1. The Wheelchair & Seating Services Approach
Implementing the
National Action Plan
The Wheelchair & Seating Services Approach
John Colvin
PURPOSE:
TO GET OFF TO A FLIER IN THE SKILLS MAXIMISATION WORKSHOPS
Not a dissertation on my successful diet plan
There will be a test at the end of the presentation

2. Introduction & Background
Moving Forward – March 2006
Scottish Executive Response to Moving Forward – January 2007
Funding announced following National Spending Review – November 2007
Business Case Submission – September 2008
National Action Plan – February 2009

3. What have the Centres done to implement the Action Plan?
Implementing our specific actions on the National Action Plan
Implementing our local business cases
Participating in national work streams
National Performance Indicators
We are currently half way through
a 2 year planned, funded project

4. How have we done this? Project Management
Governance
Planning
Risk Management
Responsibility Charting
Kaizen/Rapid Improvement Events
Continuous Improvement
Change Management
A ridiculous amount of meetings

7. User Satisfaction Survey

9. WoS WSS RTT High Level Pathway Referral To Provision
DRILLING DOWN A LEVEL IN DETAIL MIGHT ARRIVE AT THE RTT HIGH LEVEL PATHWAY
BUT THIS SHOWS SOME 6 PARALLEL PROCESSES

10. NHS Highland Wheelchair Service has previously had no information regarding the Service
A leaflet has been developed containing information about accessing the service, what patients can expect and detail of who to contact if equipment is need of repair.
Leaflet distributed to health clinics across NHS Highland as well as being sent out to patients on delivery of their equipment.

11. User’s and Carer’s Forum Established
Steering group established
Forum established (60 members)
Inaugural meeting held October 2009
1st newsletter issued (Feb 2010)
1st Open day planned for May 2010
Identified as a priority group by NHS Tayside

13. Project Managers

15. Risk Management VALUE ADDED : Must comply with ABOVE criteria
KANBAN : Can be a CARD, KANBAN SQUARE, EMPTY BIN etc ie a SYMBOL
POKE-YOKE : eg ON LINE SURVEYS, DIESEL PUMPS.
KAIZEN : KAI = CHANGE, ZEN = TO SEE OR GAIN WISDOM FROM DOING. Ie CONT. IMPRVT.
Kaizen goal is to ELIMINATE WASTE in the VALUE STREAM

16. HIGHLAND WHEELCHAIR & SEATING SERVICE WORKING WITH ILM HIGHLAND
In April 2009, as part of NHS Highland “shifting the balance” strategy the Wheelchair and Seating Service began a pilot scheme working with a local “not for profit” organisation called ILM Highland.
ILM offer a repair and delivery service to wheelchair users living in Ross-Shire, Sutherland and Caithness who in the past would have received their equipment via a courier.
They have carried out over 400 visits since the beginning of the pilot in April 2009
Operatives are trained to set up the chair correctly and are able to identify patients that have postural and pressure issues that may require a follow up visit by one of our occupational therapist and rehabilitation teams.
ILM is a social enterprise with charitable status that delivers domestic support services across the Highlands to the elderly and more vulnerable people living in the northern regions of the Highland.

19. VALUE ADDED : Must comply with ABOVE criteria
KANBAN : Can be a CARD, KANBAN SQUARE, EMPTY BIN etc ie a SYMBOL
POKE-YOKE : eg ON LINE SURVEYS, DIESEL PUMPS.
KAIZEN : KAI = CHANGE, ZEN = TO SEE OR GAIN WISDOM FROM DOING. Ie CONT. IMPRVT.
Kaizen goal is to ELIMINATE WASTE in the VALUE STREAM

20. VALUE ADDED : Must comply with ABOVE criteria
KANBAN : Can be a CARD, KANBAN SQUARE, EMPTY BIN etc ie a SYMBOL
POKE-YOKE : eg ON LINE SURVEYS, DIESEL PUMPS.
KAIZEN : KAI = CHANGE, ZEN = TO SEE OR GAIN WISDOM FROM DOING. Ie CONT. IMPRVT.
Kaizen goal is to ELIMINATE WASTE in the VALUE STREAM

