Created by Debbie Carr – BICS Team – April 2011 © Royal Bolton Hospital NHS Foundation Trust 2011. All rights reserved. Not to be reproduced in whole or in part without the permission of the copyright owner

Congratulations to the Respiratory Specialist Nursing Team for winning Best Improvement in Service Sector at the European Process Excellence Awards 2011. Beating off stiff competition from The Car-phone Warehouse, and BP amongst others. Their BICS improvement work, involving moving to seven day services, providing expert respiratory care to patients outside of respiratory wards both within the hospital and the community has had fantastic results for patients and staff, contributing to better care, responsible use of resources and improved morale. The judges told us that they were looking for something special and that is what they found in Respiratory’s award entry.

Our challenge now is how do we as an organisation spread what we are doing in respiratory and other areas of best practice across all our new organisation so this is standard for all and we can make improvements in our daily work. If you have any ideas for improvement in your area of work and need advice how to go about it, or have an

improvement story you would like to share in future editions of the newsletter, please contact bics@rbh.nhs.uk

Joy Furnival

Head of Lean Transformation

SERVICE IMPROVEMENT SUCCESS

INTERNATIONAL FORUM ON QUALITY & SAFETY

Issue: 4/11 APRIL 2011 BICS Newsletter

Using Lean for

Continuous Improvement

Special points of interest:

• Improvement News

• BICS Academy

• Sharing the Learning

• Celebrating Success

• Forthcoming events

Inside this issue: International Forum 1

Benefits Tracking 2 Specialty Review Marketplace

2

Productive Community Services

2

Shared Learning Website launch

3

Health and Wellbeing Referral Process

3

Surgical Admission Flow

3

Safety Express—Problem Solving

4

Webex’s 4

Best Practice Visits 6

Bronze Level Accreditation

6

Awards Success 7

Royal Bolton Runners 7

MSK Pathway 5

Exemplar Programme 5

Representatives from Bolton Hospital and Community services were successfully selected to present and showcase their improvement work at the event held in Amsterdam.

The 2011 International Forum captures the essence of excellent, safe and affordable healthcare bringing together an international audience of 2,700 attendees from over 80 countries. Work presented from Bolton included:

• Creating a Safety Culture in Theatres • Clinical Presentation Mapping: A new methodology for informing evidence

based practice • Respiratory Service Quality Improvements • Quality Continuum

WINNER!

Best Improvement Project

Service Sector

Created by Debbie Carr – BICS Team – April 2011 © Royal Bolton Hospital NHS Foundation Trust 2011. All rights reserved. Not to be reproduced in whole or in part without the permission of the copyright owner

Page 2 Improvement News

SPECIALTY REVIEW MARKETPLACE - APRIL 2011

A big thank you to all who contributed to the Specialty Review Marketplace held in April, presenting the success and progress of the strategic reviews. The event was an opportunity for managers, executive board and trust board members to see via specialty posters the outcomes of the review process.

The posters were well received, with positive feedback to say that the opportunity to meet and review the outcome of the reviews was helpful and informative. The marketplace was attended by staff across the hospital and community, providing an informal opportunity to talk to colleagues and see the challenges and outcomes that other specialties experienced. The event was hosted by Chief Executive Lesley Doherty, who rounded off the evening with her reflections of the review process and how we are going to take ideas forward. Overall the event was an informal way of sharing corporate learning. Posters were also displayed during BICS outbrief for visitors and staff to view and at April’s Governors meeting. Posters are now on the intranet for staff to access. A Community Marketplace Event will be held on the 19th of May 2011, 5:00 –6:30pm, staff restaurant, Royal Bolton Hospital. This event will be the opportunity to showcase community posters and learn about their services. Posters will also be displayed the following day, 10:00am—3:00pm in the BICS Event Rooms, Ground Floor, Musgrave House. To book your place contact Hifza.Quraishi@rbh.nhs.uk

The next steps for the specialty review process are for clinical teams to take forward the outcomes of the reviews. Outcomes from the reviews should directly inform the Level 3 (Departmental) Policy Deployment objectives and we will be re-visiting several specialties to ensure that the links are made. If you would like to discuss BICS support in implementation, then please contact Joanne.bolger@rbh.nhs.uk to discuss further. Next year there will be another marketplace event and we will be asking specialties to update their posters one year on to demonstrate progress in relation to implementing their strategies.

