Simon Wright Chief Executive
I was privileged to witness, and to be part of, the very first Rapid Process Improvement Workshop (RPIW) report out held within our Trust.
A RPIW is a five-day workshop which focuses on a particular process in which our staff who do the work are empowered to eliminate waste, improve the patient experience, improve their own experience and make changes that they feel are right and will be sustainable.
A RPIW is designed around the Plan, Do, Study, Act cycle. In the ‘planning’ phase we observe what really happens to our patients as they go through our services and we plan how we may improve those services. In the ‘do’ stage, we give it a go. We try changes and we are able to ‘study’ the results and try something different if the results aren’t those that we want, and then in our ‘act’ stage, we are making those changes that have been shown to give the results that we desire.
This also produces a change in thinking, an awareness that we can make successful, sustainable changes when we work together as a team.
The RPIW comes after six weeks of planning, and in that planning stage we identify the area to be our test area, our Genba. We will have identified team members, both those that will come away from their clinical areas, department areas, and work on the Plan, Do, Study, Act cycle, and those home team members who will continue their day-to-day work but working with the away team, testing those changes and providing feedback and advice on the impact of those suggested changes.
We identify a Workshop Lead and a Team Lead from the Kaizen Promotion Office (KPO) who help to maintain the methodology and the philosophy of the Virginia Mason Production System that we know works. This is a methodology that has been used for over 13 years in the Virginia Mason Hospital with significant successes. These Plan, Do, Study, Act cycles and Rapid Process Improvement Workshops are significant events in a year-long targeted improvement plan in identified areas, and in this case the Respiratory Discharge pathway.
The process involves identifying advisory members who are available during the RPIW week to advise on how changes can be implemented in a rapid way. It is important that we identify the process boundaries as this type of Kaizen event is aimed at being a ‘mile deep’ and ‘inch wide’ so we really get to understand what our staff and our patients are experiencing on a day-to-day basis: collect the data, declare the targets, communicate as much as we possibly can with the team members and wider organisation, and look to the support of the VMI sensei to guide us through the process.
The role of the Sponsor Lead is to remove barriers, motivates the teams and reminds everyone of the significant reasons and urgency of the work that is being undertaken.
Respiratory patients make up 40% of our emergency admissions to the hospital. They require on average a seven-day length of stay and so experience our services at one of the most vulnerable times of their lives when they are acutely unwell with often shortness of breath and illness which makes them extremely reliant on our services. This is a worrying time for them and for their families and we need to ensure our staff are set up with the right environment and tools to provide the service that our patients and families deserve.
It was very clear to me that the RPIW event relies on strong teams and I was extremely impressed with the performance of all the teams involved – the home time, the away team, the advisory team and the KPO team who supported and led the events. Kaizen events (the simple definition of Kaizen is ‘improvement for the better’) rely on strong teams but the whole event strengthens relationships.
Individuals who may only work loosely together come together to undertake an intensive piece of work with real emotive reasons for making improvements in just five days. In order for this to happen, as it did during the March event, silos need to come down, hierarchical walls need to be breached as people get to understand one another’s work. They get to walk in each other’s shoes, measuring in detail activity such as number of steps, the movement of equipment, following laboratory specimens through their journey, watching how a patient goes through their X-ray process. These are opportunities that do not present themselves every day to us and were wholeheartedly embraced by the Respiratory RPIW teams.
The Virginia Mason Production System which is the basis for our Transforming Care work, is totally team-based. It relies on staff members trusting each other, and creating the gold which is in the work of the team rather than individual stars.
My take away message from the week was that impressive improvements can be made by small teams in a short period of time when they share a collective and clear goal. The small team consisted of many disciplines including HCA, Consultant, Ward Clerk, Staff Nurse, who up until this week had not worked together and some did not even know each other. I can only look forward to the future RPIW’s with great excitement as we realise that together SaTH is very rapidly going to improve the existing experiences for our patients and our staff.