Measuring for improvement
NHS Ayrshire and Arran
Kirsty Murray
Programme Manager, Service Futures
Aim:
• Background – Where we are now
• Engagement and Partnership approach
• Sustainability process for data collection
• Operational example of using data for
continuous improvement post 90 day report out
Corporate Programme Office
Doing the Right
Things
Effectiveness
Portfolio
Capability
The right things to do?
How are we doing?
Can we do it?
Can we adopt it?
Run the Business
Programme
Outcomes
Benefits
Business as Usual
Processes
Project
Outputs
Deliverables
Doing the things
Right
Efficiency
How do we do it?
Lets do it the same way
Functions and Services
Corporate Programme Office
Portfolio Functions
Delivery Functions
Strategy Support
Prioritisation
Benefits
Management Dashboards
Governance support
Oversight, scrutiny and challenge
Flexible resource pool
Capacity Planning
Resource Management
HR Management
Contract Management –
external resources
Facilitate programme or
project start up - Workshops
Tools and Techniques
Workshops
Standards
Training and Coaching
Assurance
Good Practice
Knowledge Management
Tools
Consultancy
Engagement and Partnership Approach
• Corporate Programme Office approach:
• Performance
• Knowledge Management
• Finance
Proposed 30 day Sustain Process
Sustain Measures Collection Process
Kaizen Week
KPI Matrix &
Owners
1. KPI Owners
Collate Weekly
Updates
Wed - Tues
2. KPI Owners
Send Weekly
updates to
Business
Intelligence
3. Business
Intelligence
Place Weekly
Updates
on Athena
every Tues.
every Wed.
Weekly Sustain Progress Review
4. Kaizen &
Service Leads
Review
Progress on
Athena
5. Kaizen &
Service Leads
Escalate &
Resolve any
sustain issues
6. Kaizen &
Service Leads &
Finance Quantify
Benefits from
KPI’s.
7. Service Leads
& Performance
Develop
Scorecard
template
every Thurs.
9. Service manage
Performance by populating
Scorecard template
ongoing & regularly
reviewing & updating ICMB
8. Handover from
Kaizen Project to
Business as Usual
at 30 day point.
Proposed 30 day Sustain Process
•
Outputs from Kaizen Week:
•
During each Kaizen week a matrix of KPI’s will be created by the teams along with a list of Actions to
be undertaken during the sustain period. The KPI matrix will reflect the process level measures being
effected by the improvements being made during the week and to be sustained afterwards. This will
be the evidence of improvement and indicate where the benefits are.
This matrix also includes ownership for collection and reporting of each measure during the sustain
period. This will form the Scorecard to be reviewed throughout the sustain period by the Change
managers and kaizen team members.
•
Proposed 30 day Sustain Process
Sustain Measures Collection Process
1. KPI Owners
Collate Weekly
Updates
2. KPI Owners
Send Weekly
updates to
Business
Intelligence
3. Business
Intelligence
Place Weekly
Updates
on Athena
•
•
The owners identified from the Kaizen week will continue to collate
the appropriate measures to inform the wider team of the progress of
the sustain effort. These should be collated by the Tuesday. of each
of the post Kaizen weeks.
•
The owners can then send via email their weekly update values to
the responsible Business Intelligence team members every Tuesday.
This is a simple text email containing the Measure reference number
and that weeks recorded value.
•
Every Wednesday the Business Intelligence team members then cut
& paste the relevant updates from the emails into a master Matrix
held on the Ayrshire & Arran intranet Athena for all staff members to
view.
Exactly the same process is followed for any Sustain Action list
updates, allowing them to be viewed on the List master held on
Athena.
Proposed 30 day Sustain Process
Weekly Sustain Progress Review
4. Kaizen &
Service Leads
Review
Progress on
Athena
5. Kaizen &
Service Leads
Escalate &
Resolve any
sustain issues
6. Kaizen &
Service Leads &
Finance Quantify
Benefits from
KPI’s.
7. Service Leads
& Performance
Develop
Scorecard
template
•
Every Thursday a progress review can be held to assess the latest
Sustain measures and Actions from Athena. Progress can be seen
and discussed easily without being the responsibility of a single
individual to collate and distribute updates.
•
The responsible Kaizen and Change Leads can then concentrate on
managing by exception and focusing on driving progress minus the
administrative workload.
•
The easy access for all to the Performance measures allows the
Change Leads and Finance to assess and quantify Benefits arising
from the improved processes.
•
Upon completion of the 30 day Sustain period the Service need to
assess which of the measures are required to be collected and
reviewed on an ongoing basis. The further collection effort requires to
be defined and supported by the Service and a Scorecard agreed to
form part of business as usual Process Performance Management
cycle.
Proposed 30 day Sustain Process
8. Handover from
Kaizen Project to
Business as Usual
at 30 day point.
•
9. Service manage
Performance by populating
Scorecard template
ongoing & regularly
reviewing & updating ICMB
•
•
•
•
Also upon completion of the 30 day Sustain period a formal
Handover is required to recognise the transition from Project
mode to Business as Usual mode. This would be done after the
30 Day Report out at a meeting arranged with the relevant Leads.
•
•
The Service should now have a Scorecard and
Mechanism by which to measure and manage the
performance of the process.
This ongoing activity can feed further requests for
Evidence of Improvement and Benefits to any requestor
especially the ICMB forum.
RISKS & CHALLENGES:
Service staff commitment to continued measure collection and reporting during and after
sustain period.
Organisational boundaries impacting the ability to collect measures across pathways.
Ability to automate measures to ease the Performance Management effort.
The process changes . . .
•
•
•
•
•
Electronic White Board in MAU and A&E
Development of APN on SYMPHONY A&E System
Improved Patient Flow Reporting
Full representation at Daily Patient Flow Meetings
Friday Consultant Specialist Reviews in AMU
The process changes
•
•
•
•
•
•
Daily MDT White Board Meetings
Rapid response home rehab pull
Improved Escalation Protocols
New patient allocation system
Right people engaged and involved
Process in place
The impact
•
•
•
•
•
Continuous improvement to the process
Data collection for process changes remains challenging
Sustainability/BAU remains a challenge
Underpinning a reduction in beds on both main sites
Sustained CRES
Performance Changes
• ALOS Reduced:
• At 90 days sustain (Medicine Wards):
– Ayr ALOS decreased from 4.6 Oct 09 to 4.4 Oct 09
– Crosshouse ALOS deceased 4.4 Oct 09 to 4 Oct 10
• Reduced Boarding – see Graph
Crosshouse Hospital Medical Boarders 2008 - 2011
1000
900
800
700
2008
Total
600
2009
2010
500
2011
400
300
200
100
0
JAN
FEB
MAR
APR
MAY
JUN
JUL
Month
AUG
SEPT
OCT
NOV
DEC
Challenges remaining
• Process data collection remains
challenging
• Sustainability/BAU remains a challenge