Pages: 3

Quality improvement is an important consideration for all health and social care organisations. Rapid Process Improvement Workshops (RPIWs) are one method of focusing quality improvement efforts on processes in health or social care. They are not the only way of applying Lean principles to quality improvement, but they are useful in the right circumstances. This book describes their role and provides information and advice on their practical applications. This chapter describes the structure of the book and the content of each chapter.

Pages: 15

This chapter describes the application of Lean in Health and Social Care Services. All care services have many processes and aim to be as efficient as possible to avoid delays and errors in care. Demographic changes in many countries increase demands, as do developments in care. Lean is one approach to quality improvement in care services and there is evidence of effectiveness in many settings. The principles of Lean are discussed in the context of care services including value and waste; continuous flow; levelling to balance capacity and demand; and multi-process operations and multi-skilled workers. Methods of building quality into a system are reviewed including 5S, Error-Proofing and Standard Work. The chapter notes the importance of basing quality improvement work on good measurement, staff and patient engagement, and the use of Plan-Do-Study-Act cycles.

Pages: 13

Rapid Process Improvement Workshops (RPIWs) are a widely used approach to quality improvement. Workshops usually last one week and require a planning phase. RPIWs require considerable resources and the chapter considers when they are appropriate and when other options such as continuous improvement, shorter kaizen events or 3P events may be preferable. Key roles in an RPIW are described including facilitators, Process Owner, Sponsor and staff participants. A format for a Scoping Meeting to decide on the remit and requirement for an RPIW is suggested and a possible agenda is provided. Methods for promoting and supporting staff and user involvement are discussed. The ethos of an RPIW is important and the need for respect for staff and honest engagement is emphasised. Examples of a Project Form and a sheet that can be used for planning an RPIW are included.

Pages: 26

Good preparation work is essential for a Rapid Process Improvement Workshop (RPIW) to have the best chance of success. This chapter discusses observations of the process that is being targeted for improvement. Analysis and recording methods are presented including Direct Observation Records, Process Work Sheets, Work Combination Records and Work Balance Charts. The importance of measurements including Lead Time, Cycle Time and Takt Time is reviewed. It is important to engage staff and to obtain their views and Ideas Forms, and Waste Wheels can contribute to this. Value Stream Maps are a valuable method for summarising and sharing information, and guiding the targeting of improvement action. Their construction and use is described.

Pages: 5

Process mapping is a very useful team activity. Often no one is aware of the whole process, even when working in the same clinical team. Mapping a process with a team allows them to share their understanding and come to an agreement on the current process. The activity works best with two facilitators and when done in person, but the method can be adapted for online use if required. A Swim Lane diagram is commonly used and the chapter sets out how to construct a diagram and gives a worked example. A key part of the role of the facilitators is to ensure that everyone can contribute and that the true picture is presented, rather than obtaining a description of how people would like the service to run. Keeping the tone of the session respectful and focusing on the process rather than on individuals are essential.

Pages: 6

Rapid Process Improvement Workshops (RPIWs) need thorough planning. This chapter describes a four-meeting process in the run-up to an RPIW. The content of each meeting is described, together with the documentation that should be available for each meeting. Roles in the planning meetings are noted, and the importance of keeping staff and Advisory Group members updated and involved is emphasised. The Target Metric Report is introduced. Preparation for the post-RPIW phase should start before the event and it is important to support the Process Owner and to ensure that they are comfortable with the data and the plans.

Pages: 4

In a Rapid Process Improvement Workshop (RPIW), attention to detail is required. The housekeeping and arrangements around the event should go as smoothly as possible to reduce distractions and interruptions from the improvement work. Checking on room arrangements and setting up the layout, the day before the event helps. It is useful to check any janitorial arrangements and the usual issues such as anticipated fire alarm tests. The chapter suggests a room layout that can be used. The equipment required will depend on the available kit from the organisation and the core items required are noted. Catering arrangements will also vary by the organisation and venue and any current infection control restrictions. A layout for the data used in the event is identified and final checks suggested.