The method for collecting and collating safety and quality improvements in our Rapid Improvement Event (RIE) cycles has generally been far more robust than the identification of any financial savings made. This is all about to change!

During the last year Angela Sanderson (Head of Divisional Financial Management) has been working with the BICS team to find a method of recording the financial savings made by teams.

From each event cycle savings in time, stock and resources may be made for the department,

ward or division. These savings will now be recorded on a template by the team leader at the 90 day review and sent to Angela, who will convert these into cost savings and enter the information

into a database and Divisional records. By completing the benefits tracker the Team Leader, Mission Owner and Sponsor are able to fully understand the savings as well as the quality improvements made by each RIE cycle. Please fill in your benefits tracker to ensure your team receives full credit for any quality, safety and financial improvements made. For more information, please contact Alex.vincent@rbh.nhs.uk

BENEFITS TRACKING – RESPONSIBLE USE OF OUR RESOURCES

PRODUCTIVE COMMUNITY SERVICES There are now have 55 teams participating in the Productive Community Services Programme, most recently including Neurological Rehabilitation, Referral Assessment, and the Biomechanics teams. The PCS Programme has shown beneficial outcomes which have supported service delivery for patients. If you are interested in finding out more, please contact Liz Ashall-Payne 01204 463223 or come to the BICS outbrief on Friday 18th May where they will be feeding back on some of the improvement work done so far.

Created by Debbie Carr – BICS Team – April 2011 © Royal Bolton Hospital NHS Foundation Trust 2011. All rights reserved. Not to be reproduced in whole or in part without the permission of the copyright owner

Page 3 Improvement News

The SHARED LEARNING website has now gone live! Across hospital and community services 100’s of good ideas are being implemented everyday to overcome problems. Many of these are never shared with other wards and departments. The aim of the SHARED LEARNING website is to provide a place to be able to share this good practice and to offer inspiration when you are looking for ideas to address an issue The site supported by the Exemplar Programme, the BICS Team and sponsored by the North West Leadership Academy will allow you to search through hundreds of ideas already being used. It also gives you contact names so that you can find out more details and visit areas to see it for yourself.

You can get to the site going by the Trust Intranet - Trust Information - Shared Learning or via the link below: http://intranet.rbh.nhs.uk//modules/hpc/homepage/home.asp?Homepageid=240 If you have an idea to share or to find out more email the BICS Team at BICS@rbh.nhs.uk

SHARED LEARNING WEBSITE—LAUNCH

HEALTH AND WELLBEING MANAGEMENT REFERRAL PROCESS

A small team which included nursing staff, a mortuary technician, an IT systems manager and an elected governor worked together to look at the process for short stay elective patients. Data highlighted that patients fit for discharge on the day of surgery remained in hospital overnight and were not being discharged in time for the next patient to access the bed. This meant that patients were being admitted and kept on the admissions unit where there was restricted space. Patients were asked about their experience before and during the week and some told us that they were concerned about their privacy and dignity due to the environment. As discharges were not planned, patients were often placed on standby or their surgery cancelled due to no bed being available.

During the week the team sought to understand the process and the stakeholders within the process. The team then undertook a gap analysis of the current problems and barriers to identify the root causes. The team developed standard work to pull patients through from the admissions unit to the receiving ward prior to going to theatre and also standard work for nurse led discharge, ensuring patients are discharged as soon as they are fit. A change to the operation notes so that medical staff could indicate if patients could not be discharged by the nursing staff was also agreed. The team recognised that patients needed to be informed about what to expect when they were coming into hospital at pre- assessment and therefore developed a checklist for use at pre-admission. All the changes were tested during the week and the staff and patients asked for feedback which was very positive. For more information on this event, contact Carol.bernstein@rbh.nhs.uk

Congratulations to the Health and Wellbeing BICS Event Team who have worked hard to exceed all the targets that were set for 90 days post event. In week the Team set out to clarify and improve the referral and appointment process and to 6S the area to better better support the flow of work and improve working conditions. As a result:

• 63% more clients are seen and a letter is written within 12 days. • DNAs reduced by 41%. • Expenditure on print cartridges have reduced by 50%. • Appointments are arranged within 1 day instead of 3 days. • Assists the rest of the hospital and staff , by reduce sickness levels and helping people get back to

work.

