Opening Remarks
Overshadowed by the problems of confidentiality of their clients, the name and identity of the customer that hospitals have benefited from this process was for violation of the management team intends to press for his problems with the funding and efficiency.
We are in good health?
Many people in the National Health Service (NHS) recognizes that a number of important improvements in service in the pastYears, but these people also recognize that there may be many other improvements (and should) be implemented, in particular hospitals, numerous shortcomings.
This brief article is a series of projects under the National Health Service was rapidly improve the care of patients in both electoral and emergency and administrative functions. The objectives of this study were threefold:
• significant improvement in financialPerformance
• maintain or improve the quality of care
• Increase the overall experience of patients
Sound and sustainable
Before you begin, it is useful to remember that many organizations have succeeded, "Ram-raid hospitals, the low gain in the short term and sustainable improvements, which enraged the administrative staff and has lost the support of the clinical team.
Therefore, there is a balance, on the one hand, the need in the foreground,significant improvements, and secondly, the need to carry around, as the teams during the process.
Over time, we tried, a sustainable model for improving health, local authorities and described by the Council of the emergency services and other public sector organizations, based on the PRISM model:
• P - Prepare the organization
• R - Roadmap
• I - Implementation
• S - SupportImprovement
• M - Maintaining the momentum
The PRISM model uses the concepts of lean to offer, along with the most important instruments for risk management, development and management of cultural change in a framework for sustainable change in complex environments.
P - Prepare the organization
The activity of the first and most important for the implementation of PRISM model is the degree of improvement for the organization is clearly focused on the goals right. We have achieved thiswith the NHS through an exploratory meeting at the management team to discuss things like goals, the development of improvements, "fixed points" - or things will not change "impact points" - or things that may influence the success or failure of works of improvement, and also revealed that lead to improvements. It was followed by further training to identify "leaders of the process" would improve the flow.
R - Hours
After receiving theOrganization "rule" (yourself) is not an easy task, the next step in the process of alignment of the improvements we made to participate with the current value of analysis of events (for VSE) to be operated for a period of 2.5 days of effort and utilize a variety of Lean tools, program management and thinking.
The concept of the VSE is to help participants see the waste and inefficiency to help in the ongoing process of using this information toDevelop a vision of how the organization in a state of "Blue Sky" and then back to reality by creating a "realistic" future status ", which bring them closer to the" Blue Sky "as possible, taking into account the realities of budgets, resources etc.
Then the points of reference, as in the case of a group of (state) and where they want (to go the future), you can run an implementation plan.
I --Improvements
Among the later part of the PRISM model, then the team to make improvements (through a series of rapid improvement events RIE) to do - every 3-4 days and up to 4 events for improvement. For example, were led by a team of three recent EIR programs to improve
1. The use of breast reconstruction and total knee replacement, as examples of communities outside of the patient, the team initially to improve the flow through the practice targetedthat these 18 weeks in advance to meet the rule of 2007 to complete the appointments. The work led to a saving of over £ 300k and reduced the reaction time of about 7.5 months to 2 weeks under an appointment in its entirety.
2. Using examples mainly elective care, with problems resulting from an injury or emergency room, the second team to increase the capacity of the theater on time, focusing initially strengthened, started at the site from the list of Time magazine, the increase in 37%than 70%. A second advantage is that the hospital is able to work in patients over 10% without increasing the workload of staff.
3. The third team will focus on the procedure for emergencies, with particular attention to the neck "broken femur - a problem suffered mainly by elderly women who fell over - and Max Fax (pine) - and often the experience of young people fighting the influence of alcohol, where the emphasis was the reduction in the time of the DTA (decision) to admit the patientis managed, and increase efficiency. The result was the establishment of an average of 9 hours and reduced to about 3, and the ability to save lives in more than a week through a circuit of patients improved significantly.
One side of the work were some of the comments we received on our trip, including things like:
"The process is stressful, but more than any other program offers the changes we have madebefore. "
Deputy Manager (Care optional)
"Without a doubt, radically different and exciting way to improve, patients too quickly, efficiently and safely."
Director of Operations
"The work that truly integrates the improvements we've already done, but involves a fresh, high-impact approach to our traditional methods.
Service Improvement Manager
S - Keep the profit
With the improvement of health is one thing;Sustainable another and the fourth element of the PRISM model for maintaining the improvements made by an agent of change for Development (CAD), which focuses on developing technical skills and leadership of the leader "of the process responsible for himself" the management of the areas, the combination of profiles with the leadership and lean so that it best to maintain and improve the processes that have already been processed.
M - The Course
It 'important to recognize thattransform sustainable change takes time, and found that it may take up to 1 year to take root, and organizations for benefits that are possible, including equipment to become familiar with the process. This does not mean that hospitals are for one year before the situation improves, because they earn each month, in fact, means that fully realize the benefits that are measured in millions and sometimes tens of millions, while an improvementExperiences of patients and the morale of employees, requires constant attention for a long period of time.
The last element of PRISM model is to "guarantee to maintain the momentum", which aims to ensure that the organization, the benefits of a long journey to qualify further to win. These include a redefinition of the scope to improve the planning of new activities and get the agents of change "speed" and can hold events in their own right.
Without this discussiona tendency to "drift" and the people some of the old patterns of work and especially to review before making way for improvements without resorting to a rapid improvement is usually less effective and take much longer to achieve.
Concluding remarks
The NHS is brilliant significant improvements in recent years and professionals who work there are here, often with broken processes and financial and human made thing "Problems, for example, over 65% of complaints in the hospital, worked in connection with delays in the outpatient management of the reserves maintained.
Improve the experience combined with the existing tools for the NHS, in collaboration with external experts and the tools of rapid improvement, is a winning combination for the 21st Century Health Service.
In the words of one manager: "I never thought that much could be achieved in a short time, andvery professional and inspiring. "
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