It started with a tweet.<\/p>\n
08:17 [JG] The NHS is its people. If you lose them, you lose the NHS.<\/em><\/p>\n 09:15 [DO] We are in a PEOPLE business – educating people and creating value.<\/em><\/p>\n Sun 6th October<\/strong><\/p>\n 08:32 [SD] Who isn’t in people business? It is only people who buy stuff. Plants, animals, rocks and machines don’t.<\/em><\/p>\n 09:42 [DO] Very true – it is people who use a service and people who deliver a service and we ALL know what good service is.<\/em><\/p>\n 09:47 [SD] So onus is on us to walk our own talk. If we don’t all improve our small bits of the NHS then who can do it for us?<\/em><\/p>\n Then we were off … the debate was on …<\/p>\n 10:04 [DO] True – I can prove I am saving over \u00a3160 000.00 a year – roll on PBR !?<\/em><\/p>\n 10:15 [SD] Bravo David. I recently changed my surgery process: productivity up by 35%. Cost? Zero. How? Process design methods.<\/em><\/p>\n 11:54 [DO] Exactly – cost neutral because we were thinking differently – so how to persuade the rest?<\/em><\/p>\n 12:10 [SD] First demonstrate it is possible then show those who want to learn how to do it themselves. http:\/\/www.saasoft.com\/fish\/course<\/a><\/em><\/p>\n We had hard evidence it was possible … and now MC joined the debate …<\/p>\n 12:48 [MC] Simon why are there different FISH courses for safety, quality and efficiency? Shouldn’t good design do all of that?<\/em><\/p>\n 12:52 [SD] Yes – goal of good design is all three. It just depends where you are starting from: Governance, Operations or Finance.<\/em><\/p>\n A number of parallel threads then took off and we all had lots of fun exploring\u00a0 each others knowledge and understanding.<\/p>\n 17:28 MC registers on the FISH course.<\/em><\/p>\n And that gave me an idea. I emailed an offer – that he could have a complimentary pass for the whole FISH course in return for sharing what he learns as he learns it.\u00a0 He thought it over for a couple of days then said “OK”.<\/p>\n Weds 9th October<\/strong><\/p>\n 06:38 [MC] Over the last 4 years of so, I’ve been involved in incrementally improving systems in hospitals. Today I’m going to start an experiment.<\/em><\/p>\n 06:40 [MC] I’m going to see if we can do less of the incremental change and more system redesign. To do this I’ve enrolled in FISH<\/b><\/a><\/em><\/p>\n Fri 11th October<\/strong><\/p>\n 06:47 [MC] So as part of my exploration into system design, I’ve done some studies in my clinic this week. Will share data shortly.<\/em><\/p>\n 21:21 [MC] Here’s a chart showing cycle time of patients in my clinic. Median cycle time 14 mins, but much longer in 2 pic.twitter.com\/wu5MsAKk80<\/a><\/em><\/p>\n 21:22 [MC] Here’s the same clinic from patients’ point if view, wait time. Much longer than I thought or would like pic.twitter.com\/iVLTDsbG8m<\/a><\/em><\/p>\n 21:24 [MC] Two patients needed to discuss surgery or significant news, that takes time and can’t be rushed.<\/em><\/p>\n 21:25 [MC] So, although I started on time, worked hard and finished on time. People were waited ages to see me. Template is wrong!<\/em><\/p>\n 21:27 [MC] By the time I had seen the the 3rd patient, people were waiting 45 mins to see me. That’s poor.<\/em><\/p>\n 21:28 [MC] The wait got progressively worse until the end of the clinic.<\/em><\/p>\n Sunday 13th October<\/strong><\/p>\n 16:02 [MC] As part of my homework on systems, I’ve put my clinic study data into a Gantt chart. Red = waiting, green = seeing me pic.twitter.com\/iep2PDoruN<\/a><\/em><\/p>\n 16:34 [SD]\u00a0Hurrah! The visual power of the Gantt Chart. Worth adding the booked time too – there are Seven Sins of Scheduling to find. <\/em><\/p>\n 16:36 [SD] Excellent – good idea to sort into booked time order – it makes the planned rate of demand easier to see.<\/em><\/p>\n 16:42 [SD] Best chart is Work In Progress – count the number of patients at each time step and plot as a run chart.<\/em><\/p>\n 17:23 [SD] Yes – just count how many lines you cross vertically at each time interval. It can be automated in Excel<\/em><\/p>\n 17:38 [MC] Like this? pic.twitter.com\/fTnTK7MdOp<\/a><\/em><\/p>\n <\/p>\n This is the work-in-progress chart. The most useful process monitoring chart of all. It shows the changing size of the queue over time.\u00a0 Good flow design is associated with small, steady queues.<\/p>\n 18:22 [SD] Perfect! You’re right not to plot as XmR – this is a cusum metric. Not a healthy WIP chart this!<\/em><\/p>\n There was more to follow but the “ah ha<\/em>” moment had been seen and shared.<\/p>\n![\"20131019_TTchart\"](\"http:\/\/www.improvementscience.co.uk\/blog\/wp-content\/uploads\/2013\/10\/20131019_TTchart.png\")
<\/a><\/p>\n![\"20131019_WTchart\"](\"http:\/\/www.improvementscience.co.uk\/blog\/wp-content\/uploads\/2013\/10\/20131019_WTchart.png\")
<\/a><\/p>\n![\"20131019_Ganttchart\"](\"http:\/\/www.improvementscience.co.uk\/blog\/wp-content\/uploads\/2013\/10\/20131019_Ganttchart.png\")
<\/a><\/p>\n![\"20131019_WIPchart\"](\"http:\/\/www.improvementscience.co.uk\/blog\/wp-content\/uploads\/2013\/10\/20131019_WIPchart.png\")
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