Both mangers and clients have given very positive feedback and there is a sense that there is more control over the process for each group involved. The Team is now looking at where else improvements can be made. For more information on this event, contact team leader sue.whittam@rbh.nhs.uk

SURGICAL ADMISSION FLOW

Created by Debbie Carr – BICS Team – April 2011 © Royal Bolton Hospital NHS Foundation Trust 2011. All rights reserved. Not to be reproduced in whole or in part without the permission of the copyright owner

Page 4 Improvement News

Safety Express is a national improvement programme that aims to support improvements and ultimately deliver no harm care through reliable systems leading to efficiency and cost savings in four avoidable harms: pressure ulcers, serious harm from falls, catheter acquired urinary tract infections and Venous Thrombembolism (VTE). AQuA in partnership with NHS North West will support Safety Express ‘host’ organisations, of which the Trust is one. The host organisations will deliver an improvement collaborative within their health community. In April members of the Trust came together to look at ways of reducing avoidable harm to patients. We wanted to agree some rapid experiments aimed at significant reduction in all four harms [falls, Pressure ulcers, CAUTI, VTE] to ensure that 95% of our patients do not suffer any of the 4 harms. Using BICS methodology, front line teams, (those direct care givers) were pivotal to designing the changes to be tested. The methodology will then supports rapid acceleration of change to realise the benefits across the health economy. The rapid experiments identified are as follows:

SAFETY EXPRESS-PROBLEM SOLVING EVENT

Description of Experiment Start / End Date Anticipated Effect

Training for and implementation of Pressure ulcer care plan/ care bundle

April – May 2011 Increased compliance with Care plan and assessments

Validation of RCA Tool for VTE During event Enable wider use of tool and to develop themes for learning

Training for and implementation of combined wardex and VTE assessment

April – May 2011 Increase compliance of VTE assessment completion to 90%

Implemented visual management tools and training to use Falls care plan

During event- May 2011 Reduction in avoidable patient falls Increased compliance with falls assessment and care plan

Training for and implementation of care plan for CAUTI

April- May 2011 Reduction in catheter insertion Reduction in infections Increase compliance with documentation and care plan

NATIONAL INSTITUTE WEBEX’S – KAISER PERMANTE

Following the success and interest for the previous WebEx with Kaiser Permanente around HSMR the National Institute have scheduled the following series of WebEx’s with them to share information on other key topics around quality improvement. The webex’s are free to join, all you need to do is pre-register.

If you wish to register and receive joining instructions for the sessions please contact nicole.hobley@institute.nhs.uk. Please feel free to pass this invite on to colleagues who may have experience or interest in these topics.

Date Time Topic Thursday 12 May 4.00 – 5.30PM Dashboards, metrics and measurements

Tuesday 7 June 4.00 – 5.30PM Palliative care efforts

Date Time Topic Thursday 12 May 4.00 – 5.30PM Dashboards, metrics and measurements

Tuesday 7 June 4.00 – 5.30PM Palliative care efforts

Created by Debbie Carr – BICS Team – April 2011 © Royal Bolton Hospital NHS Foundation Trust 2011. All rights reserved. Not to be reproduced in whole or in part without the permission of the copyright owner

Page 6 Improvement News

New Developments:

North West Care Indicators: From May, four wards will be participating in a 3 month pilot. The monthly NW Care indicator audits will be carried out by some of the Exemplar team members instead of the ward staff, and will be directly inputted to a web-based system which will produce immediate reports. The advantage of the pilot is that we will be able to analyze information into the detail, which is something we are unable to do easily with our paper based system. Wards will then be able to highlight more specific actions needed to make improvements. Model Ward Measures: Look out for these on the Exemplar Web page shortly. Achievement Boards: To be updated with the integrated organisation’s 3 revised key objectives. -‘Better Care for Better Health’; ‘Responsible Use of Resources’; ‘Valued, Respected and Proud’. Congratulations to the following teams who have been awarded Exemplar status in April 2011 • Wards – Revalidations- D4 • Ward F6 validation

