The therapy pathway at East Wing George Bryan Centre was reviewed and T.Ohno’s Seven Wastes principle established many issues which we overcame as follows;
Motion (unnecessary movement): - Therapeutic space was provided for patients assessment needs which saved therapist time as we had a base – Joint assessments – Assessing outcome measures in 1 group session reduced set up time – Arrangement of therapy treatment suite allowed easy access for needed files
Defects (improper treatment or repairs): – Peer support to reduce human error – Spreadsheet to confirm completion of task via rag rating and to prompt if tasks not completed by therapies team – OT now in post
Transportation: – Increased use of in house assessments
Inventory: – Spreadsheet outlines tasks required/completed – Physical health codes board quick glance of treatment required for each service user – Clear process to improve communication with MDT – Calendar to show therapist availability – Folders available on shared computer drive for; o Outcome measures o Onward referral o Risk assessment and session details / group protocols – Clearly labeled condition leaflets – NICE guidelines treatment inventory – Condition of the week to highlight guideline recommendations to service users and carers
Over producing: – Joint assessments so not repeating tasks eg transfer/mobility assessment – Transparent system so easy to see when task completed
Time: – Reduced time for home visits as clear board displaying destination on discharge and able to prioritise due to estimated discharge dates – Attend daily handover so need passed on quickly, able to prioritise due to estimated discharge dates – Attend daily handover so need passed on quickly, able to see patient at the time they need to be seen, so they are not being sent through the process in a batch. – Reduced time explaining therapy role to MDT with increased number of referrals seen, promotion events used such as workout at work day/ OT Week. Events used for intervention promotion eg Alice in Wonderland sensory integration party. – Service users are more aware of goals and achievements, improving motivation and therefore effectiveness, as able to clearly see graph of progress via television in therapy suite.
Processing: – Clear, publicly accessible therapy assessment and treatment process and checklists. - Transparent initial assessment providing client centred structure for ongoing ward based assessment and interventions – Able to prove effectiveness and establish epidemiography via spreadsheet. AHP Completion rate visible to motivate therapist.
Key Outcomes:
• Reduce length of stay - at 90 days into project this was reduced by 49 days
• Clear therapy process - 100% of survey participants said it was excellent
• Clarity of tasks - Therapists using system rated it as excellent
• Improved cost efficiency - In 1 year = £15,062 as saved 96 hours of band 5 clinical time per month
• Plan discharge from admission - at 90 days into project 100% have discharge discussed within 72 hours of admission.