21. NHS Lanarkshire WSS Centre - Floor Layout Wheel chair Skills Area
Stores
Staff
Toilets,
Changing,
Showers
Wheel chair Skills Area
Clinic Rooms
Workshop
VALUE ADDED : Must comply with ABOVE criteria
KANBAN : Can be a CARD, KANBAN SQUARE, EMPTY BIN etc ie a SYMBOL
POKE-YOKE : eg ON LINE SURVEYS, DIESEL PUMPS.
KAIZEN : KAI = CHANGE, ZEN = TO SEE OR GAIN WISDOM FROM DOING. Ie CONT. IMPRVT.
Kaizen goal is to ELIMINATE WASTE in the VALUE STREAM
Break Area
Office Area
Reception
Goods In

22. Southeast Mobility and Rehabilitation Technology (SMART) Services
Fife Satellite Clinic
Lynebank Hospital, Dunfermline
Service Users involved in Design
Large Clinic Room with overhead
hoist
Workshop for minor repairs and
adjustments
‘Wheelchair Shop’ – storage for selection
of chairs and equipment
Looking at developing a similar clinic in
NHS Borders

27. THE TIME BASED QUALITY DIMENSION is the MAIN BENEFICIARY OF APPLYING LEAN TECHNIQUES

30. THE TIME BASED QUALITY DIMENSION is the MAIN BENEFICIARY OF APPLYING LEAN TECHNIQUES

31. Root Cause Analysis

33. A B Lean Programme: ONE-STOP-SHOP Start Date: 2 October 2009
Last Update: 7 April 2010
Process Owner: Bill Forsyth
A3 Compiler: Henry Collin
Westmarc
Team Members: S.Gold, R.Fiskin, A.Oliver, E.Beattie, A.Love, W.Forsyth, K.Lees, P.Greene, D.Devlin, I.Mackay, H.Collin
Review Team: Westmarc Senior Management Team
1. PROBLEM STATEMENT
Most of the patient referrals to Westmarc WSS require at least one follow up appointment before the patient is equipped with ‘a safe and useable device’
This results in:
- discomfort and frustration for the patient due to (potentially unnecessary) delays in receiving the prescribed device.
- secondary appointments being necessitated for ‘fitting and fixing’.
- an exacerbation of the waiting-list back-log
- ‘double-handling’ by Clinicians, Workshop & Admin Staff.
4. GAP ANALYSIS
7. IMPLEMENTATION PLANS
2. THE PRESENT STATE October 2009)
Jan01-Dec31, 2009 Data:
Clinical Appointments held at Westmarc = 1202 Assessments
at WestMARC clinics
= 100 per month
Current One-Stop-Shop Appointments = 0
5. SOLUTION APPROACHES
8. THE CONFIRMED STATE
At 31 March 2010:
To date, >60 OSS Clinics were successfully held
This comprises an average of 15 OSS Clinics/Month
A ramp up of >3x is required to achieve the Target State
Ramp-up Measures:
The capacity for OSS clinics was increased by opening the scope to ALL clinicians in March (was only 2 x OTs for 3 months)
Data collection measures being introduced for reasons for NON OSS clinics
3. THE TARGET CONDITION
6. PROVING TRIALS
9. LESSONS LEARNT
Don’t assume – check, quantify and check again.
Involve the staff who are essential to the process, to gain their ‘buy-in’.
Don’t be afraid to experiment (in a controlled environment).
Don’t rush in – Do the homework and preparation.
Choose the correct tools/techniques for the task.
Decision by Review Team : GO
Decision by Review Team : GO
Decision by Review Team : GO
However, for many clinical appointments, the patients needs can be satisfied
within a single appointment
with a ONE-STOP-SHOP service,
with minimal or no extension to the allotted appointment times,
by a planned approach to ‘at-hand’ inventory holdings,
and by an orchestrated interaction between the different staff groups involved in the Patient Journey (Clinicians, Technicians, Stores and Admin).
Decision by Review Team : GO
Decision by Review Team : GO
Decision by Review Team : WIP A B
A ‘Clinician Request to Workshop’ form ‘A’ was created which also enables data collection. This data is currently, manually entered into a register ‘B’ in order to permit the metics on OSS thro’put and inventory usage.
Target OSS
Appointments
= 50% of total appts
within, say, 6 mths
= 50 Appts/month
This method of data collection will continue, while establishing the robustness of the OSS process and system requirements, prior to agreeing a bespoke ReTIS report which can track the progress towards achieving the One-Stop-Shop targets.
Decision by Review Team : GO
Decision by Review Team : G0
Decision by Review Team : WIP

36. Any comments?