EXEMPLAR PROGRAMME - UPDATE APRIL 2011

MUSCULOSKELETAL PATHWAY(MSK) —EVENT JUNE 2011

 With the integration of hospital and community services, we now have the opportunity to redesign end to end pathways to improve the patient’s experience, reduce duplication of steps and frustration for staff. The redesign of the musculoskeletal (Orthopaedics) pathway is one of the Trust’s key priorities for 2011 / 2012. Week commencing 13th June there will be a Value Stream Analysis event to commence this work-stream. Please contact Helen Arnaud, event team lead for more information or come to the BICS outbrief on Friday 17th June at 11.30am where there will be a summary of achievements and next steps from the event.

Created by Debbie Carr – BICS Team – April 2011 © Royal Bolton Hospital NHS Foundation Trust 2011. All rights reserved. Not to be reproduced in whole or in part without the permission of the copyright owner

Page 6 BICS Academy

BRONZE LEVEL ACCREDITATION – JULY DATES AVAILABLE The BICS Team are pleased to offer a new date for BICS Bronze Level accreditation for July 2011. Bronze Level Accreditation is the second level of the BICS Learning and Development Academy. The course focuses on enhancing your leadership and BICS skills either to lead improvements or to be a more confident team member. It covers using tools such as A3 thinking, mapping and problem solving. It will help you to see waste and prepare for how your staff may react to change. The course provides theory, supported by practical application and examples, reflection, group discussion and sharing experiences. Should you wish to apply, please ensure you fulfil the pre-course criteria of attending Green Level Awareness and participating in at least 1 BICS event Dates available: • 19th—21st July • 20th - 22nd June (limited places still available) To apply or for further information see our Academy page on our intranet site, contact BICS@rbh.nhs.uk or phone ext. 5482

BEST PRACTICE VISIT - 14th September 2011 Would you like to learn about how leading organisations have approached service improvement and addressed the challenges that this presents?

A programme of site visits to leading companies has been set up offering the opportunity to learn from their experiences and to see improvement techniques in use in a range of very different sectors. The programme provides site tours, group discussion, sharing experiences and reflection. The programme will support your continuing personal and professional development and widen your experience and how to apply the lessons to your own workplace. The date for the visit to the Unipart Group in Oxford has now been confirmed as Wednesday 14th September. The Unipart Group employs more than 10,000 staff worldwide and has an annual turnover of more than £1billion. It is one of Europe’s leading logistics companies and a widely-recognised pioneer in the field of Lean implementation. For over 20 years Unipart has pioneered ways of engaging and empowering people at every level; called the Unipart Way. The visit will include a shop floor tour. We plan to organise transport to and from Oxford on the day.

To book a place or for further information - Phone the BICS Team on ext. 5475 or email BICS@rbh.nhs.uk

A team from Trust visited Astra Zeneca to look at how they use Lean to create improvements in designing and testing new drugs. Although a large site, departments had worked together across the value stream to create not only a new process which reduced the time spent creating and testing drugs by half, they also created a culture of really trying to understand their customer’s values.

Each area presented their improvements as we were taken around different departments on the site, describing the journey from the design of a molecule, creation of a compound, testing and finally drug approval; and it was also really interesting to see the improvement benefits attached to each area or process item that had undergone change.

The team had a great day and particularly liked the bug board (pictured) which was on the wall in all departments as a way of identifying problems which would then enable daily problem solving at morning meetings. For more information, contact Emma.broda@rbh.nhs.uk

ASTRA ZENECA BEST PRACTICE VISIT—APRIL 2011

PostImprovement

Bugs

Generalbugs

FM/IT bugs

CIideas

Current bugs

Please mark above if you suffer one of these bugs

ny unforeseen issuesas a result of recent

improvements

Ideas for furtherimprovements.

