WBS health research and SLIM
Ruth Davies
Health Research in WBS
Ann-Christine Frandsen: Where practices of Accounting and
Medical care meet
Simona Scarparo: Health care management, clinical governance,
organisational change;
Wendy Currie, David Finnegan: Integrating health care with
Information and Communication Technology
Yasmin Merali: Complexity and transformation of organisations
Davide Nicolini: practice-based approaches to the study of
knowing, learning, and change in organisations;
Jacky Swan: the implementation of innovation in health care,
Kathy Kotiadis, Antuela Tako: Using conceptual models to develop
simulation models of treatment processes;
Giles Hindle: Soft systems approaches to solving problems;
Paul Walley: Lean approaches to health care systems
Rhian Silvestro: Workforce scheduling
WBS
Strategic Lean Improvement Methodology SLIM
WIMRC
Introduction to SLIM
Strategic Lean Improvement
Technology
Start Date – April 2008
Funding
Warwick Innovation Manufacturing Centre
(IMRC) funded by EPSRC
Length 3 Years
WBS
Strategic Lean Improvement Methodology SLIM
WIMRC
SLIM Team
Professor Ruth Davies (PI), WBS
Professor Matthew Cooke, WMS
Dr Neil Davis, WMG
Dr Zoe Radnor, WBS
Nicola Burgess (RF), WBS
Claire Worthington (RF), WBS
Cathy Keay (research coordinator, P/T), WBS
WBS
Strategic Lean Improvement Methodology SLIM
WIMRC
Aims
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.
WBS
Strategic Lean Improvement Methodology SLIM
WIMRC
Research Questions
Overall, to what extent do improvement methodologies and
modelling activities have 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?
WBS
Strategic Lean Improvement Methodology SLIM
WIMRC
Longitudinal case study in a Hospital Trust
Areas of simulation application to the lean
process
Level of simulation needed
Identification of issues and benefits from
using simulation in the lean process
Evaluation
WBS
Strategic Lean Improvement Methodology SLIM
WIMRC
Acute Medical Unit – project 1
Case study on emergency flow
Apparent goal: simplified patient flow &
queue reduction
‘As is’
Arrival
A&E
AMU
Ward
‘To be’
Arrival
WBS
A&E
AMU
Ward
Strategic Lean Improvement Methodology SLIM
WIMRC
WBS
Strategic Lean Improvement Methodology SLIM
WIMRC
WBS
Strategic Lean Improvement Methodology SLIM
WIMRC
Activities
Observed and annotated SLIM workshops
Gathered data from the hospital
Developed simulations that were well received by
Trust and Lean facilitators
Evidence of hospital management’s recognition of the
benefit of using simulation
Project “signed off” with extra trolleys in AMU
Evaluation of project using interviews.
WBS
Strategic Lean Improvement Methodology SLIM
WIMRC
Case Studies of Eight Acute to determine use
and benefits of Lean and Modelling
Analysis of Annual Reports, Annual Plans and
websites of 172 Hospital Trusts in England
Supported by:
- Geographical and regional density data
- Population characteristics; size, age, health
- Healthcare Commission Health check Scores 2008
- Mortality rates
- Any other media
WBS
Strategic Lean Improvement Methodology SLIM
WIMRC
WBS
Strategic Lean Improvement Methodology SLIM
WIMRC
Emergent Levels/Stages of Lean
0 = Term ‘Lean’ not used but terms such as service redesign and waste are
cited/prospective Lean
1 = Productive Ward only/Few RIES (less than 3)
2 = Few Projects/Multiple RIES
3 = Multiple Projects/Lean Academy
4 = A systemic approach eg. ‘The Blackpool Way’
5 = A Lean organisation
WBS
Strategic Lean Improvement Methodology SLIM
WIMRC
Our sample of 8 Trusts
Trust
Population
Characteristics
Level of
Lean
HealthCheck Scores
Oct o8
University Hospital
of Coventry &
Warwickshire
Industrial area;
Large Trust
3
Quality of service = Good
Use of Resources = Good
East Lancashire
Hospitals NHS Trust
Industrial area;
Large Trust
2
Quality of Service = Excellent
Use of resources = Good
Princess Alexandra,
Essex
Suburban;
Medium Trust
3
Quality of Service = Good
Use of resources = Good
Basingstoke and
North Hampshire
Suburban;
Medium Trust
0
Quality of Service = Excellent
Use of resources = Excellent
WBS
Strategic Lean Improvement Methodology SLIM
WIMRC
Our sample of 8 Trusts cont…
Trust
Population
Level of
Characteristi Lean
cs
Royal Bournemouth &
Christchurch Hospital
Coastal, tourist.
Large trust.
1
Quality of service = Good
Use of Resources = Excellent
Blackpool, Fylde and
Wyre Hospitals NHS
Trust
Coastal,
Tourist,
Medium trust
3
Quality of service = Fair
Use of Resources = Excellent
Royal Devon and Exeter
NHS Trust
Small City,
elderly;
Medium trust
2
Quality of service = Excellent
Use of Resources = Excellent
Scarborough and North
East Yorkshire
Coastal, elderly; 1
Small trust
WBS
HealthCheck Score 08
Quality of service = Weak
Use of Resources = Weak
Strategic Lean Improvement Methodology SLIM
WIMRC
Activities
Continuing analysis of database
Interview schedule designed
Current case study – Coventry
Further Trusts contacted for future analysis
WBS
Strategic Lean Improvement Methodology SLIM
WIMRC
Summary
Considerable Health Research activities in WBS
SLIM is multi-disciplinary, funded by WIMRC
Evaluation of Lean and Modelling in the Acute Hospital
Trusts
Development of Modelling Tools to support Lean
activities.
WBS
Strategic Lean Improvement Methodology SLIM
WIMRC