Bolton NHS Foundation Trust is a leader in the application of lean principles in health care, through the development of our own Bolton Improving Care System (BICS). This is a way of reducing wasteful processes in the system (e.g. duplication, errors and work-round solution) to ensure we provide safe and high quality services that our patients' value, whilst reducing frustrations and enhancing job satisfaction for our staff.
The accompanying pages may be of particular interest to health professionals or those interested in management theory and processes.
Since 2005, teams from across the Trust including the community services have been learning to use lean thinking and the Bolton Improving Care System (BICS) - to tackle problems and improve the way we do things, so that we can deliver a better service for patients, better working lives for staff and better value for money.
We are steadily learning that lean thinking can offer a good way of really understanding our processes, and it gives teams of front-line staff some ways to start fixing them when they don't work.
We have a vision that the Bolton NHS Foundation Trust will be an organisation where the whole workforce is involved, every day, in making our services better. At the heart of this approach is getting rid of waste - the kind of thing that we all see too often in our everyday work - wasted journeys because things are in the wrong place; wasted supplies; wasted time doing things twice, or doing unnecessary things or just hanging around waiting; wasted effort, sometimes having to put right things that weren't right the first time; wasted talent of people who are distracted from what they really come to work to do - delivering a good service for our patients and customers.
Since we started using lean principles at the hospital site there have been 1,437 members of staff directly involved in 328 (May 2011) BICS Rapid Improvement Events (RIEs) - where teams get together to problem solve and make rapid and sustainable change to improve the services they offer to suit the needs of the patient.
Using BICS has been an important factor in the great progress which the Trust has made over the last five years. We have seen a reduction in hospital mortality (death) rates - improvements in Orthopaedics, Respiratory, Gastroenterology and Stroke through front-line staff using BICS methodology. We have set up new services which will help the Trust stay competitive in future and which will offer more user-friendly services for patients. In Ophthalmology, for instance, the BICS approach was used to set up a one-stop, low-wait outpatient service and in Gastroenterology and Respiratory it is helping us to ensure our patients can safely go home sooner, and in Theatres it is helping it be safer and more cost effective. Furthermore, in Health Records we are reducing the number of patient notes we can't find when we need them. We have also been pioneering the use of "Patient Based Design" within our BICS methodology, to ensure we build in what our patients' value into our services, and take out the activities and things that patients don't want.
Our Exemplar Programme and Productive Community Services is developing the concept of 'BICS as daily work' at a ward and department level linked to Care Standards and we are working on making things safer for patients and staff through programmes such as 'Safer Clinical Systems', the "North West Mortality Collaborative", 'Patient Safety First' and 'Safety Express'.
We have used BICS principles to design the physical layout of new buildings (to help patients flow efficiently through their journey) for our capital works in Women's and Children's services and in the community. Also, in "behind the scenes" processes in Pharmacy, Pathology, Facilities and Health Records, BICS has helped us save money and improve the quality of services - efficiency savings in Pathology, the Laundry, Estates, Finance Department, District Nursing and reduction in the length of hospital stay in Urgent Care.
We are also using BICS to improve the existing working space so that it is designed better for the staff who have to use it. You may have heard of "6S" and "Well Organised Working Environment" (WOWE) which has been carried out in a number of areas. It's a way for front-line teams to use a lean method to organise and improve the safety and efficiency of the workplace - giving staff a better environment and more time for their patients. We want to see more people involved in using BICS methods and more teams will be given the time to problem-solve some of the Trust's biggest challenges.
To help support this expanded programme of work we have developed the BICS Learning and Development Academy and incorporated the community improvement programme (EQUIP), set up to increase awareness amongst staff, whilst equipping them with the practical tools to techniques, and leadership skills to lead, implement and sustain improvements and over 2700 staff have now accessed this.
We hope you find these webpages useful and informative, if you have any ideas on how we can improve these webpages or can't find what you are looking for please contact us on bics@rbh.nhs.uk