LEAN
L Beyond Lean
ean, in healthcare, means effective, efficient, and patient-
focused but this does not guarantee affordable or sustainable. The challenge, therefore, goes beyond Lean.
Hard-pressed and potentially diminished numbers of staff will face increasing pressure to deliver greater efficiencies during organisational upheaval and less management capacity will make it crucial that services deliver by design rather than sheer dint of effort.
This requires better investment choices and optimum resource allocations whilst some of our biggest investments are in resource teams focused on keeping people out of hospital. These include community mental health services where teams include clinicians, community psychiatric nurses, social workers, support staff and other healthcare professionals.
Our goal must be to use available evidence and apply our collective experience and intelligence to design Lean (effective, efficient, & patient-focused) services that we can afford to fund and that well-balanced teams can deliver and sustain, but this is very difficult to achieve.
Health & social services are complex – they have multiple inter-dependencies, lots of variation in demand and delivery, and exhibit severe competition for and rationing of valuable resources. Unlike making cars, we cannot remove variation until robots can do our work. Wisely, we must acknowledge and work with the reality that people respond differently to treatment.
Spreadsheets, however, are very Sep/Oct 10
poor tools for handling lots of variation. Instead, simulation modelling is more helpful especially for big, high risk, expensive changes that would be difficult to reverse.
Powerful, highly visual simulation models like TeamFocus by Focused_On can help service providers and commissioners to resolve big, intractable problems and deliver breakthrough solutions. Indeed, the structured, analytical approach itself often proves to be very valuable in understanding your patient flows as you see the process dynamics of patients waiting to be assigned to the most appropriate teams and whether or not their needs can be met promptly.
Using the model itself can then help you to identify and isolate critical issues such as staff availability or skill mix that constrain your patient flow; quantified demand / capacity constraints can quickly help you to determine a more optimum blend of staff, the functions they offer and the amount of care they can deliver or you may choose to change the referral criteria they can accept or redefine the amount and
duration of care patients need and whether multiple episodes are likely.
In TeamFocus, a team might accept patients of working age or older people or other criteria. They flow through 3 phases: red (stabilise), amber (treat), and green (discharge) and, in the case of CMHS, some patients can transition from one cluster to another during treatment; patients entering psychotic crisis might transition between several clusters and built long journey times before being successfully discharged.
A team’s caseload will flex as patients progress through the 3 phases of care.
Case mix will vary across the teams, reflecting the criteria they accept and the clusters of care they are capable of delivering.
Such evidenced insights allow you to imagine solutions to the critical issues and you can safely test your ideas in
FOR MORE INFORMATION
Steven J Burnell (FCCA) Director E:
Health@Focused-On.com W:
www.focused-on.com
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your simulation flowmodel and so gain consensus across the different professions. together, you can implement your preferred solution with confidence and go on to find new ways of becoming even ‘leaner’.
Remember, simulation is a planning tool so don’t lose sight of your overall objectives and don’t get caught up in every detail and eventuality - your model should always ‘represent’ your system but never ‘replicate’ it.
Good quality data is important but don’t let this stop you from getting started – a well designed model will allow you to re-calibrate your assumptions as better evidence becomes available which could include the considered, collective opinion of the experienced professionals who deliver the service.
So, most important of all, get clinical input from day one – this is essential.
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