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Other Added - Leaning Health - Transforming the Health Service
A joint venture (often abbreviated JV) is a legal entity formed between two or more parties to undertake economic activity together. The parties agree to create a new entity by both contributing equity, and they then share in the revenues, expenses, and control of the enterprise. The venture can be for one specific project only, or a continuing business relationship such as the Sony-Ericsson joint venture.Generally, joint venture is the merging of two (or more) companies, enterprise or organization towards a more profitable, mutually beneficial and stronger entity in the market. They may have varied goals, or may lead only to one goal. Still, the merging was completed because it presented a win-win situation for both (or all) parties.A joint venture may be of various kinds – temporary merging or permanent partnership. This is depending on the goals or projects being covered or strategies being adopted by one or more merging parties.Organizations can also form joint ventures, for example, a child welfare organization in the Midwest initiated a joint venture whose mission is to
M - Maintaining the Momentum
It is important to recognise that sustainable transformational change takes time, and we have found that it can require up to 1 year to become embedded and for organisations to realise all the benefits that are possible, including the teams becoming familiar with the process. This doesn’t mean that hospitals have to spend a year before there are any improvements as these accrue every month, actually it means that to realise the full benefits, which are measured in millions and sometimes tens of millions, whilst also improving the patient experience and staff morale, requires continual focus over an extended period.
The last element of the PRISM model is to 'Maintain Momentum' which is concerned with ensuring the organisation continues to achieve benefits over the extended journey it needs to go through. This includes re-scoping the improvement, planning further activities and getting the Change Agents 'up to speed' and capable of running events in their own right.
Without this on-going focus, there will be a tendency to ‘drift’ and for people to revert to previous ways of working and more importantly, previous ways of making improvements, which without the foc
Employment opportunity is a depended factor on generation and development. Proportionally, it increases and decreases as per market demand, production increase and companies growth. Fortunately, all these are in a positive direction to generate the huge job opportunities in different sectors. All the job types are relative to each others. So an increment of one side forces to increase other types of jobs immediately. For an example, the increment of engineering jobs increases the management, administrative and human resource management jobs automatically.Each education educates you directly or indirectly for an employment status. Study of arts, science, commerce, engineering, medical, defense, management etc. are worthy for knowledge and making yourself skilled person so that you can serve for an organization. That makes the human potential in you. Then an employer can fit you in a job as per their need.IT jobs are booming because of the applying technology in every step of life. The workload is increased because of the implementing the technological methods. The workload only can b
Due to client confidentiality issues, the names and identities of the client hospitals who have benefited from this process have been obscured as no self-respecting management team would like the press to know about their problems with finance and efficiency.
Are We Healthy?
Many people within the UK’s National Health Service (NHS) would recognise that there have been a number of significant improvements to the service over the last few years, but these same people would also recognise that there are many further improvements that could (and need to) be made, especially with so many hospitals facing deficits.
This short article has arisen from a number of projects carried out within the NHS to rapidly improve patient pathways in both elective care and emergency admissions, as well as in administrative functions. The aims of this work have been three fold:
• Significantly improve financial performance
• Maintain or improve standards of care
• Increase the overall patient experience
Healthy & Sustainable
Before we start, it is worth stating that many organisations have been able to ‘ram-raid’ hospitals, making short term, low gain and unsustainable improvements that have irritated administrative staff and lost the support of the clinical teams.
Therefore, there is a balance to be walked, on the one hand, the need to focus on significant improvements, and on the other hand the need to bring the teams with you as they pass through the process.
Over a period of time, we have been trialling a sustainable model for improvement in Health, Local Authorities/Council, Emergency Services and other public sector organisations, based around the PRISM model which is described below:
• P - Prepare the Organisation
• R - Roadmap
• I - Implement
• S - Sustain the Improvement
• M - Maintain the Momentum
• A – Accelerate Improvements
The PRISM model uses concepts from Lean, coupled with key tools from Risk Management, Management Development and Cultural Change to provide a framework for sustainable change in complex process environments.
P - Preparing the Organisation
The first, and most important, activity in delivering the PRISM model is to scope the improvement so that the organisation is clearly focused on the right targets. We achieved this with the NHS through a management team level ‘Scoping Meeting’ to discuss such things as: Objectives, Focus of Improvements, ‘Fixed Points’ – or things that could not be changed, ‘Impact Points’ – or things that could influence the success or otherwise of the improvement work, and also identified who would lead the improvements. This was followed by training for the identified ‘Process Leaders’ who were to lead each stream of improvement.
