All staff can develop methods that trim time and effort to increase rewarding efficiency gains

All staff can develop methods that trim time and effort to increase rewarding efficiency gains

Lean methodologies are fast becoming recognised as a way of driving change quickly by reducing waste and improving quality.

Cumbria Partnership trust is one of the first mental health trusts to experience first hand the difference that lean thinking can make for its service users and staff.

Results that would once have taken months have been achieved in weeks, partly because the trust was clear from the start that this initiative was about doing, not just talking.

The trust enlisted diagnostics provider GE Healthcare to help it on its journey towards sustainable improvements. Several projects have been completed, including a pilot in an acute mental health unit, a community mental health services project in the North, and a number of inpatient ward projects. The most recent project focused on inpatient admission and discharge processes, care plans, reducing length of stay, increasing patient therapeutic intervention time and improving staff morale.

Trust director of mental health Janice O'Hare says: 'This initiative is a way for us to reach out to frontline staff to empower them to make improvements in the area where they work. Our goal is to be more efficient, while improving both staff and service user experience.'

The projects were designed with patients as the focus. By consulting patients and service user and carer forums, the trust set out to gain an understanding of their experiences and needs.

The key change event of the projects was a one-week 'kaizen event', where a multiprofessional group of staff worked together to test solutions and implement change. Kaizen is Japanese for 'change for the better.' At the end of the week, a 30-day action plan was agreed to ensure progress was monitored.

In addition, the trust has made sure the changes are sustainable by having ongoing quarterly reviews to monitor improvements and ensure old habits do not emerge.

Sharing knowledge

By partnering with GE Healthcare, the trust was able to inject expertise into the projects and enable its own staff to learn new skills throughout the initiative. All the staff involved with the projects have worked with GE Healthcare, to gain hands-on experience and achieve ownership of the improvements.

For each project, the trust put in place a defined project team with members of staff who were involved in the patient pathways, led by the lean project manager.

'Lean methodology has given Cumbria Partnership trust an opportunity to understand and reduce the variations in demand and capacity in the system,' says lean project manager Moira McIntyre.

The admission process is one area where the inpatient project has had an impact. Before this project, the process involved 29 steps, 16 of which were duplicated and fraught with problems in communication and role clarity. During the kaizen week, the process was redesigned to 13 steps with no duplication, roles and responsibilities were clarified and wasted steps were eliminated.

Not only have the projects improved patient care, but staff have also felt the benefits. The energy and commitment this brings cannot be underestimated, and the associated gains in staff confidence and motivation levels are real. At the end of the kaizen event, it was the staff who reported back to the executive team to inform them of the achievements and then presented the results to their colleagues and the board. This means they truly own and believe in the changes.

Tangible results

For Cumbria Partnership trust, the results and metrics from the Beckside ward project in Barrow-in-Furness speak for themselves. Examples from this recent inpatient project include:

  • The crisis resolution and home treatment team and community mental health team members now visit the ward every day, with 95 per cent of admissions controlled by the crisis resolution and home treatment team. (The remaining 5 per cent are Mental Health Act assessments.)
  • One-to-one therapeutic time with patients has increased by 60 per cent with no additional staffing.
  • All care plans in the unit have been reworked and are now shared, the patient is involved and the plans are used as working documents using a recovery model format.
  • Patient delays following Care Programme Approach discharges have been eliminated.

Staff have achieved these results with no additional income. The lean project manager supported the care team but there have been no other changes to resource levels. The process has been about removing waste, finding creative solutions and building a higher level of quality into the patient pathway.

As a result the trust will save more than 30 hours per week of staff time, which will be used to address other clinical and support activities. Length of stay and bed occupancy data since the kaizen event indicate that the trust can save around 500 bed-days per year.

'Teams across our footprint are now discussing lean principles and are actively seeking guidance, support and facilitation in the implementation of lean both in the community and inpatient services, which indicates that lean is becoming firmly embedded in our culture as an organisation,' says Ms McIntyre. 'However, sustainability is key and momentum cannot be compromised.'

Creating a framework for success

Four key elements have helped the trust make lean principles work:

  • having top-level/executive commitment;
  • establishing an organisational framework to embed and develop lean principles in the organisation;
  • putting in place motivated staff with the skills and authority to drive through needed changes.

For more information, e-mail Moira.McIntyre@cumbria.nhs.uk