPPLYING LEAN PROCESS IMPROVEMENTTO HEALTHCARELean process improvement, a technique honed inJapans automotive industry, has at its centre theconcept of continuous improvement andconstantly striving to eliminate unnecessaryexpenditure of resources (waste) - defined asanything that the customer does not value.Although the technique was honed inmanufacturing, it has spread widely to otherindustries where its focus on iteratively improvingprocesses has proven useful. For Bolton NHS FT The Bolton Improving Care System (BICS) isthe challenge in introducing the technique to its linked up with the high level aims of the Trustwards and services was contextualising Lean forhealthcare and demonstrating that it wasnt just a to clinicians was key to getting their furtherguise for eliminating jobs. support and buy in.The Lean team gained the trust of employees by This wasnt just tweaking around the edges, butdemonstrating that Lean process improvement a real step change in improvement, says Joywas ultimately about improving quality of care. Furnival, Associate Director of Transformation atThey demonstrated this through best practice site Bolton NHS FT. So the belief that maybe this leanvisits in the US, external speakers talking to staff, thing - this weird thing thats come fromand most importantly, by getting results that led to automotive - could have benefit in healthcarebetter outcomes for patients. began to grow.Trauma was one of the first pathways selected for But it wasnt a quick process, she cautions.improvement. Using the Lean approach the team Instead, there was gradual realization of what thewas able to redesign the trauma pathway and very goals of the programme should be: Really afterquickly achieved improvements in both mortality about a year of playing with Lean - just trying itrates and health outcomes. Demonstrating results out wherever we could - a consensus started to grow about how to take Lean forward. PUTTING PATIENTS AT THE CENTRE Putting the patient at the centre was and remains - the critical component of Boltons Lean programme. In all process improvement work undertaken, the team has strived to define value from the patients perspective. Whilst all healthcare organizations may aim to put patient care at the centre, one of the distinguishing features of the Bolton Improving Care System (BICS) approach was that patients were oftenDefining Value from the patients perspective involved in the design of processes. was a key component of BICS3|Page
  • 4. Process Excellence at Bolton NHS Foundation Trust - PEX Network Case Study For instance, using something called Patient Experience Based Design (combined with their Lean programme) the Trust involved patients in process improvement work on the pathway for hip replacement. The patients were approached and invited to participate in surveys - which asked basic questions about satisfaction levels and were also asked to keep diaries to record their whole experience of the process. Those diaries helped the Lean team identify the emotional touch point for patients things that might have seemed superfluous to the process but really mattered to the patient. In the end they invited selected participants to come and recount Patients were best placed to give each their stories on camera. other advice on how to deal successfully with hip surgery According to Furnival, they learned many things as part of that work. There can be quite large doing now, and also it gives us emotional ideas differences between what staff think patients about how we can add to that emotional value and what patients actually value, she said. experience for a patient as well as the practical For example, one patient talked about how shed process things. had diabetes all her life but when she came into The Lean team looked at things such as how pain hospital for replacement hip surgery, staff at relief is requested and administered on the ward, Bolton Hospital had taken her medications away how to deal with patients who normally self care from her for diabetes. To the patient that meant (such as the diabetic who shared her experience loss of control and she had found that quite on camera) and understanding when patients upsetting. Another, meanwhile, explained how want things. The patients themselves took action painful it was getting back into a car after the by writing the top ten tips fo


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