R - Roadmap
Having got the organisational ‘aligned’ (in itself not an easy task), the next stage is to gain alignment from those involved in improving the process, which we have achieved through Value Stream Analysis Events (VSE) which are undertaken over a 2.5 day period of concentrated effort and use a variety of tools from Lean, Programme Management & Creative Thinking.
The concept of the VSE is to help the participants to see the ‘waste’ or inefficiency in the current process, using this information to help develop a vision of how good the organisation could be in a ‘Blue Sky’ state and then coming back to reality by creating a realistic ‘Future State’ which tries to get them as close to their ‘Blue Sky’ as possible, taking into account the realism of budgets, resources etc.
Because we then have reference points, as in where the team are starting from (Current State) and where they want to go (Future State), it is then possible to create an implementation plan to execute.
I - Implementing the Improvement
Taking the next element of the PRISM model, we then assisted the team to Implement Improvements through a series of Rapid Improvement Events (RIE) – each lasting 3-4 days and covering up to 4 improvement events. For example, in a recent RIE the teams led three improvement programmes:
1. Using Breast Reconstruction and Total Knee Replacement as examples of common outpatient activity, the first team focused on improving flow through outpatients to enable them to cope with the 18 weeks rule coming in from 2007 onwards for fully booked appointments. The work achieved a saving of over ?300k and reduced the lead-time from some 7.5 months to 2 weeks to get a fully booked appointment.
2. Using primarily elective care examples, complicated by issues arising from trauma, or emergency admissions, the second team focused on increasing the ability of theatre to start on time, which resulted in lists starting ‘on-time’ increasing from 37% to greater than 70%. A secondary benefit of this is that the hospital will be able to operate on 10% more patients without increasing staff workload.
3. The third team focused on Emergency Admission procedures, particularly looking at ‘Fractured Neck of Femur’ - a problem suffered mostly by older women who have fallen over - and ‘Max Fax’ (Maxillofacial) – often suffered by young, drunk men in fights, where the focus was on reducing the time from DTA (Decision to Admit) to the patient being operated on, as well as increasing efficiency. The result was that processing times have dropped from an average of 9 hours to around 3 and there is a potential to save more lives every week through a significantly improved patient pathway.
One of the greatest side effects of the work undertaken has been some of the comments we have received on our journey, including such things as:
“The process is stressful, but delivers more than any other change programme we have done previously.” Assistant Director (Elective Care)
“It is certainly a radically different and exciting way to improve patient pathways quickly, efficiently and safely.” Operations Director
“The work really complements the improvement work we already have to do, but brings a refreshing, high impact approach to our traditional methods.” Service Improvement Manager
S - Sustaining the Gain
Making improvements in Health is one thing, sustaining them is another and the fourth element of the PRISM model is concerned with Sustaining Improvements through a ‘Change Agent Development’ (CAD) programme which focuses on developing the technical and leadership skills of the ‘Process Leaders’ who lead the areas being improved, by combining profiling with leadership and ‘Lean’, enabling them to sustain and improve the process which have been transformed.
M - Maintaining the Momentum
It is important to recognise that sustainable transformational change takes time, and we have found that it can require up to 1 year to become embedded and for organisations to realise all the benefits that are possible, including the teams becoming familiar with the process. This doesn’t mean that hospitals have to spend a year before there are any improvements as these accrue every month, actually it means that to realise the full benefits, which are measured in millions and sometimes tens of millions, whilst also improving the patient experience and staff morale, requires continual focus over an extended period.
The last element of the PRISM model is to 'Maintain Momentum' which is concerned with ensuring the organisation continues to achieve benefits over the extended journey it needs to go through. This includes re-scoping the improvement, planning further activities and getting the Change Agents 'up to speed' and capable of running events in their own right.
Without this on-going focus, there will be a tendency to ‘drift’ and for people to revert to previous ways of working and more importantly, previous ways of making improvements, which without the foc
Houston has always been a boom or bust economy. Yet it is America’s third largest city with 5.5 million people. The ten-year economic cycles have been caused by oil price fluctuations. But as Houston diversifies its economy and matures it employs larger and larger percentages of folks in retail and service sectors. Let’s discuss some other economic issues during the last recession in Houston. Albertson’s pulled out of the Houston Market, Wrath left by Enron, Arthur Anderson Collapse, Continental Airline Lay offs, HP-Compaq merger and all the oil mergers just prior. All these large corporations hurt the Houston Economy along with the telecom layoffs too; but that was over four years ago. Today we see a massive rebound and the price of oil has helped tremendous profits from the major oil companies there.If you drive around Houston and it’s inner suburbs, you see entire shopping centers, which are not doing so hot. Last year there was an article in the Houston Business Journal of the anchor store in many shopping centers through out Houston pulling out. Kmart, took out some stores, so did t
• P - Prepare the Organisation
• R - Roadmap
• I - Implement
• S - Sustain the Improvement
• M - Maintain the Momentum
• A – Accelerate Improvements
The PRISM model uses concepts from Lean, coupled with key tools from Risk Management, Management Development and Cultural Change to provide a framework for sustainable change in complex process environments.
