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Trust develops a lean training programme to enhance employees’ problem solving capability, training 400 staff members and resulting in over 100 staff completing an improvement project


    • An average of 18 patients were delayed discharge from intensive treatment unit (ITU) every week
    • Empower staff and improve their problem solving skills
    • Reduce delays for patients to move out to an inpatient bed from ITU


    • Developed the Continuous Improvement Training programme to enhance employees’ problem solving capability
    • Linked structured problem solving techniques to improvement initiatives to create absolute clarity of purpose
    • Defined value improvement across five True North strategic themes 
    • Kaizen team supported candidates through coaching sessions and enabled them to make improvements in their area of work


    • 440 staff were trained, and improved staff survey scores (2016 - 2017)
    • Resulted in over 100 staff completing an improvement project, bringing significant value to the trust
    • Reduced delays to an average of 2-4 patients per week
    • Reduced the number of night time discharges out of ITU and home
    • Resulted in being the only trust to meet the CQUIN

* Please provide a brief outline of your work.

 This outstanding training aligned to the Trusts Patient First Improvement Programme “Capability pillar” with a goal to create an Army of Problem Solvers and create a culture where continuous improvement is part of daily business at work. Structured problem solving techniques are linked to improvement initiatives that support the trust True North objectives to create absolute clarity of purpose and focus as a whole trust towards key areas.

Training was formed from global best practice in lean methodology and created ‘in house’ by lean experts within the Patient First Improvement team. Who have wide external industry experience in this field.

 * Please describe the actions you took to achieve your result.

 The cost of the training is neutral since the material was wholly created and all training delivered in house by the internal kaizen Team who support the trusts Patient First Programme across WSHT and brought external industry material and experience to create an NHS aligned lean training program.

WSHT define value improvement across 5 True North strategic Themes – Patient Experience, Staff Engagement, Quality & Safety, Working with Partners to improve flow & Cost improvement.

The Value this training brought aligned to one or more of the themes, each of which have clear high level targets to strive towards as a whole trust for every candidate. The candidates received the training and where then supported by the Kaizen team through coaching sessions for successful delivery their project. To date (2016 & 2017) 440 staff across WSHT has received the training. There are no pre-requisites to attendance in terms of grade or role.

They simply have to come with a problem to solve from their area that aligns to at least one True North theme. As such candidates from Facilities and Estates train alongside consultants, divisional managers, Nurses, Kitchen staff etc. They work together on real problems (selected by the candidates during day one) in a workshop style learning event. Once trained the candidates and use the methodology to make improvement in their area of work – this will further involve staff and in some circumstances patients as well.

In 2017 the material was revised to two individual days with one week between each day of training and monthly coaching sessions. Also the expectation an improvement project must be completed as evidence of capability before accreditation made clear at the time of registering. 220 staff have been trained in 2017 – over 100 have completed an improvement project bringing significant value to the trust in both tangible benefit and continuous improvement expertise.

Overall this programme aligns to the True North objective of Staff Engagement aimed to improve perception that staff can make improvements in their area of work, this is evidenced via improved scores within the staff survey over the past 2 years.

Two examples:-

• Care group manager - Breast Surgery locum surgeon usage project saved 20k last year by evaluating their use and taking out waste

• Cardiac Nurse Consultant - improved lipids testing to 100% of MI patients by combining with troponin

 * Please list the most significant results

 In 2017 candidates used their training to reduce ITU delay our patients that were ‘ward fit’ for greater than 24 hours waiting to move out to an inpatient bed. WSHT were the ONLY trust to meet the CQUIN. Prior to the project an average of 18 patients were delayed every week, there are now an average of 2-4 per week and those delays are clinically appropriate for special causes in acuity or individual patient need. There has also been a decline in the number of night time discharges out of ITU and the number of discharge home for our patients.

 * Describe how your project has spread to other teams, departments or organisations

 To date over 440 WSHT staff have been trained across the whole organisation - a breakdown by division is attached. We have also trained ‘free of charge’ colleagues from outside WSHT - Kingston Hospital, local CCG, BSUH & the Critical Care Network. We have also shared the entire material with other trusts and support them in setting up the training.

Most recently Kingston Hospital reached out and we have responded. We are completing YB training for SAS (Specialty and associate Specialist Doctors) this month (fee applied) and we are in conversation with local CCG to do the same.

Key individuals

Nick Chambers