Birmingham Children’s Hospital Governance Support Unit (GSU)

The Background:

The Governance Support Unit’s (GSU) motivation to improve their systems and processes is extremely high. They chose to redesign, using Lean methodology, the Serious Incident Report Investigation (SIRI) process which directly impacts patient safety.

The time taken to complete the SIRI process is critical as the SIRI identifies and removes conditions which caused the serious incident. It directly effects:

  • how long the patient and the family of the patient need to wait before receiving a full explanation and
  • the length of time that future patients are exposed to the risk of the serious incident repeating

Birmingham Children's Hospital SIRI Investigation Time

GSU wanted to achieve a 45 day target for completion of investigations. During the 12 months prior to the Lean activity, investigations took on average 74 days.

The Birmingham Children’s Hospital (BCH) and LT Consulting’s partnership started in October 2012………..

Engagement

Central to EQLeanTM activity is the full engagement and development of each member of staff and their team behaviour.

LT Consulting used psychometrics and culture surveys to establish the current situation.

Birmingham Children's Hospital SIRI Strengths

Using these tools, together with individual and team coaching, enabled each SIRI team member to develop their awareness of their own and others strengths and how these could be best utilised to maximise the improvement of the SIRI process.

SIRI Process Redesign

The SIRI team redesigned their process using Lean principles to guide them – identifying value added activities to the customer and eliminating or minimising wasteful process steps.

Through the team effort and the redesign process a commitment to change to a new way of working was firmly established.

When asked what did he most enjoy about the SIRI redesign process, Steve James, Risk Assistant said:

I enjoyed coming up with new ideas on how to run the system and the freedom to rethink everything we take for granted.

The Results

SIRI Process Completion Time

Birmingham Children's Hospital SIRI Completion Time

  • Achievement of the target for SIRI completion increased by a factor of 13, from 7% to 92%.
  • The target achieved for the last 10 consecutive SIRIs (~ 2/3 of a year).
  • Quality improved through releasing additional time for the investigation.

Administration Costs

Birmingham Children's Hospital SIRI Administration Costs

  • At least a 65% reduction in administration costs.

Process Simplification

Bimringham Children's Hospital SIRI Process Simplification

  • The revised process was simplified considerably and has created a much stress reduced environment to work within.
  • The process is not just quicker but more joined up and this has been achieved through customer focus and elimination of wasteful activities.

Engagement & Staff Buy-in

Birmingham Children's Hospital SIR Engagement

  • Survey revealed 97% of staff that had experienced the new SIRI process gave a positive response.

Culture Change & Continuous Improvement

Reflecting on the first Lean work that the Governance Support Unit (GSU) had completed, David Scott, Associate Director of Governance said:

The outcomes are already demonstrable and it has helped change thinking within the team. It was quite an emotionally draining process and was challenging in the sense that it required changes to established processes and systems. It was also intensive in terms of the time commitment but ultimately worth it.

Having achieved step changes in performance with the SIRI process the Lean activity has not stopped there!

There is clear recognition that waste exists both within and outside of the GSU. Improvement activity has been applied to other areas of GSU such as the freedom of information request and general incident reporting processes.

BCH shortlisted for the prestigious 2013 HSJ Efficiency Award

Further work has started in the root cause analysis area of the SIRI and the countermeasures already successfully applied to the SIRI process are being rolled out to similar Directorate Lead Reviews of incidents.

There are sure signs of a change in culture and mind-set, evidenced by the new Lean works being undertaken whilst sustaining and developing the SIRI improvements. The GSU are maturing their Continuous Improvement approach and are focused on the ambitious goal of becoming the number one Governance Unit within the NHS.

Download the full Birmingham Children’s Hospital Case Study

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