P - Preparing the Organisation
The first, and most important, activity in delivering the PRISM model is to scope the improvement so that the organisation is clearly focused on the right targets. We achieved this with the NHS through a management team level ‘Scoping Meeting’ to discuss such things as: Objectives, Focus of Improvements, ‘Fixed Points’ – or things that could not be changed, ‘Impact Points’ – or things that could influence the success or otherwise of the improvement work, and also identified who would lead the improvements. This was followed by training for the identified ‘Process Leaders’ who were to lead each stream of improvement.
R - Roadmap
Having got the organisational ‘aligned’ (in itself not an easy task), the next stage is to gain alignment from those involved in improving the process, which we have achieved through Value Stream Analysis Events (VSE) which are undertaken over a 2.5 day period of concentrated effort and use a variety of tools from Lean, Programme Management & Creative Thinking.
The concept of the VSE is to help the participants to see the ‘waste’ or inefficiency in the current process, using this information to help develop a vision of how good the organisation could be in a ‘Blue Sky’ state and then coming back to reality by creating a realistic ‘Future State’ which tries to get them as close to their ‘Blue Sky’ as possible, taking into account the realism of budgets, resources etc.
Because we then have reference points, as in where the team are starting from (Current State) and where they want to go (Future State), it is then possible to create an implementation plan to execute.
I - Implementing the Improvement
Taking the next element of the PRISM model, we then assisted the team to Implement Improvements through a series of Rapid Improvement Events (RIE) – each lasting 3-4 days and covering up to 4 improvement events. For example, in a recent RIE the teams led three improvement programmes:
1. Using Breast Reconstruction and Total Knee Replacement as examples of common outpatient activity, the first team focused on improving flow through outpatients to enable them to cope with the 18 weeks rule coming in from 2007 onwards for fully booked appointments. The work achieved a saving of over ?300k and reduced the lead-time from some 7.5 months to 2 weeks to get a fully booked appointment.
2. Using primarily elective care examples, complicated by issues arising from trauma, or emergency admissions, the second team focused on increasing the ability of theatre to start on time, which resulted in lists starting ‘on-time’ increasing from 37% to greater than 70%. A secondary benefit of this is that the hospital will be able to operate on 10% more patients without increasing staff workload.
3. The third team focused on Emergency Admission procedures, particularly looking at ‘Fractured Neck of Femur’ - a problem suffered mostly by older women who have fallen over - and ‘Max Fax’ (Maxillofacial) – often suffered by young, drunk men in fights, where the focus was on reducing the time from DTA (Decision to Admit) to the patient being operated on, as well as increasing efficiency. The result was that processing times have dropped from an average of 9 hours to around 3 and there is a potential to save more lives every week through a significantly improved patient pathway.
One of the greatest side effects of the work undertaken has been some of the comments we have received on our journey, including such things as:
“The process is stressful, but delivers more than any other change programme we have done previously.” Assistant Director (Elective Care)
“It is certainly a radically different and exciting way to improve patient pathways quickly, efficiently and safely.” Operations Director
“The work really complements the improvement work we already have to do, but brings a refreshing, high impact approach to our traditional methods.” Service Improvement Manager
S - Sustaining the Gain
Making improvements in Health is one thing, sustaining them is another and the fourth element of the PRISM model is concerned with Sustaining Improvements through a ‘Change Agent Development’ (CAD) programme which focuses on developing the technical and leadership skills of the ‘Process Leaders’ who lead the areas being improved, by combining profiling with leadership and ‘Lean’, enabling them to sustain and improve the process which have been transformed.
M - Maintaining the Momentum
It is important to recognise that sustainable transformational change takes time, and we have found that it can require up to 1 year to become embedded and for organisations to realise all the benefits that are possible, including the teams becoming familiar with the process. This doesn’t mean that hospitals have to spend a year before there are any improvements as these accrue every month, actually it means that to realise the full benefits, which are measured in millions and sometimes tens of millions, whilst also improving the patient experience and staff morale, requires continual focus over an extended period.
