Tees Esk and Wear Valley NHS Foundation Trust

NHS Providers Fiona Ramsay, Senior Service Development Manager, External Kaizen Promotion Office

Aims of the presentation

• Gain an appreciation into how TEWV have applied an overarching quality improvement framework across a diverse clinical service line

• Consider how TEWV Quality Improvement System (QIS) links with the Freedom to Speak Up Report

• Consider TEWV’s position in the staff survey and the reasons for this

Context Setting: TEWV

• Formed April 2006 following merger of two successful MH Trusts

• Foundation Trust July 2008 • 6500 staff • 300 million operating income • Cover a wide geographical area • 11 CCG’s • 8 LA’s

Vision (North East Transformation System)

• Improved throughput / productivity – the same people find they are capable of achieving much more

• Improved delivery – higher quality care delivered faster • Improved quality and safety – fewer mistakes, accidents and

errors, resulting in better patient care • Accelerating momentum – a stable working environment with

clear, standardised procedures create the foundations for constant improvement

• Increased staff involvement in improvement initiatives – Enables staff involvement and participation in the development of both the change plan and in the actual implementation. The idea being that “staff know best”

Compact

• In consultation with staff, a TEWV Compact (behavioural contract) has been developed to ensure no barriers for staff to eliminate waste and non value adding work (such as loss of employment)

• The Compact is between the organisation and the staff who work for the trust and is seen as the foundation for delivering quality and improvement

The Method

• Toyota – Toyota Production System (TPS)

• Virginia Mason Production System (VMPS)

• Productive series from the Institute of Innovation & Improvement - adapted and adopted so it is not something separate to the TEWV QIS

• TEWV Quality Improvement System (QIS)

TEWV house based on VMPS house

Highest Quality, Lowest Cost, Short Delivery Time, Eliminate Waste, Safety, High Morale

Exceed people’s expectations

Elimination of waste or non value added (Muda)

Levelled Production (Heijunka) and Operational stability

Just in Time

• Just what is

needed • In just the right

amount • Just where it

is needed • Just when its

needed

“minimum resources required to do the job”

Jidoka

• 1-1 confirmation detecting abnormalities

• Separate machine work from human work

• Enable machines to detect abnormalities and stop autonomously

Vision, Compact, Values and Behaviours Model Services

Training, development and coaching

Kaizen Continuous

Improvement

Highest Quality, Lowest Cost, Short Delivery Time, Eliminate Waste, Safety, High Morale

Exceed people’s expectations

Engaging staff in the Quality Improvement

System (QIS) training and improvement

work

The method

Kaizen

RPIW

RPDW

3P

Share & Spread

TEWV Training Programmes

QIS for Admin

QIS for Leaders

QIS for Medics

Certified Leader training

KPO staff

Personal development plan (PDP) have identified goals

around involvement with QIS activity

What’s important to ensure success

• Leaders being visible • Go on the Genba – otherwise you can’t change things • Observation – leads to real understanding • The tools work but maintain fidelity to the model • Consistent leadership • Changing things doesn’t have to cost money • Test/pilot the ideas – can you evidence that they work? • Relentless consistency – “This is the way we do things

around here”

Staff Involvement

• Staff at all levels are able to be involved and engaged • “The staff know best” – it is the job of management to

give them the tools to achieve change and improvement

• The importance of standardised ways of working, which staff can change if they can prove it is better

• All staff who are certified leaders and coaches must complete an annual recertification process to demonstrate their continued involvement in kaizen activity

• Relentless focus on what is value for the customer; • Structured process to improvement; • Reduce and remove waste; • ‘Scientific’ method – use before and after measurements; • About what works on the shop floor; • Values the workforce by empowering then to make

improvements to the systems and processes they use. • Board buy in at an early stage

Lessons learned

Living our values & behaviours

Embedding the values & behaviours

• Development of the staff compact – consultative process • Trust Board workshop 2008, new foundation Trust – were

we living our values? • Key principles - needs to be led from the top, by actions

and word of mouth • Consultation with staff, governors, partners and service

users and carers – involved over 400 people face to face and others by questionnaires

• Local questions in the staff survey – Aware of values & behaviours? Colleagues / mangers abide by them?

Leadership of the values

• Design of 3-day leadership development programme for senior leaders CEO and Director involvement

• Impact evaluation with reports to the Executive Management Team

• Content - Clarity of purpose - stories, why values, how well are we doing, managing performance & wellbeing, leading change

• Induction, awareness sessions for staff, team development sessions, alignment of HR processes – e.g. recruitment, appraisal

Learning

• Impact evaluation of leadership training reported to EMT every 6 months for the first 2 years.

