SLIM
Strategic Lean Improvement Methodology
Case studies of acute trusts
The purpose of this part of the study is to evaluate the impact of Lean and
modelling in a range of Acute Hospital Trusts. This addresses the main research
question and the first sub-question. We have collated data from multiple
sources in order to develop a picture of Lean and modelling activity in the NHS
Acute Trusts across England.
Websites and annual reports were reviewed systematically for each of the 172
acute hospitals in England. We analysed the narrative and content of published
Annual Reports and Trust websites using a number of search strings (Lean;
waste; productive ward; releasing time to care; simulation; modelling). The
results of the search have been captured in a database together with
demographic data including: the size of the population served, the nature of the
region i.e. rural, city, coastal and, the characteristics of the population where
possible. We included universal information related to the Hospital Trust such
as the performance scores from the Healthcare Commission’s annual health
check (ACC) and other characteristics relating to performance and service
improvement activities from official sources including the independent Dr
Foster Research and Monitor (Independent Regulator of NHS Foundation
Trusts). The database holds information relating to all Hospital Trusts in
England.
We have identified a sample of Acute Trusts to be used as case studies that
represent: a geographical spread across England; a range of performance
scores; a diverse set of population characteristics; a range of inferred maturity
in terms of the extent of lean activity and inclusion of those using simulation
and modelling techniques to assist with planning decisions and redesign. The
case studies are being undertaken in ‘matched’ pairs with NHS Trusts of similar
size, population characteristics and levels of lean activity to help to validate our
findings.
The interview questions have been designed and the case studies are
underway.
North
West
Yorkshire
and the
Humber
Devon & Exeter
And
Scarborough
East
Midlands
South West
West
Midlands
Bournemouth pair
Blackpool
East of
England
South
Central
South West
London
Professor Ruth Davies (PI), WBS
Professor Matthew Cooke, WMS
Dr Neil Davis, WMG
Dr Zoe Radnor, WBS
Nicola Burgess (RF), WBS
Vacancy (RF), WBS
Cathy Keay (research coordinator, P/T), WBS
The aim of the research will be to: determine
what approaches, encompassing both
improvement methodologies and modelling,
are effective and sustainable within a health
care setting in enhancing patient
investigation, treatment and care processes.
Research Questions
Overall, to what extent have improvement methodologies
and modelling activities had an impact on hospital
performance, in particular, on patient flow?
To characterise the nature of complexities/interactions within
the system in relation to Lean methodologies.
What level of model abstraction is required to identify
effectively the systemic interactions in relation to
the Lean methodologies?
To consider how modelling can support the identification and
subsequent sustainability of Lean methodologies?
Simulation model of the AMU process in a participating NHS Trust
Prospective Study
The purpose of the prospective study is to determine whether
modelling can be used in conjunction with lean processes to
improve patient flow. This innovative approach will be
developed and evaluated in the context of the Lean programme
in a local Acute Hospital Trust.
In this part of the study, we are following a number of Lean
projects and are introducing models as the projects progress.
We are evaluating each project after “signing off”.
North
East
Univ. Hospitals of Coventry and
Warwickshire
Pair
East Lancashire
Funded by WIMRC, from EPSRC, April 2008 – April 2011
The first two projects were concerned with the function of the
AMU in two acute general hospitals. Members of the team
observed facilitated workshops when they ran (mainly weekly).
We developed simulations of the system to assist the process.
One is shown above. When these Lean workshops finished we
conducted interviews to evaluate the Lean process and the
perceived benefits of our modelling.
A further project concerns the screening and treatment of Cystic
Fibrosis.
Princess Alexandra pair
Basingstoke
South East
Coast
Map showing locations of case studies
We are reviewing the process and methodology of this part of
the research with a view to extending the number of Trusts
involved and to consider how we evaluate our activities in a
systematic way.