The last element of the PRISM model is to 'Maintain Momentum' which is concerned with ensuring the organisation continues to achieve benefits over the extended journey it needs to go through. This includes re-scoping the improvement, planning further activities and getting the Change Agents 'up to speed' and capable of running events in their own right.
Without this on-going focus, there will be a tendency to ‘drift’ and for people to revert to previous ways of working and more importantly, previous ways of making improvements, which without the foc
Most people are well aware of those businesses in the United States of America who routinely hire illegal aliens and illegal immigrants who have snuck over the US-Mexican border and come to our great nation illegally. In fact most people can rattle off 5 or 6 industries where illegal aliens typically work and most US citizens are well aware of why these employers are hiring them and about the average wage these people work for.Most Americans realize that the business owners exploit and degrade these people to attain higher profits for themselves and do so knowing that they are hiring illegal aliens who are a severe burden on the taxpayer, yet do not care, as they only see their own short term profits and do not care about the United States of America, our economy or your children’s future with no social security, a government in severe debt and a country in ruin.Most people are also aware that there are illegal aliens and illegal immigrants working at their local carwash, yet they say nothing, even though their car wash owner there is one of those greedy human rights exploiters who
The concept of the VSE is to help the participants to see the ‘waste’ or inefficiency in the current process, using this information to help develop a vision of how good the organisation could be in a ‘Blue Sky’ state and then coming back to reality by creating a realistic ‘Future State’ which tries to get them as close to their ‘Blue Sky’ as possible, taking into account the realism of budgets, resources etc.
Because we then have reference points, as in where the team are starting from (Current State) and where they want to go (Future State), it is then possible to create an implementation plan to execute.
I - Implementing the Improvement
Taking the next element of the PRISM model, we then assisted the team to Implement Improvements through a series of Rapid Improvement Events (RIE) – each lasting 3-4 days and covering up to 4 improvement events. For example, in a recent RIE the teams led three improvement programmes:
1. Using Breast Reconstruction and Total Knee Replacement as examples of common outpatient activity, the first team focused on improving flow through outpatients to enable them to cope with the 18 weeks rule coming in from 2007 onwards for fully booked appointments. The work achieved a saving of over ?300k and reduced the lead-time from some 7.5 months to 2 weeks to get a fully booked appointment.
2. Using primarily elective care examples, complicated by issues arising from trauma, or emergency admissions, the second team focused on increasing the ability of theatre to start on time, which resulted in lists starting ‘on-time’ increasing from 37% to greater than 70%. A secondary benefit of this is that the hospital will be able to operate on 10% more patients without increasing staff workload.
3. The third team focused on Emergency Admission procedures, particularly looking at ‘Fractured Neck of Femur’ - a problem suffered mostly by older women who have fallen over - and ‘Max Fax’ (Maxillofacial) – often suffered by young, drunk men in fights, where the focus was on reducing the time from DTA (Decision to Admit) to the patient being operated on, as well as increasing efficiency. The result was that processing times have dropped from an average of 9 hours to around 3 and there is a potential to save more lives every week through a significantly improved patient pathway.
One of the greatest side effects of the work undertaken has been some of the comments we have received on our journey, including such things as:
“The process is stressful, but delivers more than any other change programme we have done previously.” Assistant Director (Elective Care)
“It is certainly a radically different and exciting way to improve patient pathways quickly, efficiently and safely.” Operations Director
“The work really complements the improvement work we already have to do, but brings a refreshing, high impact approach to our traditional methods.” Service Improvement Manager
S - Sustaining the Gain
Making improvements in Health is one thing, sustaining them is another and the fourth element of the PRISM model is concerned with Sustaining Improvements through a ‘Change Agent Development’ (CAD) programme which focuses on developing the technical and leadership skills of the ‘Process Leaders’ who lead the areas being improved, by combining profiling with leadership and ‘Lean’, enabling them to sustain and improve the process which have been transformed.
M - Maintaining the Momentum
It is important to recognise that sustainable transformational change takes time, and we have found that it can require up to 1 year to become embedded and for organisations to realise all the benefits that are possible, including the teams becoming familiar with the process. This doesn’t mean that hospitals have to spend a year before there are any improvements as these accrue every month, actually it means that to realise the full benefits, which are measured in millions and sometimes tens of millions, whilst also improving the patient experience and staff morale, requires continual focus over an extended period.
The last element of the PRISM model is to 'Maintain Momentum' which is concerned with ensuring the organisation continues to achieve benefits over the extended journey it needs to go through. This includes re-scoping the improvement, planning further activities and getting the Change Agents 'up to speed' and capable of running events in their own right.