Feedback on what works well

FM/IT issues –

direct links with both groups to minimiseproblems

Work environment,

SHE, consumables

, chemical ordering,

reward/recognition etc.

Created by Debbie Carr – BICS Team – April 2011 © Royal Bolton Hospital NHS Foundation Trust 2011. All rights reserved. Not to be reproduced in whole or in part without the permission of the copyright owner

ADVANCING HEALTHCARE AWARDS FINALS Congratulations to Janet Priest and the Diagnostic neurological services, who have been short listed in the Rethinking the patient care pathway category of the 2011 Advancing Healthcare Awards for Allied Health Professionals and Healthcare Scientists.

Further congratulations to Anna Troughton who has been short-lived in the CHPO Leadership category at the same awards.

ASSOCIATION FOR REAL CHANGE CONFERENCE: Well done to Jane Leicester (physiotherapist and staff side representative) on winning the Chartered Society of Physiotherapists Representative of the year award.

NURSING STANDARDS AWARDS—APRIL 2011:

Congratulations to the Bereavement and Donor Liaison Team who won the Professional Forum Category for work undertaken in bereavement care and support for patients and work supporting donation, caring for patients and families before, during and after death. Additional recognition goes to Fiona Murphy who leads Bereavement and Donor Liaison Team, who won Nurse of the Year. This high profile accolade will bring national recognition to Bolton and the work underway to improve end of life care.

EUROPEAN FACILITIES MANAGEMENT RESEARCH SYMPOSIUM MAY 2011 Good luck to Steve Tyldsley, Operational Estates Manager who has been short listed for a prestigious award for some of the improvement work he has lead using BICS methodology, in the Laundry.

Steve will be presenting a paper at the EURO FM conference in Vienna in conjunction with Sheffield Hallam University. The paper has been recognised by Euro FM as contributing research to improving productivity within Facilities Management. The Euro FM Research Symposium have recognised that the research provides a perceptive of Lean Approaches adding value to the customer experience.

AWARD WINNERS: Page 7

Events that took place in April :

• Productive Operating Theatre • Surgical Admission Flow • Stroke Flow Problem Solving • Safety Express • Prepping of Case-notes

Phase 2 • Ante-natal Pathway

completion plan • Day Care Unit—6S

Take a look at our case study page on our intranet site for more

information on these events.

Forthcoming Events

The following events will take place in May:

• Prepping of Case-notes

Phase 3 • Daycare • IMC/BCU Bed Base

Next BICS Outbrief

Friday 20th May in the Sports and Social Club.

11.30am

Which will also feature

feedback from

• Productive Community Services

• Slot Utilisation 90 day review • Ante-natal Pathway

completion plan • Ophthalmology diabetic clinic

Contact details: BICS@rbh.nhs.uk

ext: 5482

Website:

“Bolton Improving Care System”

Staff from the hospital are putting their best foot forward to help raise further funds for the hospital’s new Children’s Unit. Now in training to take part in the Great Manchester 10 K Run on Sunday 15 May, the 15 strong team, including BICS very own Jo Bolger and Debbie Carr are raising money to buy additional equipment. Debbie Carr, Facilitator with the BICS Team said: “Jo and I both signed up for the 10K as a challenge and to hopefully get fit. Running for a cause that will benefit the hospital we work in; as well as the local children and their families who will use the facilities will hopefully spur us on to reach the finish line!”

Currently under construction, the new children’s unit is expected to open in late 2011 and will include comfortable single rooms affording additional privacy, a new Children’s Assessment and Observation Unit (PAOU) and a dedicated Adolescent Unit. In an effort to provide the most comfortable and modern setting for children, young people and their visitors, the new unit will provide areas for families such as play rooms. Funds raised by the running team will help facilities like these to be developed in the hope that children will feel more at home and less anxious about their treatment. Jo Bolger, Senior Facilitator said: “We need all the support and sponsorship we can for this great cause and want to encourage staff and residents of Bolton to fundraise for their local hospital. So please sponsor the Royal Bolton Runners by visiting our sponsorship website www.bit.ly/royalboltonrun

PLEASE SUPPORT THE ROYAL BOLTON RUNNERS!