Getting better all the time

I have been delighted to spend most of today in the highly pleasurable company of 25 committed people working in the opthalmology team at Leeds Teaching Hospital Trust. We were working on how to improve the patient experience in their department, with me volunteering my time to the process as a patient representative.

I was delighted to be involved, having been fairly vociferous about the weaknesses (whoops, improvement opportunities!) that I came across during my recent journey through their system (not opthalmology though). Not being one to just complain (and I nearly lodged a formal complaint at one time, before realising that complaining would only lead to effort being committed to investigating my complaint rather than actually making improvements), I offered my services as both a patient and someone who claims to know a fair bit about organisational change and process improvements. That offer was taken up and so far I have been filmed telling the story that is contained in previous blogs, I have helped redesign some customer letters. Now the real hard work starts.

LTHT is one of just five trusts in the country chosen to pilot an approach to process improvement imported from Virginia Mason Hospital in Seattle. In turn they have adapted The Toyota Way – a highly structured approach to continuous improvement. LTHT are putting the patient at the forefront of their efforts in the belief that by getting this right, other things (including costs) will fall into place. That they are taking this philosophy to heart was evident by the warmth with which I was received and the attention that was paid to my observations and suggestions.  From my perspective, ‘patient first’ is a major shift and challenge in an industry that has traditionally been medic-led and where the stereotype (and all stereotypes are rooted in some reality) is of patients being called for the convenience of the staff not the patient.

A further aspect of the methodology (now branded “The Leeds Way”) is expressed as ‘Inch wide, mile deep’. Rather than looking widely across a process (‘mile wide’), they choose relatively tiny little areas (‘inch wide’) where improvements would have a big effect and study them in huge detail (‘mile deep’). So today we had a look at the core of the outpatients process (in their jargon – Pathway), searching for those few inches that needed deep study. We found them, and what was a delight was to find that the key areas of study related to minimising patient waiting times. The data was compelling – for new patients, they would typically spend around 90 minutes in the department, only 30 of which were actually spent with the specialists they had come to see; so of my 90 minutes in the department I spend a whole hour waiting for something to happen! Definitely room for improvement.

Lots of detailed investigations needed before further review by the team. However, my purpose here is not to delve into the detail of the improvement process so much as to praise the approach. Not only the approach of the improvement team and their methodology but perhaps even more the openness, creativity and enthusiasm of the range of people in the room (ranging from me and a volunteer through to General Managers, Clinical Directors and no less than the Deputy Chief Executive/Chief Nurse). Worthwhile and sustainable  improvements tend to be made by those directly involved in the processes and I feel that people left the room enthused, committed and somewhat more empowered than they arrived. Job well done.