LTC Community Nursing Teams Go Lean in Lanarkshire!

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• LTC Community Nursing Teams Go Lean in
  Lanarkshire!
• Marjorie McGinty
• LTCC Programme Manager

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Aim of this session

• Not to deliver a presentation on all things lean

• Share our experience of using lean methodology
  with our LTC Community Nursing Teams
• Our first steps.

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What is lean?

• Lean is the process of identifying the least
  wasteful way to provide value to our customers.
• Value better, safer care, with no unnecessary
  delays at lower cost
• Using recognised lean tools and techniques

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Why did we use it?

• Demand for community nurses is rising
• Complexity of patient needs are increasing
• Wanted to look at what our community nurses were
  doing to see if we could eliminate waste and
  release time for them to care for their more
  complex patients

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Integrated Care Management

• a proactive approach focused on high-risk
  patients with a combination of medical, nursing,
  pharmaceutical care and social care needs.
• We use it in some localities but not all 10
• Nurses absolutely agree with the concept but..

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Testing lean

• Could lean methodology help?
• Identified two localities Blantyre and Motherwell
• Introduce the teams to principles of lean

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Approach

• Tailored to the team
• Pre event visit to the team office
• take pics of environment
• find out about team
• identify issues within the team
• Agree a date and a non NHS venue suitable to the
  team

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Training Day

• Non NHS venue
• Casual dress
• Whole team and their Service Development Manager
• Lunch in the restaurant team time

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Content of the Day

• Personal Bingo
• Introductions roles within team
• Background to lean
• Lean Principles
• 1. Specify the value for each product
• 2. Identify the value stream for each product.
• 3. Make value flow without interruptions.
• 4. Let the customer pull value from the producer.
• 5. Pursue perfection.

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Waste
7 Types of Waste Identify waste within their
team
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Waiting Waiting to speak to GPs, waiting for
prescriptions, waiting for test results, waiting
for patients Storage Patients waiting for
clinic, lab samples for testing, stocks in
clinics, dictation waiting for typing Defects
Needle stick injury, missing patient information,
wrong information communicated Excessive
Processing Re-Sticks, re-testing, multiple
assessments Overproduction Excessive
reporting, Unnecessary tests, Irrelevant
information sent out Movement working across
multiple sites, storage of consumables
in disparate
places Transportation Moving patients to tests,
patients having to attend
different depts
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5S

• 5 S Aspects of 5S within their team
• Sort separating the needed from the not-needed
• Set in order arrange needed items so they are
  easy to find and use, label items so their store
  places are easily understood by anyone, a place
  for everything and everything in its place
• Sweep Shine create a clean and tidy working
  environment
• Standardise ensure the first three Ss are being
  maintained and incorporated into everyday
  activities
• Sustain make a habit of maintaining correct
  procedures and continuously improving workplace
  conditions

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Where do we start? Glenday Sieve

• The Glenday Sieve separates procedures,
  conditions or activities, initially through the
  analysis of current volumes.
• Identify the few procedures that make up the
  high volume
• of activities
• The results of this process can be quite
  surprising as many people insist that it is
  impossible for such a small percentage of
  procedures to account for 50 per cent of the
  volume in their organisations.

Cumulative of volume Cumulative of procedures Colour Code
50 6 Green
95 50 Yellow
99 70 Blue
Last 1 30 Red
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• 6 of the items on the menu accounts for 50 of
  the orders taken on a Saturday night!

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Value Stream Mapping

• Value Stream Mapping what is it?
• Scenario to demonstrate VSM
• Identify areas to use VSM within their team

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Team Action Plan

• 7 Types of Waste
• 5S
• VSM
• Glenday Sieve
• Team decide whether to implement their action
  plan or not

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After Training Day

• Meet on mon/tues to discuss action plan
• Each team member takes on the process owner role
  for each action
• Agree timescales
• Agree communication methods between team and
  support person

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So far.

• 4 Teams have undergone training day with a 5th
  team undergoing training this week
• Feedback very positive and encouraging

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• Office environment
• Office layout
• Store cupboards
• Computer stations
• Computer files
• Caseload profiles
• Staff manuals

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• Travel time
• Allocation of visits
• Prescription collection
• Referrals pick up
• Blood samples

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• Discharge from hospital to community team
• Requests for bloods
• Prescriptions

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What staff said
Increased Confidence
Feel they have a voice
Demonstrate and provide evidence
Staff morale increased
Staff take control
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Evaluation

• Report out for each team
• What they have done
• Impact of the changes

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Blantyres Story
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Discussion

• How are nurses coping with the increasing demand
  in terms of volume and complexity of need in
  other areas?
• Is there similar work going on in other Health
  Boards?
• Have other Boards used lean methodology in
  primary care settings?