Pages: 9

Rapid Process Improvement Workshops (RPIWs) are a new experience for most participants. The event facilitators have an important role in guiding participants through the process, helping them to feel comfortable and ensuring that they are able to contribute. The chapter describes the flow of a typical first day on an RPIW. It includes a discussion of how to engage staff and to ensure that senior people do not dominate the event. A suggested teaching plan on Lean materials is included and recommended reading is provided. The chapter emphasises the importance of modelling behaviour including good timekeeping, respect and engagement.

Pages: 11

Day Two of a five-day Rapid Process Improvement Workshop (RPIW) is important. Day One is largely concerned with information sharing and teaching. Day Two needs to bridge the gap to action and must shake off any passivity that may have taken hold on Day One. Participants have an unusual opportunity to make substantial evidence-based changes to their service and the facilitators must support the team to make the best of the chance. The team will create their preferred Future State and break up the tasks into workstreams. Team members are allocated to workstreams that best fit their interests and skills. Workstream allocations are temporary and people may move between workstreams when their skills are required by another group, and will move to a new task when the original workstream is complete. Workstream groups update other groups on their progress. Testing out ideas using Plan-Do-Study-Act (PDSA) cycles and involving the clinical or other relevant service team is essential. The chapter discusses timekeeping and how to check on team engagement, providing support as required. Prioritisation of ideas is reviewed, and a structure for the day is suggested.

Pages: 5

Days three and four of a five-day Rapid Process Improvement Workshop (RPIW) are when most of the practical change activity takes place. The role of the facilitators is to support this work and to make it as effective as possible. Workgroups may need to be closed or created as work is completed and new work is undertaken. Ensuring that people feel able to speak, that their ideas are taken seriously and that they can contribute to change is essential. The wider staff group should be engaged and involved in the tests of change. As the week progresses, the facilitators must support the Process Owner so that they are ready to take on the responsibility for the maintenance of gains and support for further changes after the RPIW. The group can also begin to prepare to report back on their work.

Pages: 4

The final day of a Rapid Process Improvement Workshop (RPIW) is an opportunity for the team to tell the story of the work they have done and to share it with colleagues. Organisations do this in different ways, but letting everyone who has taken part in the RPIW speak in the presentation is a good way of showing the importance of their work. Some staff will not be used to presenting and rehearsals are helpful. The chapter describes a possible timetable for the session and outlines the content that could be presented. The conduct of the presentation and of a question and answer session is discussed, and the final steps with the team are reviewed.

Pages: 3

The post-Rapid Process Improvement Workshop (RPIW) phase is important. The quality improvement effort does not end when the event concludes. The facilitators should meet with the Process Owner to check their understanding of the work and to seek to resolve any outstanding issues. The best results are obtained when the whole team uses the RPIW improvements as a base for further improvement work. Daily Management can help to embed change and to support further action. Data is useful when it is used routinely and contributes to further improvements. Regular updates on progress for six months to a year after the event help to maintain progress. They are an opportunity to celebrate gains and to seek senior support for any barriers that have emerged since the RPIW, which cannot be resolved by the clinical team.

Pages: 9

Rapid Process Improvement Workshops (RPIWs) have a greater impact when they are part of an organisational approach to quality. This chapter discusses strategy deployment and ways of aligning improvement activity with organisational priorities. The value of a Daily Management system is reviewed and components including Leader Standard Work, metrics, visual management and problem-solving are considered. An example of a status update form is provided and sources for further information on management systems are suggested. The importance of Leadership is examined, and suggestions are provided for leadership at an RPIW.

Pages: 3

Rapid Process Improvement Workshops (RPIWs) can be applied in all health and social care settings. When the circumstances call for a detailed investment of time in a health or social care process, then taking a systematic, structured approach to an RPIW can pay dividends. Maintaining gains over time is helped by recognising and supporting the key roles of managers; supporting the Process Owner to maintain improvements and to test and implement further improvements; using Daily Management methods to manage the process and to sustain team engagement; and by making it possible for staff to discuss problems openly and to participate in examining problems, generating ideas and testing solutions. Removing barriers to quality improvement work and investing in the use of data to manage systems and to generate ideas for areas of improvement are also important. RPIWs can be very successful and support change.