• Now over 500 staff trained – now training band 6s, 92% say met their expectations & identified actions as a result of attending in line with “living the values”

• Shift to productive conversations – 1-day event for managers

• Having value based conversations for staff – 2 hours

Development of Values Based Interviewing

• Stakeholder engagement essential – staff of different grades and professions, service users and carers, governors

• PDSA type approach to project, consult and test out • Bank of questions developed with model answers • Awareness raising for staff • Training for interviewers – much more probing approach,

have to know about and manage bias • Project for centralised recruitment for frequently recruited

to posts

Keeping our staff engaged with our business Talent management: What is potential? How do you know if your staff have it?

Appraisal: What is good performance? How do people know when they are performing well?

Health and wellbeing strategy

• 80% of our income is spent on staff – increasing productivity of staff in challenging times will lead to sustainability

• Wealth of initiatives under one strategic approach – Induction for staff and managers – Staff retreats, Staff psychology service, Employee support

officers, mindfulness service, pre retirement programme, Rapid access to physiotherapy, staff choir, stress busting events

– In development : mid career reviews, events for staff who have been bereaved

Freedom to Speak Up Review 2015 (F2SU)

Sir Robert Francis QQ

Freedom to Speak Up Review • Sir Robert Francis QC – Independent Review February

2015 • Looking into creating an open and honest reporting

culture in the NHS • Several recommendations and principles • Of the 20 Principles QIS assists with working towards

the achievement of 12 of them.

Principles of F2SU 2015

• Principle 1 – Culture of safety Patient safety alert, stop the line • Principle 2 – Culture of raising concerns Stop the line, ideas forms, RPIW week • Principle 3 Culture Free from Bullying Staff survey, process mapping , genba walks • Principle 4 Culture of visible leadership Genba walks • Principle 5 - Culture of Valuing Staff Ideas forms, RPIW week, 3P, compact

Principles of F2SU 2015 • Principle 6 – Culture of Reflective Practice PDSA, 30/60/90, PDP process, visibility wall • Principle 10 – Training Staff induction, compact, ideas forms, PDSA, PDP, 1:1 supervision • Principle 13 – Transparency Service user and carer involvement, TPR, process, visibility wall, mapping, genba • Principle 14 – Accountability TPR, 30/60/90, Genba, visibility wall, sponsor and process owners

Principles of F2SU 2015 • Principle 15 – External Review Sensei visits • Principle 18 – Students and trainees RPIW attendees • Principle 19 – Primary Care Dementia collaborative, Darlington Long Term conditions

QIS and F2SU culture of safety

Francis talks about raising concerns as a normal activity and getting away from the blame culture and making spotting of safety issues part of what we do. He cites examples from Virginia Mason Production System. Within this “everyone plays a part in contributing to the safety culture and the quality of care provided”.

QIS and F2SU culture of coaching

• Within TEWV we focus on developing the self and others using coaching techniques.

• Pay attention to the innovations that happen on the frontline

• Close enough to the work that they are doing • Learning lessons - 4th in the DoH Learning from Mistakes

League in the country

QIS and F2SU culture of leadership • Visible leadership is integral to the QIS work we do and

enables us to carry out our kaizen (continuous improvement) activity successfully.

• Trust leadership and management development programmes are being reviewed taking into account our ambition to embed the world class management modules and everyday lean management module from the QIS.

• In addition, a bespoke Trust induction programme would be established for any staff being appointed to their first managerial post in TEWV, irrespective of seniority of that post.

QIS and F2SU culture of engagement

Staff engagement survey – ranked independently as the best for 4th year running • Consistently high but gap between TEWV and 2nd place

has got bigger • TEWV’s improvements have been sustained when

organisational pressures are greater than ever– we believe QIS is part of this consistency

Staff Survey - Local Questions & Recent Results

• 86.9% of staff are aware of the compact and of these 96.1% of staff believe that the compact is being adhered to by colleagues and 89.3% of staff believe that the compact is being adhered to by the Trust

• 98.2% of staff are aware of the Trusts values and behaviours statements and of these 94.3% believe that their colleagues work by them and 89% believe that their senior manager works by them.

The above results have continued to improve year on year and the QIS has certainly played its part in bringing this situation about.

Final Questions