Without this on-going focus, there will be a tendency to ‘drift’ and for people to revert to previous ways of working and more importantly, previous ways of making improvements, which without the foc
In today’s competitive environment, hiring has increasingly become a key link in establishing and maintaining your company’s edge. By attracting and hiring the best people, your company can move quickly and grow steadily. On the flip side, however, poor hires cost you precious time, money, and opportunity. Poor hiring could cost you your company.Unfortunately, hiring candidates who can do what they say they can do is getting tougher. A whole industry has sprung up in the past ten years helping job seekers land a job — sometimes at all costs. You can’t afford to hire someone who can’t do the job, do it with minimal direction, or do it quickly. Fortunately, there are techniques that you can use to ensure that the candidate you select can do the job. We will examine four techniques here — demonstrations, simulations, problem solving, and testing — and introduce a powerful interviewing technique — High Performance Interviewing — that we will cover in more detail in the next issue of Performance News.DemonstrationsIdeally, the best way to see if a candidate is able to do th
3. The third team focused on Emergency Admission procedures, particularly looking at ‘Fractured Neck of Femur’ - a problem suffered mostly by older women who have fallen over - and ‘Max Fax’ (Maxillofacial) – often suffered by young, drunk men in fights, where the focus was on reducing the time from DTA (Decision to Admit) to the patient being operated on, as well as increasing efficiency. The result was that processing times have dropped from an average of 9 hours to around 3 and there is a potential to save more lives every week through a significantly improved patient pathway.
One of the greatest side effects of the work undertaken has been some of the comments we have received on our journey, including such things as:
“The process is stressful, but delivers more than any other change programme we have done previously.” Assistant Director (Elective Care)
“It is certainly a radically different and exciting way to improve patient pathways quickly, efficiently and safely.” Operations Director
“The work really complements the improvement work we already have to do, but brings a refreshing, high impact approach to our traditional methods.” Service Improvement Manager
S - Sustaining the Gain
Making improvements in Health is one thing, sustaining them is another and the fourth element of the PRISM model is concerned with Sustaining Improvements through a ‘Change Agent Development’ (CAD) programme which focuses on developing the technical and leadership skills of the ‘Process Leaders’ who lead the areas being improved, by combining profiling with leadership and ‘Lean’, enabling them to sustain and improve the process which have been transformed.
M - Maintaining the Momentum
It is important to recognise that sustainable transformational change takes time, and we have found that it can require up to 1 year to become embedded and for organisations to realise all the benefits that are possible, including the teams becoming familiar with the process. This doesn’t mean that hospitals have to spend a year before there are any improvements as these accrue every month, actually it means that to realise the full benefits, which are measured in millions and sometimes tens of millions, whilst also improving the patient experience and staff morale, requires continual focus over an extended period.
The last element of the PRISM model is to 'Maintain Momentum' which is concerned with ensuring the organisation continues to achieve benefits over the extended journey it needs to go through. This includes re-scoping the improvement, planning further activities and getting the Change Agents 'up to speed' and capable of running events in their own right.
Without this on-going focus, there will be a tendency to ‘drift’ and for people to revert to previous ways of working and more importantly, previous ways of making improvements, which without the foc
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M - Maintaining the Momentum
It is important to recognise that sustainable transformational change takes time, and we have found that it can require up to 1 year to become embedded and for organisations to realise all the benefits that are possible, including the teams becoming familiar with the process. This doesn’t mean that hospitals have to spend a year before there are any improvements as these accrue every month, actually it means that to realise the full benefits, which are measured in millions and sometimes tens of millions, whilst also improving the patient experience and staff morale, requires continual focus over an extended period.
The last element of the PRISM model is to 'Maintain Momentum' which is concerned with ensuring the organisation continues to achieve benefits over the extended journey it needs to go through. This includes re-scoping the improvement, planning further activities and getting the Change Agents 'up to speed' and capable of running events in their own right.
Without this on-going focus, there will be a tendency to ‘drift’ and for people to revert to previous ways of working and more importantly, previous ways of making improvements, which without the focus on Rapid Improvement will often prove to have less impact and take much longer to achieve.
Closing Comments
The NHS have made significant improvements over the last few years and the professionals who work within it are performing brilliantly, often with broken processes which cause financial as well as ‘people’ problems, for example some 65% of complaints received by one hospital worked with were related to delays in the way they handled bookings in outpatients.
Combining the professional expertise, with existing improvement tools within the NHS, combined with external expertise and Rapid Improvement tools, is a winning combination for the 21st Century Health Service.
In the words of one Chief Executive, "I would never have believed that so much could be achieved in such a short time and in such a professional and exciting fashion."
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