Improved health Best possible care Satisfaction and pride in work Value for money

Principles Design care around the patient Identify value for the patient Minimise time to treatment

No process for staff to volunteer for training Little scope for learning outside project group No cross-project learning Training quality and organisation

Doing a few small projects on Lean methods does not form an integrated approach to service improvement

Move governance of Lean training to hospital Create internal stable and supportive structures Initiate dynamic process for change Create culture receptive to Lean thinking

stable structures for continual improvement education and training

Build leadership at every level Secure better staff engagement Assist directorate teams to redesign services Support staff to be innovative / solution- focused Increase clinical engagement Office for Transformation was created to

Lean Academy strategy

Lean Academy strategy (continued)

HOSPITAL EXECUTIVE LEADERSHIP TEAM LEAN STEERING COMMITTEE EXECUTIVE MEMBERS HEAD OF TRANSFORMATION EXECUTIVE CHAMPION provides membership for one of its members appointed actively engages with key governing body for Lean LEAN MANAGER MMUH BLACK BELT TEAM LEADER MMUH GREEN BELT TEAM LEADER MMUH GREEN BELT TEAM LEADER MMUH GREEN BELT guides all projects and trains / mentors Green Belts owns success of the journey LEAN STRATEGIC BOARD

Project Name Project Goal Right meal right patientAssisting dysphagia patients Picc ‘n’ goImprove flow of interventional radiology Suite scopeBronchoscopy Suite flow and TAT Screen saversScreening programme for MRSA Store warsComplete 5S to Clinical skills labs Stacking the stocks Planning equipment usage for a new hospital Hip pathway2 nd of three incremental hip fracture pathway projects Green belt 4 (Current Projects in training with Lean Academy/UCD) using Lean Six Sigma

Project Name Project Goal Breath of fresh airAsthma pathway Hip hop to theatreHip fracture pathway to theatre Req to chequeGI unit procurement project Fast track to PACSStreaming patients to post acute care Breaker breakerSmall fracture pathway Pit stopED assessment project One directionED triage review project Green belt 3 (Projects just completed with UCD/Lean Academy) % of cases operated on within 48hours of ED presentation is 71% (up from 55% in 2014) 15 minutes from Start of Registration to Completion of Triage in ED 45% reduction in total ordering process for GI unit & 23% reduction in number of line items

Project Name Project Goal Culture clubReducing Blood culture contamination rates Productive pantryStreamlined single pathway for pantry supplies/layout Don’t bed block meImproving TAT for Norovirus specimens Let’s get physioImproving physio referral pathway from fracture clinic Hiper activityImproving Hipe coding Green belt 2 (improvements in first 6 months) 100% reduced time towards goal of 24 hours from referral to triage for physio referrals from fracture clinic using Lean Six Sigma framework

Project Name Project Goal PhD pathwayNew ulmonary hypertension disease patient pathway It’s about timeTackling clinic overruns There’s no place like home39% reduction in ward round time on pilot wards Lock stock and flowStreaming drug delivery to release time to care X-ray visionImproving CT reporting Door to needleAcute stroke thrombolysis pathway Green belt 1 (improvements in first 6-12 months) overall ‘patient wait’ decreased by 2 hours report times fell by 26 % DTN time decreased from 80 to 44 mins on Stroke Pathway

Primary driver Secondary driver Interventions Identify processes, set goals, set priorities, nurture right culture, embed in leadership Lean principles embedded in strategic planning Lean as a strategic framework

Primary driver Secondary driver Interventions Align service improvements to corporate objectives, key champions, support training & development, plan and implement changes, focus on delivery, design work practices Lean principles in processes, decision making, planning and managing services Lean operational management

Primary driver Secondary driver Interventions Staff will learn to look for better way to serve patients and routinely use observational skills and 5S All service leaders, including administration, will deliver continuous frontline improvement Continuous improvement at frontline

Primary driver Secondary driver Interventions Hospital will exceed national targets, meet HIQA standards, achieve SHINGO standard, reduce defects and inventories, increase efficiencies and be 100% patient focused Set objective measures and targets for continuous quality improvement at all levels Measurement

Primary driver Secondary driver Interventions Provide training to other Irish healthcare organisations, host Lean events / conferences and annual symposium, seek SHINGO status, develop communications strategy Celebrate successes and spread Lean transformational changes to wider healthcare community Profiling / message spread

Pathway by pathway identification of NVA. Implementing JDIs and streaming to obviate NVA e.g. Senior Assessment Sooner Pilot in MMUH showed PET time for triage category 3 patients was reduced by 90 minutes Prioritising patient access – right patient, right time, right place. E.g. Dec 2015 Access to AMAU CT Mean TAT order to completed 2.9hrs (86%) Access to AMAU MRI Mean TAT order to completed 0.8 days (90%). Patient pathway from decision to discharge to rehabilitation Scheduled care – patient pathways for scheduling, DNAs, cannot attends, cancellation, rescheduling and admission – new pathway

Development of shared understanding about process Staff collaboration to develop and design processes Continuing education and stable structures for continual improvement Management demonstrate that improvement is everyone’s responsibility Lean is an evolutionary process and not just a matter of putting in place these four components

Only university accredited complete Lean Six Sigma Healthcare pathway from White Belt (fundamentals of Lean) to Black Belt (Level 9 Graduate Diploma) in Ireland.

Vision and commitment of CEO Training Executive team & Board members Supporting staff with tools to tackle problems Attention to components 3 and 4 from early stage Interdisciplinary staff training (all grades) Developing in-house training & Lean expertise Development and growth of Lean in the Mater is attributed to the following