Delivering clinical research to make patients, and the NHS, better

An Improved Lean Service inthe Heart of England

Carly Craddock – Research Delivery Manager/CI LeadNIHR CRN: West Midlands

Why....?

• Were we providing the SERVICE that customers wanted?

• Were we providing a consistent service across our 9+ mental health Trusts?

• Funding would not increase year-on-year so how could we manage capacity?

• Started in 2006 - were we doing things because “that’s the way its always been done”?

First Steps….Staff training event (one day)

• Who are our customers/stakeholders

• Principles of ‘lean’ and tools

• Identify areas for improvement

• Ownership

• Action

• VISION

Getting Used to the Idea….• Application in the workplace

The Need for Facts! To address the questions raised

earlier….need facts.

• Small (8 people) working groups of stakeholders to map out current and ideal processes for 3 stages of process

• Project briefs for managing expectations of time and commitment

Current Flow time = 154Workingdays

Ideal Flow time = 95 Workingdays

What happens 80% of the time?

Making the improvements….• Its not measured nationally so data collection

locally

• Suggestions from staff about their work

• Ownership & accountability (time for consultation)

• One month from current to ideal process and regular TCs

• Team-wide rollout

• Measure & feedback

Actual set-up time (Nov 2013)

95Working

days

A reduction of38%

Embedding Improvement• Written guidance & visual aids

for all three stages

• Inductions

• Staff supervisions and appraisals

• On-going reviews

• On-going training

• Culture/coaching for trial and error

• Personal and organisational learning – not blaming

Snowballed….• Publicity – recognising it as an

improvement project

• Sharing of experience/tools

• Providing training

• Input in to NIHR national CI Steering group

• Won an award

Impact – The Staff

• Own their service delivery

• New ideas, capture knowledge & share expertise

• Culture

• Develop routines therefore attend to unusual/complex studies

• Development opportunities = CV

• A Manager who wants the team to be the best it can (not necessarily THE best!)

• Pride & making a difference

Challenges• What works in one place may not fit

another

• Change fatigue

• Managing resistance

• Trusting people to act

• Balance standardisation with innovation/autonomy

Since Then….Nationally• NIHR CRN Reorganisation/re-structuring

• From Lean to Continuous Improvement

• National remit to develop and sustain a culture for continuous improvement

• 15 X Continuous Improvement Leads

• National Leader to drive it forward

• Developing sustainable, cost-effective training & mentoring

• Project registration form

STAFF EMPOWERMENT ON A LARGER SCALE

Since Then….West Midlands

• Existing/past projects

• Identify expertise in the region

• Steering group/advisers

• Meet the CI team communication

• Communication in newsletters

• Capitalise on national initiatives (NHS Change Day)

Since Then….West Midlands• Starting point – survey (TNA)

• Who are we reaching

• Personal contact

• Cultural survey to inform a strategy

• Training and follow-up events to discuss projects & access support

• Awards for Bright Ideas

In Summary:My Reflection

• Embed in/link to the values of the organisation(s)

• Capitalise on interested/keen people

• Don’t assume staff understand who the customers are and their demands of the service/ recognise the service offering ‘bigger picture’

• A continuum between practical experience and knowledge of tools, and knowledge of theory

• Make it easier for people – provide the tools

• People can choose the tools/methodologies they feel comfortable with using (and not tool overload)

• Improvement happens all the time – just not defined, measured and shared

In Summary:My Reflection

• Be realistic of limitations (e.g. Network, NHS IT systems, nature of the job role)

• Balance between collection of data and measurement overkill

• Being a complex organisation and limited direct management – take time and start with where do have direct management

• Don’t rely on written comms! Have those conversations – it takes time

• Training to deliver or identify a project?

• Bottom-up and top-down required

• Encourage people to give it a go!

Contact Carly

Carly.Craddock@bsmhft.nhs.uk