Our Journey - a lecture to the King's Fund by Professor Elaine Mead

The following is the transcript of a lecture given by Professor Elaine Mead at the King's Fund.  (You can watch the lecture by clicking on the video link.)

We’re at the very very north of Scotland. Geographically the very largest health board covering about 41% of the land mass and a very large number of inhabited islands. So you can imagine we have some complexities in the way that we have to deliver care across the Highlands. It’s a fully integrated health and care system in the Highlands, so from primary care, from GPs practices, from acute hospitals, but we also even look after the cat in the care home here, so it is a whole system. It’s because we’re remote and we really have to be quite innovative, we have to think carefully about how we do things, and it’s led us to look quite carefully at quality improvement and innovation.

We have had some great leadership in Scotland, Derek Feeley I'm sure will be known to many of you, he’s now the president and CEO in the Institute of Health Improvement in Boston and Derek taught us all to steal shamelessly and that’s something that we do do, and of course I stole immediately from the Institute of Health Improvement’s triple aim and we looked at this a number of years ago and were very interested in the thought of balancing off that better care for individuals, for populations and also looking at the cost.

We had an early dabble in lean and we worked very well, the Scottish government allowed us to have a strategic partner, ours was General Electric and we worked with them and did some great pieces of work, so fantastic pieces of work we saw. But it became apparent to us that these pieces of work were in isolation, and we struggled with that for a while, and wondered why we hadn’t joined it up. It was quite clear to us that there were some cultural limitations. We weren't winning peoples’ hearts and minds. And actually what needed to change was our attitude.

The aha moment I think for me came when we spent a little bit of time over in Boston. We enjoyed being over there but it allowed us some time away from base to really immerse ourselves in what was going on and think bigger than Highlands, bigger than Scotland, what was actually important? And we met many colleagues there that were doing fantastic work and inspired us to think about how can we see what else is going on across Scotland and in a very different way?

Again in Boston we’d met colleagues from Virginia Mason and we were really interested in bow they’d taken a process from business with Boeing and adapted that to a health care setting, and we wanted to know a little bit more about that. We sent out then some colleagues, we sent one of our most sceptical medical directors and we sent a couple of other clinical directors with them to really unpick this and see if what they were saying was really happening. So it’s trying to take what others are doing and blending it for your circumstances and making it work for you.

So we’ve now tried to develop something called the Highland Quality Approach. It’s hard to say what that is, it’s definitely not lean, it’s an umbrella for a lot of things but it captures the spirit of what we’re trying to do and really describes the way we want to do things here in Highland. And people seem to get that. It’s an umbrella now for all of our quality work in Highland.

So we then set about giving people tools. We’ve trained now a number of people in lean tools and techniques, we actually have got his embedded right across the organisation but the first people to be trained, some in Virginia Mason, we sent three folk out there, so having that rigor of knowledge, understanding the process was really important and we’ve now developed our own capacity, our own training and our own coaches.

Let me just touch a little bit about what that’s about. So Kaizen you will have heard about, it’s all about having rapid process with the emphasis on rapid, to make the improvement. But it brings together people who are completely different parts of the organisation, who have an interest in something and again you will have heard us describing this as a particular area inch-wide mile-deep in an organisation. We take people out for a whole week, we’ve already done twelve weeks’ lead-in to that work, and then we really will analyse and understand what the current state is and get from the colleagues in the room and patients that we involve, what should the future look like? How can we take waste out of the system? And frankly it’s extraordinary, it’s extraordinary to be part of it, it’s extraordinary to coach it and the outcomes that get reported out on a Friday afternoon are unbelievably better than we ever imagined.

Now there’s some consistency to that, so there’s a strict rigor about how you report out, we also go back after 30 days, 60 days, 90 days and 365 days to check on progress. So it’s not something you do in isolation and that’s how that’s different from what we were doing previously with our colleagues and in GE.

But once you have those waste eyes, once you’ve seen that with your own eyes you can't take those glasses off and every one of these rapid process improvement workshops teaches at least 50 people what this means to them, and they all start looking in their own organisation for waste. Then they have the responsibility of doing something about that. And that’s really the fun bit. The real waste, and we use the word waste but the waste is now recognised as the burden of work that puts on people. How are we wasting their time and not adding value for the customer? That’s really important and that again resonates with people.

So is it about saving money? No it’s not. Some of it will save money for us, and I believe some of our savings last year came from absolutely this work. Qualitative goals are very very woolly and that seems to be difficult to quantify for people and hard to show what the impact is although we know there is one. And although we’re all looking to save money, we’re absolutely clear this is a long game and what you need to do is to hold your nerve.