Laying foundations for transformation

 The Children’s Hospital in Birmingham is no different to any other hospital in the United Kingdom in that it has a passion for giving excellent care to all that need it. Having gained Foundation Trust status in 2007, the organisation set about understanding in detail, what the needs of its patients were and how it could improve the experience for carers, patients, and staff. The hospital needed to understand how this experience could be made safer and more efficient. In the autumn of 2008, the Trust therefore embarked on a coordinated programme of change called the “Transformation Programme” and one of the first activities was to harness the talent and develop the improvement skills of its workforce. As the transformation lead, I recognised the need to recruit some outside assistance to develop the knowledge and skill of the Trust at all levels. Enrolling the Children’s Hospital on to the NHS Institutes’ for Innovation and Improvement Practice Partner Network was the first step into securing expert knowledge skill and help. The Institute is an organisation that really understands the NHS and the context in which it operates. The Practice Partner Network is where NHS organisations can be exposed to the vast range of Institute products and have the opportunity to test new ones in their own Trusts. Having tested an innovation process prototype in a previous role, I grasped the opportunity to test a new programme of work with the NHS Institute called the iLINKS programme. Representatives from both organisations met and developed a programme that included a training programme for 20 key staff. The staff chosen were already working on the first vital strands of improvement work, and attended a facilitated day where clinical and service leads were bought together to understand the local issues of demand for services, capacity to deal with them and why the Children’s Hospital was experiencing issues with the flow of patients through the hospital. The first challenge was initiated with a call for people to join the programme. Demand was high and priority places were allocated to staff completing key improvements. Before starting the course, we randomly selected 20% of all staff in the hospital and invited them to complete a survey, seeking their views about improvement and whether they had ever heard of any of the tools available. Interviewing trainees beforehand meant we understood their personal objectives for the course and their current improvement knowledge. Most had done some sort of improvement activity before and we needed to build on this.

Adding value

The course was a six-day modular course, with some bespoke elements built into the existing NHS Institute course. It covered key “lean thinking”’ principles with a specific focus on waste spotting and how we can ensure any changes in services add value to the recipients of the service. Adding value was defined by the Children’s Hospital as being about timeliness, safety, a positive experience for patients and staff, as well as being clinically effective, efficient and cost-effective. The training culminated in a celebration event where the trainees shared their improvement work with the rest of the organisation. The range of improvements were wide and varied, with examples in bed management, Productive Theatres, changes to day case flows, the setting up of a national paediatric intensive care retrieval service and general personal development. The organisation was impressed by the range and depth of the improvements that had already been achieved. Feedback on the training course by the participants was that we needed to have many more health related examples and that the trainees needed formal support in between training days to help them in their projects. Weekly improvement forums and drop in sessions have been intermittently used but the benefit of peer support, and some healthy competition for ensuring changes are made and sustained, cannot be over emphasised. The day, which was facilitated by Kate Silvester and Richard Steyn, provided an insightful look at how our systems and processes were generating the symptoms of delays in access; increasing waiting in some areas; and what had been modified recently to change how patients entered and left the Children’s Hospital. We covered some principles of “lean thinking” followed by a high level overview of what was happening with patients attending the Children’s Hospital. A lively discussion ensued and the participants left the event with more questions than answers. Some of the reflections on the day were summed up by the following: “We assume we know the answer is more beds to get what we want – no cancelled operations and no delays to admission. However, I can now see that adding more will not solve our problems… We may need more resources in some areas, but we have to understand where.” It stimulated an appetite to look at the demand and capacity issues that the Children’s Hospital faces. A steering group and a bed management group have been set up. They are using the lean methodological approach to understand the problem, get a firm grip on the current situation, clearly state what we want to achieve, develop counter measures to issues that are raised by these new ways of working, and monitor and control the process on a continual basis. The groups now have a much clearer, shared view of what the problem actually is, which is a significant leap forward. Prior to this, those involved did not readily understand the root causes of the issue of bed management and flow of patients. While we have not yet made a significant impact on the issues, we are on a journey of continuous improvement and are definitely closer to achieving our goals. The Children’s Hospital Birmingham has set itself an ambitious transformation programme but firmly believes it will succeed. Together with the improvements in service provision, it is working towards developing the ability to transform through a series of critical success factors that truly transformational organisations have followed, to achieve sustainable performance. This article focuses on the need to build capability and understanding in an organisation in order to transform.